The penis consists of three tubes: the hollow urethra that carries urine and sperm, and two soft, spongy tubes called cavernous bodies that fill up of blood to stiffen the penis in an erection. All three are enclosed in a hard fibrous sheath called tunica albuginea which, when the plaque is formed, makes the sheath less flexible. Depending on the location of the plaque (in 70% of cases, it forms on the top of the penis), the penis can bend, bend down or stand on its side when it stiffens. Sometimes a plaque forms around the penis, creating a narrow band like a bottle neck.

Heredity and certain connective tissue disorders, such as Dupuytren contractures, increase the risk of developing Peyronie's disease. High blood sugar, smoking and pelvic trauma also increase the risk. The disease can develop gradually or appear suddenly. It occurs in two phases: acute and chronic. The acute phase, which often causes painful erections, lasts from six to 18 months, during which the plaque is formed and the erect penis malformation deteriorates. In the chronic phase, the pain ends, the plaque stops growing and the deformity stabilizes.

Mr. Cummings' doctor told him it was good for him to come for treatment early, before the plaque became calcified and more difficult to treat. As he has described, the numerous injections of verapamil have pierced the plate, the "changing Cheddar in Switzerland" and making the penis more flexible. He also spent hours a day stretching his penis with a traction device called Andropenis, an FDA approved penis extender.

This device and similar devices can help lengthen a penis shortened by Peyronie and promote more direct remodeling as plaque replaces with healthy collagen.

"Xiaflex is not a miracle drug," said Dr. Mills. "The trial that led to F.D.A. Approval resulted in a 35% improvement in curvature, although we found a decrease of about 50%. I tell patients, "You will never get back the penis you had, but you can get a functional penis," which most men want. The problem is rarely resolved without treatment.

Serious cases that do not respond well to injections can be treated surgically, an option generally reserved for men with debilitating deformities that make sexual activity difficult. The surgery is not complete until the plaque and curvature have stabilized. Options include shortening the side of the penis opposite the curve or extending the curved side by adding a graft, a more difficult approach.

Some men with Peyronie's disease and also suffering from erectile dysfunction may be equipped with an inflatable. pump or malleable silicone rods that straighten the penis and make it rigid enough to allow penetration.