Peyronie’s Disease Impotence

Peyronie's Impotence facts

There are several reasons why Peyronie’s disease impotence (erectile dysfunction) develops in about 75 percent of the men who have this condition. Peyronie’s disease impotence can be mild or total, it can be occasional or constant, but it is extremely common for men with Peyronie’s disease to experience sexual intercourse performance problems or alteration of erection strength.

Impotence is defined as the continual inability to sustain an erection long enough or strong enough for sexual intercourse or the inability to achieve ejaculation, or both. Peyronie’s disease impotence is the erectile dysfunction that develops due to abnormal changes in the penis that are part of Peyronie’s disease.

Most people assume that Peyronie’s impotence develops due to lack of blood flow to the organ. This might be true in especially in those cases in which the man has an underlying problem with the cardiovascular system (high blood pressure, elevated cholesterol, vascular disease, diabetes, etc.) In other men , another occasional cause of Peyronie’s disease impotence is emotional. Because of the reduced self esteem, shame, embarrassment and anger related to penile distortion and reduced length and girth of the organ, a man can develop strong emotional reactions expressed as Peyronie’s impotence. However, for most men the primary cause of Peyronie’s disease impotence is simply due to what is known as “venous leakage.”

Peyronie’s impotence fundamentals

In a great number of cases of Peyronie’s disease impotence the fundamental problem is that the blood is no longer being trapped by the veins of the penis to dam it up to create the greater fluid pressure of an erection. The problem is that the veins of a man with Peyronie’s disease do not close to trap blood well. This imperfect or absent closing is caused in great part by the presence of the Peyronie’s scar. The scar acts like something that is blocking a door from closing. That is where therapy should be directed in Peyronie’s disease impotence – toward removal of the scar so the veins can close to allow a normal erection to develop.


Cause of Peyronie’s disease

How Peyronie’s disease starts

As anyone who has the problem knows, the cause of Peyronie's disease is not well understood.  However, any research topics that shed light on this basic question are of great interest to men who have Peyronie’s disease.

Perhaps a good question to start with is, what causes the erect penis to bend in a case of Peyronie’s disease?  The answer lies in the function of the corpora cavernosa functions in the mechanism to produce an erection. There are actually two corpora cavernosa, laying side by side like two cigar shaped, paired balloon-like chambers that must be filled with blood to create an erection. Their connective tissue wall, the tunica albuginea, offers resistance and rigidity when it is stretched to its maximum.  The tunica is elastic to a point, but unlike the thin and flexible wall of a balloon, the tunica albuginea is interlaced with strong connective tissue fibers. These strong fibers do not allow for much expansion, and eventually determine the shape of the erect penis because of their structural rigidity.

Thus, in a very real and fundamental way, Peyronies disease is a disorder of the tunica albuginea. By producing dense and rigid areas of the tunica, called Peyronie's plaque or scars, Peyronie’s disease interferes with the full expansion of the tunica. Plaques are either regions of reversible inflammation in early phases of Peyronies, or permanent scars later if the inflammation is severe and continues too long.  Much like a piece of tape placed on the wall of a balloon, the plaque or scar causes uneven filling and expansion of the tunica, and this causes bending  of the column of the corpora cavernosa.

A basic question is, what causes these plaques to begin?  Microscopic and chemical studies show that plaques represent an early stage of the wound healing process when the tunica is injured. Whatever starts Peyronie’s disease, the problem seems to the inappropriately increase of the normally healthful and proper process of wound repair.  Actually, wound healing may not be the appropriate term in all situations.

Most likely cause of Peyronie's disease

One cause of Peyronies disease is obvious and direct trauma to the erect penis. This trauma can range from sudden and unexpected angulation during sex, to am actual rupture of the corpora cavernosa.  However, the fact is, many men with Peyronies do not recall any such traumatic occurrences.

Over time, all sexually active men will experience some degree of wear and tear on vulnerable areas of the soft tissue erection mechanism. Both the structural arrangement of the corpora and the inherent elasticity of its connective tissues counteract the strong mechanical stresses created by strong sexual activity.  But when men reach their mid-fifties, fundamental connective tissue elasticity throughout the body, and the penis, is on the decline.   And so, it just so happens that the average for appearance of Peyronies disease is fifty-four.

Peyronies plaques most often appear along the top surface of the penis. It is this region where the two corpora meet side by side, along the upper edge of the “inflatable I-beam” created during an erection that is most vulnerable to stress induced delamination.  Another word for a layer is a lamina; when layers are disrupted or separated, it is called delamination.

Autopsy studies in the mid-1990s on men have shown the earliest microscopic changes thought to be early Peyronies disease changes are actually a common finding.   It seems that while many men develop these changes, they will evolve into Peyronies plaques only for a small percentage of cases.

So what causes the process of normal wear and tear to develop abnormally into the destructive process of wound healing that is called Peyronie’s disease?  There are no clear answers to this question.   However, Peyronies disease is more common in diabetics, as well as men who have gout.  These are two conditions that can have an adverse affect on normal connective tissue healing. It is also more common in the presence of Dupuytren’s contractures. These scars of the fascial covering of the finger tendons in the palm of the hand are thought to be inherited, and may reflect an abnormal tendency toward scar formation in other areas.

Thus, we see that much is still to be learned about Peyronie’s disease, but as these microscopic tissue clues are unraveled, the mystery of this problem will be advanced, as well as Peyronie’s disease treatment.

Peyronie’s Disease Plaque, Viagra, Cialis, Levitra, and Blood Supply

Different way to look at Peyronie's disease and blood supply

Peyronie’s disease is all about the Peyronies plaque, because the Peyronie’s plaque causes all the problems we normally associate with this condition.  To back this idea up, and to show you are doing something that is potentially dangerous to your Peyronie’s disease by using erection enhancing drugs, let’s review some interesting research that took place about 15 years ago.

First, some background.  According to two Peyronies disease researchers, Drs. J. A. Lopez and J. P. Jarrow, from the Department of Urology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, most of the erectile dysfunction that is associated with Peyronies disease is probably not due to reduced blood supply coming into the penis.  Hence, taking Viagra, Cialis, Levitra, or any erection producing drugs, is often not effective and when it is it could be dangerous when someone with PD takes any erection producing drug.

Let’s get through the technical material first and then I will put it all together as it relates to using these drugs because you have Peyronies.

In the study done by Lopez and Jarrow, they did a penile vascular (blood flow) evaluation; they tested the penis arteries (to determine blood flow coming into the penis), and they tested the penis veins (to determine the blood flow leaving the penis).

They tested 95 consecutive men who came to them for evaluation or treatment of Peyronie's disease; of these 95 men, 19 were potent (able to become erect) and 76 were impotent (not able to become erect).  They also did the very same kind of penile vascular (blood flow) evaluation on 100 consecutive impotent men who did not have Peyronie's disease so they could compare the condition of their blood vessels as it relates to erections and erectile dysfunction.

Potent men with Peyronie’s disease

After testing the 19 potent men who had Peyronie's disease, they found only one (5%) of the 19 potent patients had abnormal arterial blood flow coming into the penis, and none (95%) had evidence of abnormal venous blood supply leaving the penis.

Impotent men with Peyronie’s disease

After testing the 76 impotent men who had Peyronie's disease, they found that 27 men (36%) had abnormal arterial blood flow coming into the penis, and 44 men (59%) had evidence of abnormal venous blood supply leaving the penis.

Potent and Impotent men who did not have Peyronie’s disease

There was no significant difference in historical risk factors for impotence between the impotent men with or without Peyronie's disease and the control population of impotent patients.

After testing the 100 men who did not have Peyronie’s disease they found they had about the same percent of abnormal arterial blood flow coming into the penis.  However, they found these same men had significantly less (16%) abnormal venous blood supply leaving the penis.

So the big difference was that the impotent men (59%) with Peyronie’s disease had a whole lot more abnormal venous blood supply leaving the penis, than the impotent men (16%) who did not have Peyronie’s disease.

This means that although men with Peyronie's disease may suffer some impotence due to artery blood flow problems, the research proves that the primary and overwhelming cause of impotence in men with Peyronie’s disease is abnormal venous blood supply leaving the penis.

So you ask, “What could be wrong with my venous blood flow leaving my penis?”  Answer:  your Peyronie’s plaque.

Peyronie’s plaque causes impotency

It is the Peyronie’s plaque that causes the veins of the penis to not close properly. Click here to understand a bit about Peyronie's disease and erection.

There are special valves within the veins of the penis that close off at special times, to trap the blood inside the penis – to create an erection.  If the veins do not trap the blood, no erection.  The presence of the plaque or scar material is the problem that causes the valves of the veins to not trap blood, hence a poor or absent erection.  Yes, there are surely many emotional reasons a man with Peyronies will develop impotency, but this vein problem is by far the primary physical reason for this erection problem that we all are interested in.

Imagine that you want to close a door to trap warm or cold air inside a room.  You try to close the door, but you cannot because there is something causing the door to not close all the way – perhaps the door is warped, or maybe there is something lying across the doorway like a doorstop and the door will not seal the room shut.  If the door cannot be closed fully, it will be difficult or impossible to close the door, and you cannot trap the air in that room. It is the same in Peyronie’s disease. If the valves of the veins cannot be closed fully, it will be difficult or impossible to close them, and you cannot trap the blood to create the erection.

The presence of one or more Peyronie’s disease plaques or scars can and will cause physical interference with the normal closing of the valves inside the penis veins and one or more areas of the penis stay soft, preventing intercourse.  It is as simple as that.

So your medical doctor, hearing that you are having a problem with impotence along with your Peyronie’s disease says to you, “Do not fear.  I have my magic prescription pad here.  I will happily write a prescription for  Viagra, Cialis, or Levitra and you will get an erection that will amaze and delight the woman you love, and amaze all your family, friends and neighbors.  Please pay the nurse at the front desk as you leave.”

Elsewhere I will write more about the potential dangers of erection producing drugs like Viagra, Cialis, and Levitra in relation specifically to Peyronies.  For this discussion it is sufficient to state that Viagra, Cialis, and Levitra only bring more blood into the penis.  The do not and cannot help you to trap it there to create an erection.  This is why they may or may not work for you, and in fact, could potentially make your Peyronie’s disease worse.

For more information about the safe and effective treatment of Peyronie’s disease with Alternative Medicine, go to the Peyronie's Disease Institute website.