Richard was in the middle of a passionate love-making session when he suddenly experienced a sharp pain where it was least welcome.
In the midst of what he describes as 'vigorous’ sex, his penis had accidentally hit his partner’s pelvis, causing him instant searing pain.
’I knew at once that I’d done something wrong,’ he recalls. 'It felt like it had buckled. I just didn’t realise it would impact the next 20 years of my life.’
As a result of his injury, Richard (who does not want to give his full name), a retired businessman from central London, went on to develop Peyronie’s disease.
This causes the penis to curve, as well as shrink in length and circumference.
Peyronie’s disease causes the penis to curve, as well as shrink in length and circumference
Often painful, it leads to problems getting or maintaining an erection, which can have a devastating impact on men’s sex lives and self-esteem.
Not surprisingly, research shows that many with Peyronie’s also suffer from depression.
The triggers for Peyronie’s include sexual trauma, vascular disease, diabetes and a genetic predisposition to abnormal wound healing, according to David Ralph, a professor of urology at University College London and a leading expert on the condition.
It’s not clear why, but these problems can lead to fibrous tissue or scarring within the penis, with thickened nodules (called plaques) in the shaft. This results in curved and painful erections. In addition, calcium deposits can form in these plaques, causing lumps.
The curvature – which only occurs when the penis is erect – is the most common symptom, says Rowland Rees, a leading urology consultant.
Studies show Peyronie’s affects 5 per cent of men over 40, although some experts estimate there could be as many as 2.5million men in the UK with the condition.
’I believe the numbers could be even higher,’ says Leon Almashan, a men’s health specialist at the private MansMatters clinic in London.
Yet many men have never heard of it – and awareness among GPs can also be low. 'Awareness is extremely low, but the prevalence is much higher than anyone would ever imagine,’ agrees Mr Rees. He adds that he sees 'hundreds’ of men a year with Peyronie’s – and most of them say they’d never heard of it until they developed symptoms and googled it.
The degree to which a man is affected can vary depending on the angle of the curvature or deformity, explains Mr Almashan.
Some experts estimate there could be as many as 2.5million men in the UK with the condition
’With a curvature of 20 or 30 degrees, a man might still be able to have sex. Beyond this, it becomes considerably more challenging in terms of sexual positions – in extreme cases the curvature can reach over 120 degrees.’
Some men’s partners may be 'put off by the deformity’, he says, adding that the situation commonly leads some men to avoid sex or dating altogether for fear it might worsen the condition or because they feel insecure, depressed and ashamed.
Some also have problems with urination.
Professor Ralph explains: 'When the plaque is deeper within the penis, it can impinge on the erectile tissue causing a hinge effect on erection.
’Men are often shocked when, for example, they wake up with the typical morning erection and upon going to urinate, they find themselves aiming in the wrong direction because the penis is bent.’
Although it is most prevalent in the over 40s, younger men can develop Peyronie’s – which is usually attributable to an injury or accident, says Mr Rees.
This could be an injury during intercourse but also an everyday or sporting injury, such as being hit in the groin by a football.
However, with older men the cause may be less obvious.
’The average age of men I see with Peyronie’s is mid-50s and most don’t recall a specific trauma – this is basically because the older you get, the less trauma you need to induce these changes,’ explains Mr Rees.
As men age their penis becomes less rigid when erect, making it more susceptible to injury during intercourse.
’The trigger can be quite innocuous – even rolling over in bed with an erection or normal intercourse can sometimes trigger it,’ says Mr Rees.
’But the more metabolic risk factors a man has, the more likely he is to get Peyronie’s.’
High blood pressure, diabetes, trauma and cardiovascular disease all contribute to damage to the tiny blood vessels in the penis, says Mr Almashan.
Peyronie’s also occurs in those with connective tissue problems such as Dupuytren’s contracture – where the fingers start to curl into the palm as a result of similar scarring. Genetics could play a role, too.
Mr Rees says that men usually don’t visit a doctor until their sex lives are affected or they struggle to maintain an erection, although some do so after discovering a lump in their penis.
Not all men with Peyronie’s suffer curvature, adds Professor Ralph: 'It depends on the site of the fibrous plaque. There is usually a curvature towards the plaque but if there are multiple plaques then there may be balance with a straight, but often shorter, penis.’
Signs of Peyronie’s disease include: deformity of the penis (which can include curvature, indenting, or an hourglass shape); loss of penile length; pain in the early stages which disappears as the condition matures; shrinkage in the penis circumference; a lump or hardness on the penis; loss or reduced sensitivity; and erectile dysfunction. These symptoms can come on overnight or over a couple of months.
Mr Rees explains: 'During the acute phase, which is often painful, an area of inflammation will start to form scarring (or a 'plaque’) within the penis, and usually within a year it will have developed into the chronic stage, where the plaque is fully formed but the pain has often disappeared.
Urology consultant Rowland Rees says that most men won’t visit a doctor until their sex lives are affected or they struggle to maintain an erection
Scarring within the penis and thickened nodules (called plaques) result in curved and painful erections. Calcium deposits can form in these plaques, causing lumps
’The scarred area or plaque will reduce the elasticity of the penis on the affected side, thus causing the penis to bend on erection.’
There is 'a 30 per cent chance’ the curvature will naturally improve over time, he adds. But if not, there are treatments that may help.
The first-line treatment is often traction therapy, 'where the penis is put in a narrow tube and an erection is induced with the aid of a vacuum,’ says Mr Rees.
This stretches the scarred side and has a 'modest’ success in around 20-25 per cent of cases, if used daily and diligently.
The treatment can be administered at home and is risk-free, but works best in the early stages.
Drugs such as Viagra or daily tadalafil can also help by improving erections and increasing blood flow to the area.
Some private clinics offer therapies that aim to reduce scar tissue.
One involves injecting an enzyme, collagenase clostridium histolyticum (brand name Xiaflex), to break down the fibrous tissue.
While this can help some patients, Mr Rees says: 'Unfortunately, due to its high cost and only 50 per cent or so success rate, it is no longer available in the UK or Europe, but is available in the U.S.
’Another option involves injections of verapamil, a drug for high blood pressure that’s also thought to help break down fibrous tissue, though the evidence for this is not conclusive.’
Professor Asif Muneer, a consultant urological surgeon and andrologist at University College London Hospitals NHS Trust, adds: 'Shockwave therapy has a role in improving erections in some people with Peyronie’s disease who have erection problems.
’Men with Peyronie’s often get pain early on and shockwave can help with the pain – that’s what the evidence has shown.
’It can’t break down plaque, but it promotes improved blood flow which can help with the erections.’
A final step is surgery. This is the mainstay of treatment for men who still have a curvature after some time.
However, experts agree it should be seen as a last resort, as potential risks include a shorter penis, erectile dysfunction and scar formation.
Men’s health specialist Leon Almashan sees 'hundreds’ of men a year with Peyronie’s disease
Penile surgery is the mainstay of treatment for men who still have a curvature after some time
There are three types of surgery for penile curvature, explains Mr Rees.
The Nesbit procedure involves shortening the longer side of the penis to match the side that has been shortened by Peyronie’s, using a stitch or by removing a piece of tissue.
Although many men are put off the idea of shortening their penis, 'in fact the shortening has already been caused by the disease itself, and the average shortening is 1cm – so not as dramatic as men think’, says Mr Rees.
Where the penis is very bent or has an indentation, a urologist may use the Lue procedure, to 'lengthen the short, scarred side’.
This involves cutting into the scarring on the short side and inserting a graft made from a manufactured collagen matrix. This operation has a higher complication rate than the Nesbit procedure.
The third option is a penile prosthesis or implant.
’We’re increasingly offering these to men with severe Peyronie’s,’ says Mr Rees, as they treat both the curvature and any erectile problems simultaneously and insure against further erectile dysfunction and shortening that may occur with time.
Unlike many men affected, Richard did not experience a curved or bent erection.
Nonetheless he soon noticed he could no longer get erections as he did before – a sign that plaque had already begun to form under the skin.
He saw his GP, who diagnosed Peyronie’s disease and referred him to a specialist who said it was a 'minor injury’ that might heal in time.
’At that stage I could still get an erection although it was painful,’ he recalls.
However, as Richard aged his condition worsened.
When his relationship ended, and he subsequently got a new partner, Richard found himself often unable to 'perform,’ he says, which led to him losing his sex drive too which was 'psychologically damaging’.
He adds: 'The fear of failure eats away at you.’
Richard’s GP referred him to a specialist who explained that his injury had caused plaque to form. He was prescribed Viagra, but resigned himself to putting up with his condition.
One sufferer, Richard, believes there needs to be more awareness about the condition and the impact it can have on men’s lives. He says being unable to 'perform’ was 'psychologically damaging’
’I was always told there was nothing to be done, just to live with it, and pop the pills to aid blood flow – and that it was exacerbated by age, the general declining physical prowess,’ says Richard.
It wasn’t until he found himself 'entering the dating game again’ that he finally decided to go to a private clinic in London last year – and underwent a course of shockwave treatment.
He was also given injections of platelet-rich plasma (PRP), which contains cells from the patient’s own blood that produce growth factors thought to promote tissue healing. The treatment was not available on the NHS.
Richard responded well to treatment, despite having had the condition for decades; six months on, he can maintain an erection.
Now 70, he’s single, but says he’s much happier and more confident in himself – although disappointed it took so long to finally find a solution.
’There’s a lot of information about women’s health – and rightly so – but men are often the ones who don’t go to the doctor and grin and bear it,’ he says.
’There needs to be much more awareness, particularly among GPs about Peyronie’s and how quickly it can worsen, and the terrible impact it has on men’s lives.’
