Peyronie’s disease is a connective tissue disorder that causes scar tissue to build up in the penis, causing a curvature or indentations. This penile curvature can make erections and intercourse painful. It can also increase the risk of erectile dysfunction.

What is erectile dysfunction?

An estimated 30 million men in America have erectile dysfunction. Men who experience erectile dysfunction are unable to get an erection or keep an erection firm enough for sexual intercourse. There are differing degrees of erectile dysfunction (sometimes referred to as ED).

You may have erectile dysfunction if you:

• can get an erection, but not consistently every time that you want to have sex

• can’t maintain a firm enough erection to have fulfilling sex

• can’t get an erection at all

Can Peyronie’s disease cause erectile dysfunction?

It’s estimated that up to half of men with Peyronie's disease experience erectile dysfunction. Problems with erections are a common symptom of Peyronie’s disease. 

As many as 1 in 10 men have some degree of penile curvature due to Peyronie’s disease. Many men have slight curvatures that don’t interfere with sexual intercourse. The disease doesn’t affect ejaculation or sperm count (fertility), but it can make sex more challenging and affect erections.

How does Peyronie’s disease increase the risk of erectile dysfunction?

Men with Peyronie’s disease may experience erectile dysfunction due to:

• anxiety 

• buildup of scar tissue

• fear and loss of pleasurable sensations

• other health conditions

• painful erections

• smoking

Anxiety

Peyronie’s disease changes penis shape: You may have a mild or severe curve. Some men have indentations that give the penis an hourglass appearance. The scar tissue that causes Peyronie’s disease can cause a hard lump under the skin that you and your partner can feel. For some men, scar tissue makes the penis shorter or skinnier.

These physical effects of Peyronie’s disease can affect mental health, body confidence, and intimacy. One study found that 8 in 10 men feel distressed about their condition, and half experience depression. Anxiety, stress, or worry about your appearance or your partner’s reaction to your appearance may affect your ability to get an erection or perform sexually.

A mental health counselor, sex therapist, and/or support group can help you find healthy ways to cope with these emotions and live with Peyronie’s disease.

Buildup of scar tissue

An injury, often during sex, can cause scar tissue to build up in the penis, resulting in Peyronie's disease. Scientists have a few theories as to why these hardened plaques of scar tissue might contribute to erectile dysfunction. The plaques may:

• weaken or damage smooth muscle tissue in the penis, making an erection more difficult

• slow blood flow to the penis, making it difficult to get a firm erection

• cause blood to leave the penis too quickly, resulting in a premature loss of erection

Fear and loss of pleasurable sensations

Significant penile curvatures of more than 30 degrees can make sexual penetration and intercourse more difficult, and sometimes impossible. You may be able to get an erection but not be able to keep it because sex is more challenging and less pleasurable for you and your partner.

You or your partner may also be fearful that intercourse will cause each other pain or discomfort, or worsen the penile curvature. Feelings of fear combined with loss of pleasurable sensations can lead you to lose an erection or not be able to get one at all.

Other health conditions

Certain conditions increase your chances of erection problems. If you have Peyronie’s disease plus one of these conditions, the risk of erectile dysfunction is greater.

These conditions can cause Peyronie’s disease and increase erectile dysfunction risk:

• Autoimmune diseases like lupus, Sjogren's syndrome, or Behcet's disease can make you more prone to Peyronie's disease and erectile dysfunction. When you have an autoimmune disease, the body’s immune system attacks healthy cells and tissue. 

• Diabetes can damage the nerves and blood vessels that help you have an erection. Research shows that men who have diabetes-related erectile dysfunction are up to 5 times more likely to develop Peyronie’s disease.

• Prostate cancer is a type of cancer that develops in the prostate gland. It affects 1 in 9 men. Men who get certain treatments for prostate cancer, like surgery or radiation therapy, are more likely to have Peyronie's disease and erectile dysfunction.

Painful erections

Pain is a common symptom when the penis is still curving. This is known as the early, or acute, stage of Peyronie's disease. You’re more likely to have pain when getting an erection. If your mind associates erections with pain or discomfort (and not pleasure), you may find it more difficult to get an erection.

Smoking

The use of nicotine or tobacco products after a penile trauma or injury (which can occur during sex) can slow wound healing and lead to the development of scar tissue. Smoking also affects blood flow to the penis, which can interfere with erections. Even exposure to secondhand smoke can lead to erectile dysfunction.

What are the treatments for Peyronie’s disease and erectile dysfunction?

Certain erectile dysfunction medications may also be used as treatments for Peyronie's disease in its early stages. Medications like tadalafil (Cialis®), sildenafil (Viagra®), and vardenafil (Levitra®) bring more blood flow to the penis, helping you to achieve and maintain an erection. Tadalafil may also reduce scar tissue buildup, slowing the progression of Peyronie’s disease.

Men who have had Peyronie’s disease for at least 9 to 12 months without a worsening of the curvature (chronic stage) may benefit from surgery. Penile implants (prostheses) can work well for men who have Peyronie’s disease and erectile dysfunction. Your doctor may also perform a grafting and modeling procedure while placing the implant. This step removes scar tissue and helps straighten the penis.

Types of penile implants include:

• inflatable implants that you inflate (to get an erection) and deflate (after intercourse) via a pump hidden in the scrotum

• firm, but flexible, semirigid rods that you position away from the body for sex and toward the body at all other times   

• positional implants that use springs at the ends of semirigid segments that allow you to better maintain upward and downward positions

How successful is surgery for Peyronie’s disease and erectile dysfunction?

Satisfaction rates among men who get penile implants (and their partners) are more than 90%. Still, you should be prepared and understand what to expect from surgery for Peyronie’s disease. There’s always a risk of infection with any surgical procedure. Most men get 15 to 20 years of use from penile implants before they need replacement surgery.

From the community: “I had an implant … done 3 years ago and couldn't be happier with the results. I had PD and ED making an implant the only reasonable solution. If you have an experienced doctor and some patience, you will probably be very pleased with results, as well.” – Inspire member

Sources

• Key statistics for prostate cancer. American Cancer Society. January 2021. 

• Peyronie’s disease. Cleveland Clinic. August 2020.

• Five things to know if you’re considering a penile implant. Houston Methodist. February 2020.

• Can smoking affect a man’s erections? International Society for Sexual Medicine.

• How might Peyronie’s disease cause erectile dysfunction? International Society for Sexual Medicine.

• Penile implants. Mayo Clinic. December 2019.

• Definition and facts for erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases. July 2017.

• Penile curvature (Peyronie's disease). National Institute of Diabetes and Digestive and Kidney Diseases. August 2019.

• Symptoms and causes of erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases. July 2017.

• The Role of PDE5 Inhibitors in Penile Septal Scar Remodeling: Assessment of Clinical and Radiological Outcomes. The Journal of Sexual Medicine. May 2011.

• Psychological aspects of Peyronie’s disease. Translational Andrology and Urology. June 2016.

• Penile implants. University of Utah.

• Factors associated with erectile dysfunction and the Peyronie's disease questionnaire in patients with Peyronie's disease. Urology. September 2017.

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.