There are probably plenty of occasions where telling a patient to wait and see how a condition develops before starting treatment where it’s the appropriate response.

For men with both erectile dysfunction and Peyronie’s disease, that standard advice might be costing them their best shot at avoiding surgery.

New research shows men who start combination therapy early achieve successful sexual intercourse 78.3% of the time. Those who wait drop to 42.8%.

Surgery rates follow the same pattern. Early treatment patients need it just 13.3% of the time versus 35.7% for those who delay.

These are, as you can see, major differences. Let’s explore the research that reinforces the importance of early intervention in patients with both Peyronie’s and ED.

The overlap nobody talks about

More than half of men with Peyronie’s also experience ED. The conditions share common risk factors: diabetes, smoking, obesity, and penile trauma.

The connection makes biological sense.

Peyronie’s causes plaque formation that can restrict blood flow. The curvature itself can make penetration difficult or impossible.

Add in the psychological impact—performance anxiety, depression, relationship stress—and you’ve got a combination that’s tailor-made for worsening erectile function.

Yet many providers still treat these conditions separately. Or worse, they adopt a wait-and-see approach during the critical early window when tissue remains responsive to treatment.

What the data actually shows about early intervention

The evidence for early action keeps mounting. A comprehensive analysis of combination therapies found that 68% of patients showed significant erectile function improvement when treatment started during the acute phase.

Compare that to men who delay treatment. Once plaque calcifies and fibrosis sets in, even aggressive therapy yields limited results. At that point, surgery becomes the primary option, with all its associated risks and recovery time.

The acute phase typically lasts 6-12 months. During this window, the plaque remains malleable and blood flow can still be optimized. Tissue responds to both medical and mechanical interventions.

Miss that window, and options narrow considerably.

Treatment combinations that move the needle

The most successful early intervention strategies use multiple approaches simultaneously. Here’s what the research supports:

Medical combinations

PDE5 inhibitors plus antioxidants show improved erectile function without increased side effects. Tadalafil combined with pentoxifylline demonstrates quality of life improvements over either medication alone.

For more aggressive cases, collagenase Clostridium histolyticum (CCH) combination therapy produces a mean length improvement of 0.81 cm (p=0.01) along with reduced symptom burden.

Mechanical interventions

Penile traction therapy works best during early disease phases, before plaque hardens. When combined with medical therapy, vacuum erection devices can also help patients achieve erections sufficient for intercourse.

Low-intensity shockwave therapy paired with oral medications shows promise, particularly for vascular-related ED components.

Intracavernosal injections (ICI)

For men who don’t respond to oral medications, injection therapy becomes critical. Success rates for achieving intercourse-ready erections range from 54% to 100%, depending on patient selection and dosing protocols.

One thing that is important to note is that repeated injections carry a small but recognized risk of penile fibrosis or curvature, which in some cases may resemble early Peyronie’s disease. All patients should receive clear instruction on proper injection technique and periodic monitoring should ICI be the best treatment option.

Who benefits most from early treatment

Not every patient responds equally to early intervention. The research identifies clear predictors of success:

Mild curvature (<30 degrees)

These patients show the best response rates to combination medical therapy. The tissue remains flexible enough for meaningful remodeling.

Active disease phase markers

Pain during erection, palpable nodules, and recent onset all indicate active inflammation, the optimal time for intervention.

Preserved baseline function

Men with some remaining erectile function respond better to enhancement strategies than those starting from complete dysfunction.

When surgery becomes inevitable

Despite optimal early intervention, some men will need surgical correction. The data shows clear patterns for who ends up in the OR:

Severe curvature (>60 degrees) rarely responds adequately to conservative measures. Men with calcified plaque on imaging have missed the therapeutic window. Hourglass deformities and severe instability typically require surgical reconstruction.

For these patients, penile prosthesis implantation addresses both curvature and erectile dysfunction simultaneously. Modern implants offer reliable outcomes, but the recovery process and cost make prevention through early intervention preferable when possible.

The research gaps we’re still facing

Current studies suffer from notable limitations. Small sample sizes plague most trials. Outcome measures vary wildly between studies, making direct comparisons difficult. Few trials extend beyond 12 months, leaving long-term efficacy questions unanswered.

The field desperately needs large, multicenter trials with standardized protocols. Until then, providers must extrapolate from imperfect data while closely monitoring individual patient responses.

How to incorporate this approach into your practice

You know your patients best, and every practice has its own workflow. Based on what the research shows, here are some approaches to consider:

Screening protocols

You might consider evaluating any patient with new-onset ED for signs of Peyronie’s. Similarly, comprehensive erectile function assessment for Peyronie’s patients could catch overlapping issues early. Some practices find success with standardized intake questionnaires that flag potential dual diagnoses.

Treatment timing

The data suggests that immediate intervention upon diagnosis yields better outcomes. You might develop a protocol that initiates combination therapy at the first visit rather than scheduling follow-ups to “monitor progression.” Some providers find success with same-day medication starts when appropriate.

Combination strategies

Rather than starting with monotherapy and escalating, consider beginning with multiple interventions. Many practitioners report better results when they stack oral medications with mechanical therapies from day one, adjusting based on response rather than waiting for failure.

Tracking systems

Consistent documentation helps identify response patterns. Some practices use digital tracking tools, others prefer paper logs. Whatever system works for your workflow, regular measurements of curvature, erectile function scores, and patient-reported outcomes can guide treatment adjustments.

Patient education

Setting realistic expectations up front may improve compliance and satisfaction. Consider developing educational materials that explain the acute phase window and why early aggressive treatment matters. Some providers find video resources particularly helpful for complex topics like injection training or traction device use. menMD offers a wide range of resources and has videos addressing this topic specifically.

Referral pathways

If certain interventions fall outside your scope, establishing clear referral relationships ensures patients don’t lose time during the critical early window. Quick access to providers who perform CCH injections or implant surgery can make the difference between successful conservative management and surgical necessity.

Moving Forward

The data makes one thing increasingly clear: men with combined ED and Peyronie’s disease who receive early, comprehensive treatment avoid surgery more often and maintain better sexual function than those who delay.
The traditional “wait and see” approach deserves reconsideration. The 6-12 month acute phase represents a limited opportunity for meaningful intervention. After that, both providers and patients face fewer options with less favorable outcomes.
The tools exist and evidence supports their use. Now we need to ensure every appropriate patient gets timely access to combination therapy before that window closes for good.

Interested in seeing how menMD can help?

menMD and our Pharmacy provider offer a large selection of resources and a comprehensive selection of products for treating Peyronie’s Disease and ED. To discuss how you can get started or take advantage of our resources available, please fill out the contact form on this page to be connected with one of our Sales Representatives.