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.