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| Illustrations by Rod Clement |
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It is called Peyronie's disease.
Many men have it, but are so embarrassed they never admit to it--even though it may seriously interfere with their sex life and injure their relationships.
Don, age 45, and his wife Sue, age 42, were enjoying themselves passionately and energetically during sexual intercourse when all of a sudden they heard the sound of a crack. Don was immediately in excruciating pain. As he later told the story, Don thought at first that his erect penis had "snapped" or somehow "broke". Don remembered the cracking sound as similar to the one he heard when he broke his nose playing gridiron. After an hour or so, the pain subsided. Don and Sue went to sleep thinking nothing more about the incident. However, a few days later, during their next attempt at sexual relations, Don felt the pain in his penis return. It was not as sharp as before, although still quite uncomfortable. And Don noticed something else--something odd and scary. His erect penis seemed no longer to point straight out as before. Instead, it now pointed at a distinct angle off to the right side. More oddly still, over the next few weeks, it seemed that the angle of the curvature had increased.
A visit to his family physician and then to a specialist urologist revealed that Don had Peyronie's disease. Peyronie's disease is a surprisingly common but rarely talked about condition believed to occur in about one in every 100 men. Very few men with Peyronie's disease know they have a disease and still fewer seek treatment.
Peyronie's disease, also known as Penis Induration, Penis Plastica, or Fibrous Cavernitis, is the abnormal, curvature of the erect penis. The deformity, the degree of bending, ranges between 0 and 99 degrees. The curvature may be ventral (towards the front), dorsal (towards the back), or lateral (towards the side). It is a serious condition because, during an erection, there can be so much pain that sexual intercourse becomes impossible. Not surprisingly it can also frighten a man. Some think they may have cancer. Sadly, anecdotal reports from family physicians and urologists indicate that some men suffer for years in silence before seeking medical help. Untreated Peyronie's disease can be a cause of impotence. Sometimes marriage relationships are strained by the lack of sexual activity that it causes.
The Peyronie's disease curvature is actually caused by the build up of plaque. The plaque is inside the tunica albuginea (the dense, white, fibrous sheath) enclosing the corpora cavernosum (the spongy, body of the penis). However, what causes the plaque is still somewhat of a medical mystery.
In Peyronie's disease, "a definitive cause of plaque formation is not known" according to Dr. Malcolm Lindsay of the University of Health Sciences, Chicago Medical School and five colleagues writing in the JOURNAL OF UROLOGY in 1991. Trauma during sexual intercourse is one theory, but there are others. In 1982, Dr. J. Vande Berg and eight other doctors argued in the JOURNAL OF UROLOGY that the plaque is possibly caused by a problem with a man's auto immune system. That same year, Dr. W. Bias and three colleagues disagreed. In the AMERICAN JOURNAL MEDICAL GENETICS they claimed instead that the plague was due to hereditary factors.
However, the most famous theory accounting for the plaque is also the oldest one. In 1743, Dr. F. de La Peyronie was the first to describe the disease that bears his name. According to de La Peyronie, the plaque is caused either by "chronic irritation" through excessive "self-abuse" (masturbation) or by some sexually transmitted disease of an unknown variety. Very little was known at the time about sexually transmitted diseases (STDs). Although de La Peyronie's description of the disease remains valuable today, modern medicine has rejected his theory explaining the disease.
Treatment of Peyronie's disease is far less mysterious. Sometimes the disease can resolve itself without treatment. This happens in a small percentage of cases according to Drs. Martin Gelbard and two colleagues from the UCLA School of Medicine writing in the JOURNAL OF UROLOGY in 1990. They add that symptoms can "improve somewhat or deteriorate somewhat" without the patient or the doctor doing anything. However, they add that where this does not happen, "patients with Peyronie's disease have two treatment options: medical therapy . . . or an operation." Medical therapy usually consists of vitamin E treatments, potassium para-amino benzoate treatments, and/or steroid injections. Radiation therapy used to be commonly used, but with only mixed results. Surgery is used to correct severe curvature as a last resort. It is also possible for a prosthetic to be inserted in the penis for an impotent patient. More recently, a dermal patch graft has been more or less successful. For example, in a study by Drs. D. Irani, S. Zeighami, and A. Khezri in the Spring 2004 issue of the UROLOGY JOURNAL found that 66 per cent of men treated with a dermal patch graft were able to resume a normal sex life.
In any case, should a man experience this problem, he should consult his physician. Don sought and received treatment. His condition has greatly improved. Don and Sue have resumed a normal sex life and their relationship remains intact.
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