Erectile Dysfunction and Peyronie’s Disease

sad-man-outdoorsMale sexual health has taken on increased importance as the population ages, develops coexisting sexual disorders, and undergoes treatments that can affect sexual health. This article focuses on two major areas of male sexual health, erectile dysfunction (ED) and Peyronie’s disease (PD). It is estimated that ED affects as many as 30 million men in the United States alone. While neither ED nor PD is life-threatening, these conditions may result in withdrawal from sexual intimacy, reduced quality of life, decreased working productivity, and increased healthcare costs.

What is erectile dysfunction (ED)?

ED is defined as the persistent “inability to achieve or maintain an erection sufficient for satisfactory sexual performance. According to WHO, a three-month minimum duration of these symptoms is needed before a definite diagnosis of ED can be established. It should be noted that ED can be a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections.

What causes ED?

ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. For example, ED is usually associated with a medical condition such as diabetes, high blood pressure, nerve disease or nerve damage, multiple sclerosis, atherosclerosis, and heart disease. Similarly, lifestyle choices that contribute to heart disease and vascular problems also raise the risk of ED. Smoking, drinking alcohol excessively, being overweight, and not exercising are possible causes of ED.

How is ED diagnosed?

A person’s medical and sexual histories help define the degree and nature of ED.

Treatment of ED

ED is treatable at all ages. Treatments include lifestyle and medication changes, psychotherapy, drug therapy, vacuum devices, and surgery.

Relationship of ED with Peyronie’s disease

One major physical problem than can cause incomplete erection and dysfunction is Peyronie’s disease, often called penile curvature.

Peyronie’s disease can be a defined as an abnormal curve along the shaft of the penis. While Peyronie's disease may occur in up to 3% of the population, it is associated with ED in more than 50% of patients. Most men with the problem are between the ages of 45 and 60. It should be noted that many men have a slight curve in the penis that is considered normal and as long as there is no pain or problem with sexual performance, men with a slightly curved penis should not be concerned and do not need to see a doctor.

However, some men develop a more serious bend in the penis that interferes with sexual function or causes pain. This occasionally happens after the penis is injured, either during intercourse or from a motor vehicle or industrial accident. Such men report complete or partial inability to perform sexual acts with their partners.

Peyronie’s disease may start with pain in your erect penis. At this point, you may feel firm lumps in the shaft of your penis. Usually, these lumps are the small areas of plaque forming in the shaft. As the plaques develop, you will see a bending of your penis during erections. In severe cases, the bending can make sex impossible or uncomfortable for you and your partner. It can also cause worry and anxiety. This in turn can lead to erectile dysfunction.

Peyronie’s Disease is most common between ages 40 and 70 but no age is exempt and even teenagers can be affected. The exact cause of the disease is not known.

Treatment of Peyronie's disease

How long Peyronie's disease lasts is difficult to predict. In more than one third of men, there is a gradual improvement over 12 to 18 months without any specific treatment. In others, the scarring is permanent or worsens over time. However, one-third to one-half percentage of men with Peyronie's disease improves without treatment. Other men have mild symptoms (such as mild curvature or decrease in erections) that can be tolerated and that do not interfere with sexual activity, so they choose not to seek treatment. Men with Peyronie's disease who experience pain or difficulty with intercourse sometimes are offered medical treatment. Options include the following:

  • Oral medications such as vitamin E, para-aminobenzoic acid (a B vitamin) and colchicine (sold as a generic).

  • Injections of cortisone or other medications such as verapamil into the scar tissue

  • Ultrasound or radiation therapy

  • Only a minority of men eventually will require surgery.

Peyronie's disease never develops into cancer or other serious conditions.

Hope through new devices

Advances in suppositories, penis extenders, implants, and vacuum devices have expanded the options for men seeking treatment for ED especially linked with Peyronie's disease. Traction and penis extenders have specifically improved some cases of Peyronie's disease associated with ED. These advances have also helped increase the number of men seeking treatment. These therapies are now being tested in several centers and may offer long-lasting therapeutic approaches for both ED and Peyronie's disease.

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