Q:

My husband was recently diagnosed with Peyronie's Disease. What suggestions can you tell me to continue to have sex? It is very frustrating for him and me.

A:

Peyronie's disease is a condition marked by a plaque, or hard lump, which forms on the penis. This lump can form on the upper or lower side, usually within the tissues needed for erection. Symptoms can develop slowly or overnight and can be mild to severe. For instance, the harderned plaque may reduce flexibility of the penis, resulting in pain and forcing the penis to bend or arc during erections, making intercourse difficult.

We don't know what causes Peyronie's disease (named after the French surgeon who first described it in 1743), but estimates are it affects up to 15 percent of all men. About one-third of men with the condition also develop fibrosis, or hardened cells, in other parts of their body, leading researchers to suspect it may be a systemic disease, possibly related to inflammation or some auto-immune affect. There's also some evidence it may have a genetic basis. Some researchers, however, think it's the result of an injury (during intercourse) to the penis that causes inflammation and bleeding and doesn't heal properly.

The good news is that the plaque is noncancerous. However, because it may affect sexual functioning, it can have a negative affect on a couple's relationship and a man's self esteem.

Because we don't know what causes Peyronie's, there's no specific, nonsurgical medical treatment. About 20 to 50 percent of men improve on their own with no treatment, usually within six to 12 months of diagnosis.

Although some small studies have been conducted using oral vitamin E, Potaba (potassium aminobenzoate, a B vitamin), and colchicine (a gout medication), the results are inconclusive. Nonetheless, many doctors still prescribe 200 to 300 IU of vitamin E a day for Peyronie's disease. Other, nonsurgical treatments, including ultrasound, radiation, laser therapy, and lithotripsy, also show mixed results.

One treatment involves corticosteroid injections directly into the plaque and tissues around it. This can be very painful, however, since no anesthetic is used. A newer method of cortcosteroid administration is called electromotive drug delivery. In this procedure, a special machine is used to drive the drug treatment through the skin and directly into the plaque.

If all else fails, your husband might want to talk to his doctor about surgery. Several surgical techniques are used, including removing the plaque and repairing the damage on the penis with a skin graft, and inserting a prosthesis into the penis to make it straighter. However, if the erectile nerves are damaged during surgery, your husband could be left impotent or with less rigid erections.

Regardless of what medical procedures you choose to explore, I urge you and your husband to seek some couples' counseling to help you get through what can be a very difficult time in your relationship.