Peyronie's disease is a benign (noncancerous) condition of the penis that tends to affect middle age males. The incidence is 4.3 per 100,000 men aged 20 to 29 years and increases to 66 per 100,000 men aged 50 to 59 years. Approximately two thirds of affected men are between the ages of 40 and 60 years. The exact cause of Peyronie's disease is not known. The disease is characterized by the formation of plaques in the tunica albuginea of the penis. These plaques may be felt on penile examination and at times can feel as hard as bone. The plaques are like scar tissue and affect the function of the tunica in that area. Because the plaque is not elastic and stretchy like the rest of the tunica, it pulls the penis to the side of the plaque during an erection and may also cause "wasting" (an indentation in the penis) at the site of the plaque. There may also be pain associated with an erection. Lastly, because the plaque does not behave like normal tunica, it may also cause erectile troubles. The plaque may occur anywhere along the penile shaft but is more commonly identified on the top (dorsal) surface of the penis. More than one plaque may be palpable. The hallmarks of Peyronie's disease are a palpable plaque (a hard spot along the shaft of the penis that one can feel when examining the penis), penile curvature, and a painful erection.

The first symptom of Peyronie's disease may be focal pain with erection, new curvature with erection or inability to penetrate as a result of curvature or distal flaccidity.^3,4 Some patients who do not have pain with erection have tenderness on palpation of the indurated plaque.

During the first year or so after formation of the plaque, while the scar in the tunica is undergoing the process of remodeling, penile distortion may increase, remain static or, as is most often the case in younger men, resolve and disappear spontaneously.^3-5 In most patients the curvature remains static as the scar matures although, in some patients, it becomes worse as fibrosis ensues and the scar contracts. In 25 percent of these patients the scarring process progresses to calcification, and in 25 percent of those it progresses to bone formation.^3,5

After the scar has matured, the configuration of the tunica albuginea is unlikely to be changed by nonsurgical treatments.⁴ However, many patients with advanced disease who have not sought surgical correction have been able to continue mutually satisfactory sexual intercourse with a partner. Approximately one third of patients with end-stage disease have a disabling curvature that requires surgical correction.

Pain that occurs in conjunction with Peyronie's disease may also progress with the onset of new injuries to the corpora cavernosa occurring as a direct result of the patient's attempts to correct or compensate for the original defect during sexual intercourse.⁵ One of the more common reasons for seeking treatment involves discomfort of the patient's partner during intercourse, which is associated with penile curvature.

Peyronies Diagnosis

The disease typically has a slow onset, and most men cannot identify a precipitating factor. Several theories exist as to the cause of Peyronie's disease; the most commonly accepted theory is that minor trauma during intercourse leads to minor tears in the tunica or rupture of small blood vessels. Bleeding and abnormal healing occurs after this injury and produces the plaque. In some men, there is a family history of Peyronie's disease, and 16% to 20% of men with Peyronie's have a disease called Dupuytren's contractures. Dupuytren's contractures is an inherited condition that causes contractures in the hands that pull the affected fingers inward. An increased incidence of arterial disease (30%) and diabetes with its associated small arterial disease (2.7% - 12%) has also been noted in men with Peyronie's disease.

The natural history of Peyronie's disease is variable. The disease is thought to have two phases: the acute phase, which usually lasts up to 18 months and is associated with pain, penile curvature, and plaque formation, and a more chronic phase, in which there is minimal or no pain, a palpable plaque, and residual penile curvature. Over time, the disease may progress in about 42% of men, improve in 13%, and remain the same in about 45%. In many cases, the disease produces few symptoms, the curvature does not prevent sexual performance, and there is no pain or associated erectile dysfunction. In such cases, reassurance that there is nothing bad going on is often all that is necessary.

Evaluating your Peyronie's disease?

As with any initial presentation, the evaluation of Peyronie's disease starts with a history of symptoms: duration and presence of pain; current erectile status and erectile status before the onset of the Peyronie's disease; whether symptoms are stable, progressing, or regressing; and degree of penile curvature and its effect on sexual function. The physician will ask about a history of prior penile trauma or manipulation.

1. Erectile dysfunction is found in about 19% of men with Peyronie's disease. The erectile dysfunction in Peyronies disease may be the result of: performance anxiety;
   
2. the penile deformity preventing intercourse; a flail penis, whereby extensive Peyronies disease causes scarring in a segment of the penis that therefore does not become rigid, while the remainder is able to become rigid
3. an impaired erection, which may be related to concomitant arterial disease (36%) or veno-occlusive disease (59%)

Enzyme Therapy, a new approach to Peyronies Disease?

The definition of enzyme therapy is when a proteolytic enzyme or systemic is present in an enzyme formulation dissolution of fibrin occurs. Over time these enzymes can actually digest unwanted scar tissue. Many diseases in humans are associated with inflammatory reactions and scarring. Because both these conditions can be corrected by enzyme therapy there is great potential for improving health using systemic enzyme therapy. Among the conditions enzymes help are:

1. Arteriosclerosis Excessive clotting and inflammation are routine in the developing arterial plaques. Enzyme therapy digests the fibrin and reverses the inflammation which results in decreasing the size of the artery obstructing plaques. Symptoms of angina, impaired blood flow to the brain, and poor circulation to the legs often disappear..
2. Painful Conditions (Trauma) Enzymes can block the release of pain producing amines from tissues that are becoming inflammed. This means that early use of large doses of enzymes in broken bones, dislocated joints, sunburn, dental extractions, injuries, and migraine headaches have the capability of preventing swelling and pain from appearing. Keloids, some individuals develop greatly enlarged unsightly scars which can be prevented and dissolved with enzymes.
3. Arthritic Diseases All joint diseases manifest swelling and pain. (osteoarthritis, rheumatoid arthritis, bursitis) which enzymes can alleviate. Systemic lupus erythematosus has circulating immune complexes and scleroderma has extensive scarring both of which respond to enzymes. Fibromyalgia patients have recovered using enzymes probably because of improving blood flow in the painful areas.
4. Arteriosclerosis Inflammation plays a key role in causing artery plaques to appear. There is also a tendency to excessive clotting. Both these problems can be reversed by systemic enzymes permitting the existing plaques to slowly disappear with disappearance of symptoms (angina, exertional leg pain, brain dysfunction from poor blood flow).