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WHAT EVIDENCE LINKS ERECTILE
DYSFUNCTION DRUGS AND PEYRONIES DISEASE?
Before we look into the actual evidence let's just logically
review what could be the link. You have a middle age men with
some penile wear and tear due to age and past sexual activity.
The ED drug causes an excess amount of blood to enter the
penis, engorging it beyond what is usual, so the TA is
stressed and stretched beyond its natural limits. The man can
thrust longer and harder than normal and when he finally
ejaculates the penis is still erect for a longer than normal
period of time. This results in trauma or micro trauma to the
TA and over time scar tissue forms. Is there any scientific
evidence to support my hypothesis?
- An article appeared in the International Journal of
Impotence Research (2002)14 titled, Epidemiology of
Peyronies Disease. It discussed the prevalence of PD in
the area around Cologne, Germany. The researchers
concluded that the incidence of PD may be higher than
reported due to the embarrassing nature of this
condition. Most clinicians note that the number of PD
patients have increased since the advent of Viagra. With
more men being successfully treated for ED, an
increasing number of cases are being presented for
evaluation. Unfortunately, there is no citation to confirm
the increasing number of cases of PD being seen by
physicians.
- A previously mentioned article appeared in the Los
Angeles Times, February 09, 2009, titled Preventing Penile
Fractures and Peyronies Disease. The urologist
interviewed referred to PD as an increasing prevalent
condition that may be linked to the use of drugs like
Viagra, Cialis and Levitra. Experts say that these drugs
help protect some men from injuries during sex and put
others at greater risk. The article continues that too
much blood in the CC stresses the TA and that could lead
to injury. Then the article discussed penile fracture. The
point to remember is this article states that the use of ED
drugs may lead to dangerous stress on the Tunica
Albuginea leading to injury.
Before reading any further go back to the anatomy picture
and familiarize yourself with the Corpus Carvernosum and
Tunica Albuginea. This is crucial to understand this research
effort. Note this research is focused primarily on the CC
where PD is a disorder of the TA, the tissue that is attached
as a covering to the CC
.
By far the most important research in this area has been
conducted by the Department of Urology, School of Medicine,
Celar Bayar University, Manisa, Turkey. Their article
appeared in the journal, Acta Histochem, 2004 February; 106
(1):37-45 and was titled Histopathological Effects of Sildenafil
Citrate on Rat Corpus Cavernosum. According to the authors,
research was conducted because the long term effects of
sildenafil citrate (Viagra) on the penis and its components,
particularly the CC are unknown.
Twenty male rats were utilized, all 10-12 weeks old. Ten were
a control and the other 10 were given sildenafil citrate on
alternate days (3 days a week) for 4 weeks. One month in a
rat’s life is equivalent to 2.5-3 years in human life. On days
the drugs were given, male rats were coupled with female rats
for sexual activity. The rats were then sacrificed and tissue
analysis revealed some important difference between the
control and treated group.
- Light micrographs of penile tissue were examined. The
dorsal vein and CC showed increased density of collagen
bundles in the stroma of the CC - Increased amounts of dense collagen fibers were
observed in the region between the CC of the treated rats. - Fibroblast's in the penile tissue of the treated rats
appeared to be active cells. In addition to fibroblast's
there were an increased number of inflammatory cells
such lymphocytes and macrophages in the penis of the
treated rats. - Tissue changes found in this experiment “may be
irreversible results causing fibrosis as a long-effect of
sildenafil citrate treatment on penile tissue.”
Discussion: My first reaction in reading this report was why
didn't’t anyone think of doing this type of experiment before?
It seems so logical. Why was this research not done in the US
and what explains why so much important research on this
topic is coming out of Turkey, Iran, Egypt, etc. and not the
Western world where PD is suppose to be the most
prevalent?
Is This a Smoking Gun linking PD and the use of ED drugs?
In fairness, I would have to conclude it isn’t, for the simple
reason that the study in Turkey focuses on the CC and not
the TA. Additionally, it involved rats and not men. However, in
my opinion, it is clearly very strong evidence demonstrating a
definite relationship between the prolonged use of ED drugs
and fibrotic changes to the penile tissue.
Finding No. I. The TA is adjacent to the dorsal vein and CC
and it seems entirely logical that increased collagen that
would affect these two tissues would also produce similar
changes to the TA.
Finding No. II mentions active fibroblasts. Collagen is a
component of scar tissue. It is produced and deposited by
scar cells (fibroblasts). Lymphocytes and macrophages are
part of the body's response to an injury and wound healing. It
seems almost certain that if this process is activated in the
CC and surrounding tissues it would also affect the TA.
In summary, this seem like very strong evidence that the
prolonged use of sildenafil citrate is related to penile injury
and aberrant healing, leading to an increased incidence of
PD. If I had to use a baseball analogy in linking ED drugs and
PD, we have passed 3rd based and are headed home.
But Wait! There are more interesting findings.