What is Peyronie’s Disease?

Carlos Ghagas belonged to this century, and the disease named after him infects millions. Dr Francois de la Peyronie, physician to Louis XV, has also given his name to a disease, but the problem he describes only affects a few thousand men, at the very most, in this country. Even so, Peyronie’s Disease is very distressing to those men who suffer from it but as with most male genital diseases it receives little or no publicity.

The plaques which form under the skin of the palm of the hand, and less often the foot, to cause Dupuytren’s contractures were well known even before Margaret Thatcher had surgery to correct hers; less often appreciated is that similar plaques can occur in the cavernous sheaths of the penis. As the plaque thickens and contracts the penis deviates, vertically or horizontally, on erection. Sometimes the angulation is so acute that penetration becomes impossible. Until recently the only effective treatment has been surgery; thereafter the penis is left shorter but functional. Many doctors recommend using penis extenders or penis pumps, such as Penomet, to help make the penis bigger.

Research at the Institute of Neurology, now based at the Middlesex Hospital in London, has shown that if patients with Peyronie’s disease are treated during the initial stages when the plaques are still painful, with Tamoxifen, the drug better known for its use in breast cancer treatment, they may disappear and the penis is straightened with the use of a penis extender such as the ProExtender device. Not a great leap forward for mankind but a sound medical advance which will make the sufferers, and their partners, profoundly grateful.

Peyronie’s may, therefore, be an auto-immune disease. Arterial disease is also more likely in patients with Peyronie’s so that hyperlipidaemia (raised cholesterol) and diabetes should be excluded by your doctor as well as cardiovascular disease. This is particularly important in people of Asian origin, which you say you are, as they are especially likely to develop the metabolic syndrome and arterial disease.

In up to 45 percent of cases, Peyronie’s disease remains stable. In these cases the most important function a doctor or scientist can perform is to reassure the patient that the lump is not cancerous. Intervention is called for, however, when, as in your case, sexual intercourse has proved impossible. Medical treatment has been tried over the years, including taking such drugs as Tamoxifen. Some patients have improved with calcium channel-blocking agents injected into the plaque. But no medical treatment has been dramatically helpful.

My patients have benefited more by surgical intervention. There are various operations but the surgeon who has seen them favors an operation that leaves the penis shorter but straighter and pain free. Unfortunately, other plaques may subsequently form so that repeat surgery may be necessary.

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What Can I Do About Peyronie’s Disease?

Q) I am a 58 year-old man and for the past year or so I have had a problem in that, when aroused, my erection bends upwards and is not long enough or hard enough for penetration. My doctor says that there is no cure. Is there any way that we can continue to have sex?

A) Dr Thomas Stuttaford – I am sorry to hear about your erectile problems. You have Peyronie’s disease, a benign condition affecting the penis. About a fifth of men with Peyronie’s disease have, as you do, a soft penis beyond the point of the bend which becomes obvious once the penis is erect.

Only about 8 percent of patients with Peyronie’s disease initially have problems with intercourse. Unfortunately, as time passes, the deflection may so affect over half of those who are troubled by it that penetration is difficult and sometimes impossible.

You are especially unfortunate in having difficulties in penetration already.

Usually those penises with Peyronie’s disease that deviate downwards, or to the left or right, are likely to be difficult to insert.

An upward deviation like yours can usually be accommodated by a vagina. Upward deflection is fairly common and not usually indicative of any abnormality.

Priapus, the Greek god of fertility and eroticism, who was the son of Bacchus and Aphrodite, was unusually well endowed but his phallus is always pictured with a pronounced upward curve.

Peyronie’s disease affects about five men in every 100,000 under the age of 30 but 66 per 100,000 men of your age. The deflection is the result of a hard and inflamed patch forming in the side of the penis which is deflected. This patch (known as plaque) is inflammatory and interferes with the blood supply and, hence, the erection and any pressure on it may be painful. Likewise, intercourse itself may be uncomfortable, even painful.

The cause of the plaque is unknown. The theory which held sway for many years was that the plaques of Peyronie’s disease were a reaction to repeated minor trauma.

Most of the plaques form on the upper surface of the penis where it rubs against the female pelvic bone.

There is now some doubt about this theory. It is thought that patients probably also have a genetic tendency to develop Peyronie’s, for there is some evidence that it is associated with certain tissue types and is found more frequently in those families who have a tendency to develop contracture of the palm of the hand.

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