Peyronie’s Disease with Erectile Dysfunction: Treatment Options
When Peyronie’s disease and erectile dysfunction (ED) occur together, treatment must address both penile shape and erection quality. A straight penis that is not rigid enough for intercourse is not a successful outcome, so erection assessment comes first. Men with mild or treatable ED may use PDE5 inhibitor tablets and then receive curvature treatment based on disease phase and deformity. If ED remains severe despite appropriate medical therapy, penile prosthesis surgery is usually the preferred surgical option because it restores rigidity and can be combined with manoeuvres to straighten the penis.
Why Peyronie’s disease and ED commonly overlap
- The same vascular risk factors that cause ED may be present independently of the plaque.
- Severe curvature or hourglass deformity can make an otherwise firm erection functionally unusable.
- Pain and fear of injury can reduce arousal and maintain performance anxiety.
- Peyronie’s plaque and corporal fibrosis can reduce penile elasticity.
- Diabetes, smoking, hypertension, pelvic surgery and age can contribute to both problems.
First question: is the erection firm enough for penetration?
| Erection quality | Typical treatment direction |
|---|---|
| Good erections without medication | Treat the deformity according to phase, severity and bother. |
| Good erections with PDE5 inhibitor | Curvature treatment can still be considered; ED medicine may continue. |
| Poor erections despite properly used tablets | Further ED assessment may be needed; injections or prosthesis discussion depending on goals. |
| Severe established ED not responsive to acceptable therapy | Penile prosthesis usually becomes the main surgical strategy. |
Medical treatment of the ED component
PDE5 inhibitors such as sildenafil or tadalafil can improve erection quality when there is adequate nerve and blood-flow response. Current EAU guidance supports PDE5 inhibitors in Peyronie’s disease when ED is present. Correct timing and use matter. Penile injections can also provide erections in selected men, but recurrent injection trauma and priapism risk mean they should be prescribed and taught properly.
What can be done for curvature if erections are adequate?
During the active phase, traction and selected intralesional treatments may be considered. Once the disease is stable, plication is suitable for many men with good erections and a simpler curve; grafting may be considered for severe or complex deformity when erectile function is strong enough to tolerate the higher ED risk.
Why plication or grafting may be the wrong surgery if ED is severe
These procedures straighten the penis but do not create an erection. If a man already cannot achieve reliable rigidity despite treatment, a technically successful straightening procedure can leave him unable to have penetrative sex. Grafting can also worsen erectile function in some men. This is why significant ED should be identified before selecting curvature-only surgery.
When a penile implant is preferred
A penile prosthesis is recommended for Peyronie’s disease with ED that does not respond adequately to pharmacological treatment. The cylinders restore rigidity and frequently improve curvature. If a meaningful curve remains, the surgeon can add controlled modelling, plication or plaque incision/grafting during the same operation.
When is penile Doppler useful?
Penile Doppler is a second-level test. It is particularly helpful when the history does not clearly establish whether erections are vascularly adequate, when previous treatment response is uncertain, or when the result would change the choice between plication/grafting and prosthesis surgery.
When Peyronie’s disease and ED coexist, solve the erection problem first
The most important distinction is whether erections are reliably firm enough for penetration with acceptable medical treatment. If yes, curvature can be treated on its own merits. If no, plication or grafting may produce a straighter penis that is still not usable. In men with ED that does not respond adequately to tablets or injections, penile prosthesis surgery can provide rigidity and often correct part of the curvature at the same operation, with additional straightening only if needed.
When Peyronie’s disease and ED occur together
- Describe whether penetration is possible without medication, with tablets or only with injections.
- Bring erection photographs showing the deformity when the penis is maximally rigid.
- Bring any penile Doppler report if already performed; it is not automatically required for everyone.
- List prior ED and Peyronie’s treatments and what each one actually improved.
- Clarify the main goal: reliable rigidity, straightening, length preservation, or a combination of these.
FAQs
Can tadalafil straighten Peyronie’s disease?
Tadalafil can help the ED component and support erections, but it is not a reliable stand-alone treatment for established curvature.
If I can get an erection with injections, do I need an implant?
Not automatically. If injections are effective, acceptable and safe for you, they remain an option. Implant surgery is considered when non-surgical ED treatment is ineffective, unsuitable or not preferred after counselling.
Can Peyronie’s surgery itself cause ED?
Yes. Any penile surgery can affect erectile function, and the risk is particularly important with grafting procedures. Preoperative erectile assessment reduces the chance of choosing the wrong operation.
Will an implant also straighten the penis?
Often partly or substantially. Residual curvature may require modelling, plication or plaque incision/grafting during implant surgery.
Related reading
- Erectile Dysfunction: Causes, Tests and Treatment
- Penile Doppler Test for Erectile Dysfunction
- Peyronie’s Disease Surgery: What Are the Options?
- Penile Implant for Peyronie’s Disease
- Urologist in Latur
References
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Penile Curvature. 2026 https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/penile-curvature
- Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie’s Disease: AUA Guideline. J Urol. 2015;194(3):745-753. doi:10.1016/j.juro.2015.05.098.
- Chierigo F, Fallara G, Tozzi M, et al. Guideline of guidelines: Peyronie’s disease. BJU Int. 2026;137(5):770-782. doi:10.1111/bju.70201.
- Tozzi M, Gobbo A, Fallara G, et al. Erectile dysfunction in patients with Peyronie’s disease treated with different grafts: a systematic review. Sex Med Rev. 2026;14(1):qeaf053. doi:10.1093/sxmrev/qeaf053.