Q: My 52-year-old husband has been having a lot of problems. First, he wasn’t able to get an erection and was having pain in his lower abdomen. His doctor treated him for prostatitis. It helped relieve the pain, but then he got worse. He went to a urologist and was put on Flomax. He has been able to get erections, but they are painful, especially at the tip.
After taking this medicine for about a month, he began experiencing a curved penis. He went back to the urologist who told him he had Peyronie’s disease and said there was nothing he could do and handed him a brochure.
He used to take meds for hypertension and high blood pressure. He drinks two or three glasses of Scotch every night. He is now taking two vitamin E pills a day. Please send us any information you can.
A: Your husband is coping with two related but distinct issues: erectile dysfunction (ED) and Peyronie’s disease. The good news is that both can often be improved with the right plan and specialist follow-up.
Why ED Happens
Medically, ED is the persistent inability to achieve or sustain an erection firm enough for intercourse. While anxiety can play a role, ED in midlife is more often linked to physical factors that reduce blood flow or nerve signaling to the penis. Common contributors include:
- Vascular disease: atherosclerosis and hypertension reduce penile blood flow.
- Neurologic injury: diabetes, stroke, pelvic surgery, or trauma can affect the nerves involved in erection.
- Medications and substances: some antihypertensives, antidepressants, sedatives—and alcohol—can impair erections or libido.
- Prostate and urinary symptoms: conditions such as prostatitis or enlarged prostate (BPH) can contribute to pain and performance issues; learn more in What is Benign Prostatic Hypertrophy? Symptoms and Signs of BPH.
For an evidence-based overview of causes and treatments, see the National Institute of Diabetes and Digestive and Kidney Diseases’ guide to erectile dysfunction (NIDDK).
About Peyronie’s Disease
Peyronie’s disease (PD) involves scar-like plaques in the tunica albuginea that cause penile curvature, painful erections, and sometimes ED. It can appear after micro-trauma, with certain medical conditions, or seemingly out of the blue. Many cases stabilize, and some improve over time, but active management can help with pain, curvature, and function. For a deeper dive into treatment options, including non-surgical and surgical approaches, see Treating Long-term Peyronie’s Disease.
Next Best Steps With His Urologist
- Reassess medications and alcohol use: Review all prescriptions with the urologist and primary care doctor. Reducing nightly Scotch can meaningfully improve erections and sleep quality, and lower blood pressure.
- Optimize cardiovascular health: Tight control of blood pressure, lipids, weight, and exercise benefits both heart and erectile function.
- Clarify the prostate picture: If urinary symptoms persist, confirm whether BPH—not just prostatitis—is present and whether the current alpha-blocker is the best choice and dose.
- Tailored ED therapy: Options include PDE5 inhibitors (e.g., sildenafil), vacuum erection devices, intraurethral or injectable prostaglandins, and—when appropriate—surgical solutions. If he prefers to avoid ongoing medications, a vacuum device can be a non-drug alternative, and penile implants are a definitive option for refractory cases.
- Targeted PD care: Depending on curvature severity and phase (active vs. stable), therapies may include traction therapy, intralesional agents, or surgical correction.
What About Vitamin E?
Vitamin E has historically been used for PD, but evidence for meaningful benefit is limited. It’s generally safe at modest doses, yet it shouldn’t replace treatments with stronger evidence. Discuss dosing and interactions with his clinician—especially given hypertension history and any blood-thinning medications.
Bottom Line
Your husband’s ED likely has multiple contributors—vascular risk factors, medications/alcohol, prostate symptoms, and Peyronie’s disease. A coordinated plan that addresses lifestyle and cardiovascular health, reviews medications, and applies focused ED/PD therapies offers the best chance of reducing pain, improving function, and restoring sexual confidence.