Peyronie’s disease is characterized by the formation of fibrous scar tissue, known as plaque, on the penis. This can lead to a noticeable and sometimes painful curvature or indentation during an erection. Peyronie’s disease is often accompanied by erectile dysfunction (ED), the inability to get or maintain an erection sufficient for intercourse, leading many to ask how ED medications fit into a treatment plan.
The Link Between Peyronie’s Disease and Erectile Dysfunction
The connection between Peyronie’s disease and erectile dysfunction is physical. The penis’s main erectile bodies are encased in a flexible tissue sheath, the tunica albuginea, which expands as it fills with blood during an erection. The inelastic scar tissue from Peyronie’s does not stretch with the healthy tissue, which can interfere with the penis’s ability to store enough blood.
This structural impairment can cause a venous leak, where blood cannot be trapped effectively to sustain rigidity, making a firm erection difficult. Beyond the physical impediment, the pain that can accompany erections can create a psychological barrier to sexual activity. Anxiety about performance and the appearance of the penis can also contribute to ED.
How Viagra Addresses Symptoms
Medications like Viagra, containing sildenafil, are phosphodiesterase type 5 (PDE5) inhibitors that address blood flow mechanics. Upon sexual stimulation, nitric oxide is released in the penis, triggering the production of cyclic guanosine monophosphate (cGMP). cGMP relaxes smooth muscle tissue and widens blood vessels, increasing blood flow into the penis to produce an erection.
Viagra works by inhibiting the PDE5 enzyme, which naturally breaks down cGMP. By blocking this enzyme, sildenafil allows cGMP to remain active longer, enhancing and prolonging the blood inflow from sexual stimulation. Viagra treats the symptom of ED by improving blood flow, but it does not act on the underlying cause of Peyronie’s disease or break down the fibrous plaque.
Using Viagra with Peyronie’s Disease
For men with both Peyronie’s disease and ED, Viagra can be a functional tool. By improving erectile function, it can allow for successful intercourse despite the penile curve. A common concern is whether enhanced erections from Viagra could worsen the plaque or curvature, but medical research suggests this is not the case.
Viagra or any other PDE5 inhibitor must be used only under a physician’s guidance following a proper medical evaluation. A doctor will assess for contraindications, such as certain cardiovascular conditions or the use of nitrate medications for chest pain. Combining sildenafil with nitrates can cause a dangerous drop in blood pressure. A physician will also determine the appropriate starting dose and adjust it based on efficacy and tolerance.
Comprehensive Treatment Approaches for Peyronie’s Disease
A comprehensive treatment plan must also address the physical plaque and curvature of Peyronie’s disease. Urologists have several approaches that are considered after the disease has stabilized, which occurs 6 to 12 months after onset. These treatments target the scar tissue directly to reduce the deformity and improve function.
One non-surgical option involves injectable medications. Collagenase clostridium histolyticum is an enzyme approved to treat Peyronie’s by breaking down the collagen that forms the plaque. Other injections, like verapamil and interferon, are also used to disrupt scar tissue and may help with pain. Penile traction therapy is another method where a device is worn to stretch the penis, which can help straighten and lengthen it.
For severe cases or when other treatments are ineffective, surgical options are available. Penile plication involves suturing the side of the penis opposite the curve to straighten it. Another procedure, plaque incision or grafting, cuts the scar tissue and fills the space with a graft. If severe Peyronie’s disease and significant ED are present, a penile implant may be recommended to provide both straightness and rigidity.