While some people with Peyronie’s disease may develop erectile dysfunction, the majority of people report that the erectile problems came before the Peyronie’s disease symptoms.

It’s estimated that up to a third of people with Peyronie’s disease will also have erectile dysfunction, with more than half of those people reporting that the erectile dysfunction started first. If erectile dysfunction develops after Peyronie’s disease symptoms begin, it may be a result of the pain or curvature from the condition.

Some cases of Peyronie’s disease are caused by trauma to the penis. This forms scar tissue, or “plaque.” It can also damage blood vessels and nerves responsible for erectile function.

It’s important to remember that erectile dysfunction is often due to a variety of factors. The distress from penile curvature, possible performance anxiety, and pain can play a role in diminished erectile function.

What’s more, a 2021 Swedish study showed that men with Peyronie’s disease were more likely to have a substance use disorder, anxiety, and depression. All of these can impact erectile function in different ways.

It’s important that erectile dysfunction be addressed in people with Peyronie’s disease, and in general should be treated before or in conjunction with treatment for Peyronie’s disease.

Some treatments for Peyronie’s disease may improve erectile function.

In the active phase of Peyronie’s disease, pain can be a significant factor in limiting erectile function. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can provide enough pain relief to improve erectile function.

A 2018 research review shows that shockwave treatment to the penis may help ease pain in the active phase of Peyronie’s disease and treat erectile dysfunction as well. However, it’s not proven to treat curvature or improve erectile function over the long term.

PDE5 inhibitors, like sildenafil, have been shown to improve both Peyronie’s disease and erectile dysfunction symptoms at doses as low as 25 milligrams.

In complex cases of Peyronie’s disease with severe erectile dysfunction, a penile prosthesis can be surgically implanted, which can fix both issues at once.

Pain from Peyronie’s disease may resolve without medical treatment in 12 to 18 months for as many as 90 percent of people with the condition, according to a 2019 study. Only about 3 to 13 percent of people with Peyronie’s disease will see improvements in penile curvature without treatment, though.

As one can imagine, people with more severe curvature are less likely to see spontaneous improvement, and those with compromised sexual function or significant distress are more likely to need treatment.

It’s important to consider the psychological impact as well. Up to 80 percent of men with a Peyronie’s disease diagnosis will experience mental health conditions, such as anxiety, depression, or both. These conditions may worsen over time without treatment.

There are several ways to break up plaque in people with Peyronie’s disease who need treatment.

A physician may inject medications directly into the plaque to break up the deposited collagen. The injection options include:

  • verapamil (a blood pressure medication)
  • interferon alpha-2b (an immune system modulator)
  • collagenase clostridium histolyticum (Xiaflex)

Each of these medications has associated risks and side effects, which you should discuss with your healthcare provider.

Plaques can also be removed surgically or through incision to correct the curvature.

While shockwave treatment is currently recommended only for pain management in the active phase, researchers are looking into the use of this treatment to disrupt plaque as well.

Intralesional collagenase is an effective treatment for Peyronie’s disease plaque. The Food and Drug Administration (FDA) approved it in 2013 and it has since become widely used.

It works by chemically digesting the scar tissue, which can help straighten the penis and ultimately improve erectile function.

Research is ongoing on:

  • new topical therapies like magnesium and liposomal recombinant human superoxide dismutase
  • injections
  • mechanical therapies such as penile stretching

However, they require further study.

Peyronie’s disease pain can often go away on its own. Penile curvature is less likely to resolve without treatment, but it does happen for some people.

Perhaps a bigger question is whether patients with Peyronie’s disease need to be treated or not. Though Peyronie’s can be a distressing condition, it’s not life threatening — so treatment decisions should be determined on an individual basis.

People with minimal curvature or mild symptoms are unlikely to benefit from treatment. In the same vein, people with more severe curvature who aren’t concerned about sexual function, don’t have pain, and aren’t distressed by the condition may not need treatment, either.

In a word, yes.

Phosphodiesterease inhibitors like Viagra (sildenafil) have been studied both alone and in conjunction with other therapies to treat erectile dysfunction and penile curvature from Peyronie’s disease.

A 2014 study showed that using sildenafil helps improve erectile function and curvature. At least one study showed that the combination of sildenafil with collagenase offered more improvements to curvature than collagenase alone.

People who have both erectile dysfunction and Peyronie’s disease should get treatment for the erectile dysfunction first, as that can impact treatment decisions for Peyronie’s.

Peyronie’s disease has a variable course. Most people will see improvements in their pain levels over time, with or without treatment.

Curvature improves spontaneously in some people with Peyronie’s disease. But for most people, the curvature will stabilize or continue to progress.

PDE5 inhibitors like sildenafil may have some benefit in reducing fibrosis of the penis and slowing down the progression of the disease.

Some studies also suggest that injections of certain medications during the active phase of Peyronie’s disease could influence the natural progression of the disease, but more research is needed.

As with any condition, people experiencing symptoms of Peyronie’s disease should speak with their primary care physician or urologist to learn how their condition can best be managed.

Dr. Joseph Brito provides general urologic care at Yale Medicine with a special focus on minimally invasive surgical techniques and urologic oncology. Dr. Brito received his MD from George Washington University School of Medicine and Health Sciences. Dr. Brito completed a residency in Urology at Rhode Island Hospital and Alpert Medical School of Brown University and trained at Yale School of Medicine in clinical oncology. Dr. Brito is a member of the American Urological Association.