Changes in sexual function, relationship satisfaction, and quality of life in men with untreated peyrones disease

Objective(s): Here, we sought to report on the natural history of sexual function in men with untreated Peyronie's Disease (PD). Material and Method(s): 720 patients who underwent evaluation for PD at our institution between 1990 and 2012 were randomly chosen to receive a questionnaire that included prompts regarding the impact of PD on sexual function, relationship satisfaction, and quality of life. A database of patient-responses was compiled, and descriptive statistics were performed. Result(s): A total of 162/720 (23% response rate) PD men completed our survey including 125 with no history of intrale-sional or surgical therapy for PD. These patients comprised our cohort. Median (IQR) age at diagnosis was 65 (62;68) and PD duration was 8 (5;12) years at the time of survey. Medical comorbidities in our cohort included hypertension (39%), hyperlipidemia (53%), coronary disease (19%), and diabetes (16%). Forty-two percent of patients reported worsened ability to perform penetrative intercourse over time. Median (IQR) IIEF-5 score was 16 (5;21), and scores (median, IQR) were significantly lower in patients who reported a lateral curve (11, 4;20) compared to dorsal (17, 13;21), possibly due to physical inability to penetrate with select curvatures. Sixty percent of patients experienced decreased erectile function over time, including 35% who noted a gradual decline and 25% who experienced an initial abrupt decline at the time of diagnosis with subsequent stability. Also, 50% of patients reported that PD had negatively impacted their self-esteem and self-image. Interest-ingly, on univariate analysis factors including age, time from diagnosis, and the presence of medical comorbidities were not associated with differences in sexual dysfunction, relationship satisfaction, or self-esteem. However, patient-reported penile shortening was associated with decreased intercourse frequency (p=0.02), negative self-esteem (p=0.04), and lower IIEF scores (P=0.008). Conclusion(s): The majority of patients with untreated PD experience negative changes in sexual function, relationship-satisfaction, and self-esteem over time. Although these findings are independent of age, time from diagnosis, and medical comorbidities, penile shortening may predispose to worsened sexual function and lower self-esteem.