Yes, Peyronie’s Disease (PD) can cause Erectile Dysfunction (ED). The two conditions are closely linked through both physical changes and psychological impact.
PD is characterized by the development of flat, non-elastic scar tissue, or plaque. This plaque causes a noticeable bend or curvature when the penis is erect. The structural damage from PD directly interferes with the mechanics of an erection, and the resulting distress often contributes to functional issues.
Understanding the Nature of Peyronie’s Disease
Peyronie’s Disease is a connective tissue disorder where hard, fibrous plaque forms inside the tunica albuginea, the tough sheath surrounding the erectile chambers. This scar tissue causes the affected area to lose elasticity and prevents it from expanding properly during an erection. The disease typically presents in two phases: the acute phase and the chronic phase.
The acute phase, lasting up to 18 months, is marked by inflammation, plaque formation, and often pain. During this time, the curvature or other deformities, such as indentation or shortening, may progress. Once the condition enters the chronic phase, the plaque stops growing, the curvature stabilizes, and the pain usually subsides.
The most accepted theory is that PD results from repeated, minor trauma to the penis, often occurring during sexual activity when erections are less rigid. This micro-trauma triggers a faulty wound-healing response leading to the deposition of scar tissue. Genetic predisposition and coexisting health conditions, such as diabetes, also increase the risk for developing the disorder.
The Physical Link Between PD and Erectile Dysfunction
The structural changes caused by Peyronie’s Disease directly impair the physiological process necessary for a rigid erection. The non-elastic plaque prevents the penis from stretching and expanding fully, which is necessary for maximal firmness. This loss of elasticity can lead to partial erections or an “hourglass” deformity, where the shaft narrows at the site of the plaque.
A significant physical consequence is the development of veno-occlusive dysfunction, sometimes called “leaky veins.” A healthy erection requires the veins to compress against the tunica albuginea, trapping blood within the erectile tissue. The inflexible scar tissue may prevent this proper closure, causing blood to leak out too quickly and resulting in an inability to maintain rigidity.
The plaque can also weaken the surrounding smooth muscle tissue and impair blood flow, meaning insufficient blood may enter the area for a firm erection. Studies suggest that over half of men with PD experience some form of ED, with the risk increasing alongside the severity of the curvature. The physical discomfort and visible deformity also contribute to a psychological component, worsening erectile function through performance anxiety and emotional distress.
Treating the Underlying Peyronie’s Condition
Treatment for Peyronie’s Disease focuses on reducing the plaque, minimizing curvature, and alleviating pain. The approach depends on whether the disease is in the acute or chronic phase. Non-surgical options are often the first line of defense, especially during the active phase, and include intralesional injections of medication directly into the plaque to break down the fibrous tissue.
Collagenase Clostridium Histolyticum (CCH) is an FDA-approved injectable that degrades the collagen within the scar tissue, helping to reduce penile curvature. Other non-surgical methods include penile traction devices and vacuum erection devices (VEDs). These devices stretch and remodel the penile tissue, encouraging straighter healing and potentially improving length.
Oral medications, such as pentoxifylline, may be used early on to reduce inflammation and slow plaque formation. However, their direct effectiveness on reducing curvature is limited.
Surgical intervention is typically reserved for men in the chronic, stable phase with severe curvature that prevents intercourse or for those who have failed non-surgical management. Surgical options include plication, which shortens the unaffected side of the penis with sutures to straighten the shaft. Alternatively, a surgeon may perform plaque incision or excision, removing the scar tissue and covering the defect with a graft.
Management Strategies for Resulting Erectile Dysfunction
Even after treating the penile curvature, erectile dysfunction may persist, requiring specific management strategies focused on improving rigidity. Phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil or tadalafil, are frequently used to enhance blood flow to the penis and improve erection quality. These agents may be used alone or with other curvature treatments.
Mechanical aids, such as vacuum erection devices (VEDs), can create an erection by drawing blood into the penis, separate from their use in stretching the plaque. For individuals whose ED does not respond to oral medications, advanced options include intracavernosal injection therapy, where a vasoactive drug is injected into the erectile tissue to produce a firm erection.
In the most complex cases, especially when severe ED accompanies significant, refractory penile curvature, a penile implant is often the most definitive solution. The prosthesis effectively treats both the ED and simultaneously straightens the penis, providing a reliable and rigid erection. The implant’s rigidity can also prevent the micro-trauma that might lead to further scar tissue formation.