It is estimated that up to three quarters of men with Peyronie’s disease have some psychological disturbance as a result of their condition. The commonest of these is depression. However, very few medical studies have been conducted assessing this. Dr. Mulhall is leading an international study to assess this by administering questionnaires to men when they present with Peyronie’s disease to answer the question are these men depressed and is their quality of life impaired. For any physician who manages a lot of Peyronie’s disease patients, it is clear that there is a significant negative impact upon their general quality of life, self-confidence and self-esteem. Finally, the impact of man’s Peyronie’s disease on his partner’s mental health must not be underestimated. We receive at this website many questions and pleas from partners asking for information and support.
The exact incidence of ED in men with Peyronie’s disease is not well known. There is little doubt that Peyronie’s disease can cause erection problems and this can occur in 3 different ways (1) Peyronie’s disease has its commonest incidence in middle age to older men and therefore many patients who present for evaluation of Peyronie’s disease have a variety of medical condition that are associated with ED such as hypertension, cholesterol issues, CAD and diabetes. Therefore it is likely that many men with combined ED and Peyronie’s disease have their erection problems as a result of vascular disease unrelated to their Peyronie’s disease (2) there are many men with Peyronie’s disease, especially the younger patients who are so psychologically perturbed by their Peyronie’s disease and the penile deformity that when they obtain an erection there is such a massive release of adrenaline that their erections are impaired (adrenaline is an anti-erection chemical) (3) in some men the presence of the plaque can cause problems with erectile function. The plaque is a scar and it may extend into the underlying erectile tissue (the smooth muscle within the corpora cavernosa) causing damage to this tissue. This in turn can lead to a condition called venous leak (indeed, to be more specific this may lead to site specific leak, that is leakage at the site of the plaque). Another means by which the Peyronie’s disease may lead to ED is distal softening that is that the penis is less rigid beyond the plaque than it is behind the plaque. Finally, some men have combined curvature and waisting or shaft narrowing which may cause instability of the penis even at maximum erection, that is that the penis bends and buckles at the point of the plaque (this is also known as the hinge effect). A patient with combined Peyronie’s disease and ED may benefit form a vascular evaluation of the penis (such as a penile ultrasound) to define the cause of their ED.