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.