Peyronie's disease is a benign condition of the penis of unknown cause characterised by formation of fibrous plaques, or hard lump, within the upper or lower side of the penis in the layers containing erectile tissue, usually causing deformity and angulation of penis and a degree of erectile dysfunction. Peyronie's disease was first observed by Fallopius & Vesalius in 1561 but was fully described by François Gigot de la Peyronis in 1943.

It is thought to affect about one in 100 men. It usually appears in middle age but younger and older men can also develop it. It begins as a localised inflammation and can develop into a hardened scar. It isn't cancerous.

Usually the plaque forms on the top of the shaft, making the penis bend upward. But if the plaque is on the underside it will bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis.

In the worst cases, the hardened plaque reduces flexibility and causes so much pain, bending and emotional distress that sex becomes impossible.

The causes

The cause of Peyronie's disease isn't certain. There's a link to fibrosis or scarring of other tissues in the body such as a condition known as Dupuytren's contracture of the hand. There's also a mild family tendency to the disease.

Many researchers now think that the plaque or lump in Peyronie's disease develops following trauma such as hitting or bending that causes localised bleeding inside the penis. This leads to injury of the elastic lining of chambers inside the penis.

Ageing increases the risk as a general reduction in elasticity of the body's tissues increases the chances of injury. If the damaged area heals slowly, the plaque undergoes fibrosis, or formation of tough fibrous tissue, and even calcification (formation of calcium deposits) resulting in a long-term problem.

But this theory doesn't explain those cases which develop slowly, or why similar conditions such as Dupuytren's contracture don't seem to result from severe trauma.

Treatment

Peyronie's disease often occurs in a mild form that heals without treatment in six to 15 months. However, for some men the problem is severe and permanent.

The main aim of treatment in Peyronie's is to help the man stay sexually active, but doctors try to avoid intervening as far as possible because there's no strong evidence to show that any treatment other than surgery is effective. So information and reassurance is usually the first step and for many men that is enough.

Surgery is usually performed after several years when the disease is stabilised and the deformity prevents intercourse. Because the plaque of Peyronie's disease often shrinks or disappears without treatment, medical experts suggest waiting one to two years or longer before attempting to correct it surgically. Other currently unproven treatments include:

Vitamin E tablets (200mg three times a day) - has antioxidant properties which helps relief pain.

Tamoxifen (20 mg twice per day) is believed to inhibit inflammatory response.

POTABA (potassium aminobenzoate) tablets- 12 g/day. Inhibit abnormal fibroblast proliferation.

Injections of chemical agents such as collagenase, dimethyl sulfoxide, steroids and calcium channel blockers directly into the plaques (the most promising being collagenase, an enzyme that attacks collagen, the major component of Peyronie's plaques).

Radiation therapy has also been used. But while it can reduce pain it has no effect on the plaque itself and can cause unwelcome side effects.

Extracorporeal shock wave therapy, (ESWT) is being used in some hospitals. Although initial results have been promising, the long term outcome is yet to be determined.

Surgery

This is only considered if you've had Peyronie's disease for a year or more and it hasn't progressed for at least three months. The three most common operations are:

Removal or expansion of the plaque followed by placement of a patch of skin, vein or artificial material. This can involve partial loss of erectile function, especially rigidity.

Removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect Nesbitt procedure. This causes a shortening of the erect penis.

Implantation of a device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin).

It will also help as well if you talk to your partner. Support and understanding removes a lot of the worry and pressure. Try to encourage your husband to talk to his doctor about it. They'll be able to refer him for assessment by a urologist who specialises in the problem.