Peyronie's disease is not a household name. Most people have never heard of this condition, which affects the most private part of a man's anatomy. Yet it can have a major impact on self-esteem and even marital relations.
No one knows exactly how common Peyronie's really is. Many men are too embarrassed to discuss it with their doctors. Often, it's the wife who insists on a medical consultation.
An anatomist named Giulio Cesare Aranzi described an unusual curvature of the penis in the medical literature of his day 1587. But the condition bears the name of a Frenchman, Francois de la Peyronie, who described three cases in 1743. As the king's surgeon, he was already a celebrity, so perhaps that's why he grabbed the glory.
Peyronie's disease hasn't changed much in the centuries since then. Doctors still puzzle over why it occurs and what to do about it. The best guess is that a small tear or injury during intercourse results in scar-tissue formation. As a patch of tissue becomes fibrous, it cannot expand normally. The result can be a crooked erection.
For some men, the condition is temporary, though unsettling:
"While living in Sweden in 1990 I got Peyronie's disease. It seemed to come literally from one day to the next for no known reason. The curvature was inconvenient but did not prevent me from continuing to have sexual relations.
"A doctor suggested surgery, but added that sometimes it just went away. A year or so later, that is exactly what happened again, very rapidly. It has not recurred. I did not treat it in any way."
Others, however, discover that the condition is so disabling that it prevents intercourse: "My husband developed Peyronie's disease and has such a bend that sexual relations are nearly impossible. He has been taking vitamin E and an anti-inflammatory drug, but erections are still painful. This has altered our sex life and is affecting our marriage."
There are treatments for Peyronie's disease. Although oral medications are not an instant cure, some men benefit from vitamin E and an old-fashioned gout medicine, colchicine. Potaba (potassium para aminobenzoate) may also help soften the scar tissue.
If these oral medicines don't work, a urologist may inject the scar tissue with a blood pressure drug called verapamil. It has shown some benefit in clinical trials. So has another compound called alpha-interferon. The Food and Drug Administration has not approved either drug for treating Peyronie's.
During the first year or two, Peyronie's may disappear all by itself, as our visitor to Sweden reported. Men who continue to have severe curvature or pain after this time might require surgery.
A skilled surgeon has several techniques that can be useful. Men who consider this approach, however, need to know what to expect. Although satisfaction scores are generally high, the surgery may result in a shorter penis.
No one knows for sure, but Peyronie's disease seems to be more common these days. Some urologists believe this is because erectile-dysfunction drugs like Viagra or Cialis unmask a problem that would have gone undetected in times past.
Now that men can talk about such things, they need to seek treatment for Peyronie's disease. It need not ruin a relationship.
Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer questions from readers. E-mail them via their Web site: www.PeoplesPharmacy.com.