Peyronie’s disease is a condition where fibrous scar tissue, known as plaque, forms inside the penis. This plaque can cause the penis to bend or curve during an erection, and may also lead to pain, shortening, or indentations. The condition can affect a man’s sexual function and, in some cases, indirectly impact his ability to conceive a child. This article explores how Peyronie’s disease can influence fertility, when to seek a fertility evaluation, and the various management and treatment options available.
Mechanisms of Fertility Impact
Peyronie’s disease does not directly cause infertility by affecting sperm production or quality. However, it can significantly hinder a man’s ability to achieve natural conception through several indirect mechanisms that interfere with sexual intercourse. The most apparent impact is mechanical obstruction, where severe penile curvature or shortening makes successful vaginal penetration difficult or impossible. A bent or curved penis, especially with an angulation of 15 degrees or more, can physically impede sperm delivery into the vagina, reducing natural fertilization chances.
Erectile dysfunction (ED) frequently co-occurs with Peyronie’s disease, independently impairing the ability to achieve or maintain an erection firm enough for intercourse. The presence of scar tissue can affect penile rigidity, or anxiety and stress related to Peyronie’s disease can contribute to ED. Plaque formation can also cause pain during erections or sexual activity, which may deter intercourse and subsequently reduce opportunities for conception.
The psychological impact of Peyronie’s disease also plays a role in fertility challenges. Men with the condition may experience stress, anxiety, depression, or self-consciousness regarding their penile appearance or sexual performance. These emotional difficulties can lead to reduced libido or avoidance of sexual activity altogether, further diminishing the chances of natural conception.
When to Consider Fertility Evaluation
Couples affected by Peyronie’s disease should consider a professional fertility evaluation if they have been unsuccessful in conceiving after a certain period of unprotected intercourse. For couples where the female partner is under 35 years old, evaluation is recommended after 12 months of trying to conceive. For couples where the female partner is over 35, this timeframe is shortened to 6 months.
Earlier evaluation may be warranted if the symptoms of Peyronie’s disease significantly impede intercourse. This includes cases where penile curvature is severe enough to make penetration difficult or impossible, or if associated erectile dysfunction is profound. A comprehensive fertility evaluation will also consider other potential male and female factors that could be contributing to difficulties in conception.
Management and Treatment Approaches
Addressing fertility challenges associated with Peyronie’s disease involves a multi-pronged approach, focusing on treating the underlying condition and, if needed, utilizing assisted reproductive technologies. Non-surgical options for Peyronie’s disease include oral medications such as pentoxifylline to reduce scar tissue, and injections directly into the plaque. Collagenase clostridium histolyticum (Xiaflex) is an injectable medication that helps break down collagen buildup and is used in conjunction with penile modeling. Other injectable medications like Verapamil or Interferon are used to reduce curvature and pain. Physical therapy, including penile traction devices, can reduce curvature.
When non-surgical treatments are insufficient, surgical options may be considered to correct the curvature and facilitate intercourse. Procedures include plication, where the unaffected side of the penis is shortened with stitches to straighten the penis, used for less severe curvatures. Surgical approaches also include plaque excision or incision with grafting, where scar tissue is removed or cut and the space is filled with a graft. Penile prosthesis implantation is an option for men with severe curvature and erectile dysfunction that has not responded to other treatments, as it addresses both issues by inserting implants that allow for an erection.
Erectile dysfunction that accompanies Peyronie’s disease can be managed with various treatments, including oral medications like PDE5 inhibitors (e.g., Viagra, Cialis), vacuum erection devices, or penile injections. These treatments aim to improve erectile rigidity sufficient for sexual activity.
If natural conception remains difficult despite addressing Peyronie’s disease and associated ED, assisted reproductive technologies (ART) can be a path to parenthood. Intrauterine insemination (IUI) involves preparing sperm and placing it directly into the woman’s uterus, bypassing potential difficulties with intercourse. In vitro fertilization (IVF) involves fertilizing eggs with sperm outside the body, then transferring the resulting embryo into the woman’s uterus. Intracytoplasmic sperm injection (ICSI), a specialized form of IVF, involves injecting a single sperm directly into an egg.