The name of Marquis Frangois Gigot de la Peyronie, personal physican to King Louis xv, is linked to a most unusual abnormality of the penis. Peyronie’s disease indicates a crooked erect penis caused by excessive connective tissue formation in the wall of the erectile tissue compart­ment. At the point affected a hardening develops and elasticity is lost, hence causing crookedness in the erect position. The ailment is common, affecting an estimated 3.6 per cent of all adult males, and in most cases the onset is around the age of fifty. Approximately 20 per cent also suffer from connective tissue formation in and around tendon sheaths in the palm (Dupuytren’s disease), and the occasional one has problems on the sole of the foot. The cause of Peyronie’s disease is an abnormal inflammatory reaction in and under the capsule around the erectile tissue compartments, virtually always on the top, which means that the crooked position in the vast majority of cases is towards the abdomen.

A crooked penis may also be the result of a congenital asymmetry of the erectile tissue compartments, in which case the bend is towards the ground or sideways. The estimated incidence of congenital crooked­ness is six per thousand male babies.

Peyronie’s disease is not an easy ailment to go public with, or a suitable conversation topic at parties. Consequently the patient often thinks that he has a ‘unique’ malady, whereas it is something run-of – the-mill. Its manifestations are pain, insufficient hardness of erection or an awkward intromissio vaginalis, in which the penis can be inserted only with great difficulty. Above all a member shaped like a boomerang can make sex very painful for the woman, though many women appeared to be intrigued by a crooked penis.

The cause of Peyronie’s disease is still unknown. Mainly on the basis of the existence of related ailments thinking tends to favour abnormal genes, for which scientists are at present searching. As regards treatment, the Marquis de la Peyronie sent his patients to Barega, a spa in the Pyrenees. Not such a bad cure, when one knows that 40 per cent of patients will show some improvement in due course. However, the restoration of a ramrod-stiff penis will be out of the question for the patient concerned. Over the years more than a hundred non-operative

Подпись: Crooked position in Peyronie’s disease.
The crooked penis

treatments have been described in the literature. That in itself says enough: not a single one has been convincingly proved to produce a cure.

If a year after the onset of the disease there is still serious crooked­ness, then provided the complaints of pain have ceased, there is good reason for an operation to correct the crookedness. Problems of rigid­ity are not solved by an operation, but problems with intercourse can be alleviated. The most frequently mentioned problem is that the penis regularly ‘flops out’ while the patient is thrusting. There are two different operations. In one the hard area is cut away and the defect created is covered with tissue taken from elsewhere or with synthetic material. In the other surgical technique the hard area is left untouched, and instead the operation takes place on the healthy side, where the penis is pulled back into line by the cutting out of small elliptical sections of wall or by a series of so-called reef knots. The main snag is that the penis may be shortened slightly, in addition to the shortening caused by the disease. The advantage is that there is no chance of developing ed. In contrast to the first operation, where the diseased tissue is removed, the malady is here treated with stitches on the healthy side.