Early-Stage Peyronie’s Disease: What Should You Do in the First 6 Months?
Noticing a new penile bend, painful erection, indentation or loss of length can be worrying. Many men are unsure whether they should seek treatment immediately or wait for the condition to settle.
The first six months are an important time to confirm the diagnosis, document any changes, manage pain, protect erectile function and consider whether early non-surgical treatment may help.
This does not mean every man needs medication, injections or surgery. Treatment should depend on the type of deformity, whether it is changing and how much it affects sexual function.
What is early-stage Peyronie’s disease?
Peyronie’s disease develops when an area of scar tissue, known as a plaque, forms within the strong tissue surrounding the erectile chambers of the penis. The plaque does not stretch normally during an erection and may cause:
Penile curvature
Painful erections
An indentation or hourglass shape
Loss of penile length
A hinge or unstable area
Difficulty achieving or maintaining an erection
Difficulty with sexual penetration
Peyronie’s disease is not cancer, contagious or caused by a sexually transmitted infection. It is thought to occur when penile tissue heals abnormally after an injury or repeated minor trauma, although many men do not remember a specific injury.[1-4]
The condition is generally divided into an active phase, when pain or penile shape may be changing, and a stable phase, when the deformity is no longer progressing.[1,4,5]
The active phase can last 12 to 18 months. Pain is common but may be absent. The most useful sign of active disease is a recent change in curvature, length, indentation or erection quality.[1,4,5]
Should you wait and see?
Observation may be reasonable when the curve is mild, erections are comfortable and sexual activity remains possible.
However, waiting without documenting the condition makes it difficult to know whether it is progressing.
Pain often improves over time, but spontaneous straightening is less predictable. Some men remain stable, while others develop greater curvature, shortening, narrowing or erectile difficulty.[4,5]
An early assessment does not commit you to treatment. It provides a baseline and allows you to discuss whether observation, traction therapy, erectile dysfunction treatment or another conservative option is appropriate.
What should you do during the first six months?
1. Arrange an early assessment
Consider seeing a urologist experienced in Peyronie’s disease if you develop:
New or changing curvature
Painful erections
Penile shortening
An indentation or hourglass shape
An unstable hinge
Reduced erection quality
Difficulty with sexual penetration
The assessment usually includes questions about when symptoms began, whether the deformity is changing, erection quality, pain, loss of length and the effect on sexual activity.
The penis is generally examined while soft to identify the plaque and measure stretched penile length.[1-3]
Ultrasound is not needed for every patient. It may be useful when the diagnosis is uncertain, significant calcification is suspected, penile blood flow needs assessment or surgery is being considered.[1,3]
2. Create a baseline
Photographs of a full erection can help document the direction and severity of curvature.
Take photographs:
From above and from the side
In the same room and camera position
With a similar erection quality
Approximately every four to six weeks
Store the images securely. Checking every day is unlikely to be helpful and may increase anxiety.
Curvature is only one part of the condition. An indentation, hinge effect or loss of length may cause significant difficulty even when the angle is not severe.[1-3]
3. Treat pain safely
Pain is most common during the active phase and often improves as the condition settles.
Non-steroidal anti-inflammatory medicines may be used for pain when medically appropriate.[1] They may not be suitable for men with kidney disease, stomach ulcers, certain heart conditions or those taking blood-thinning medication.
Improvement in pain does not necessarily mean the curvature has stopped changing.
Shockwave treatment may reduce pain in selected men, but it has not been shown to reliably straighten the penis or reduce the plaque.[1,10]
4. Discuss penile traction therapy
Penile traction therapy uses a medical device to apply controlled stretching to the penis. Its goals may include:
Reducing curvature
Preserving or recovering length
Improving penile shape
Supporting other non-surgical treatments
Randomised and follow-up studies of modern traction devices have reported improvements in penile curvature and length for some men.[6-8] However, results vary, and the evidence is specific to the devices and treatment schedules studied.
International guidelines describe traction as a reasonable conservative option while acknowledging that the overall evidence remains limited.[1,6]
Traction should not cause significant pain, numbness, skin damage or discolouration. More force is not necessarily more effective.
Aggressive manual stretching, bending exercises and “jelqing” are not evidence-based substitutes for medical traction therapy and may cause further injury.
5. Consider vacuum therapy in selected cases
A vacuum erection device draws blood into the penis and gently expands the penile tissues. It may be considered when loss of length or reduced erection quality is also a concern.
A small observational study reported curvature improvement in some men using vacuum therapy, although the evidence is weaker than the evidence for modern traction devices.[11]
European guidance allows vacuum therapy to be considered as part of conservative treatment but notes that outcome data remain limited.[1]
Vacuum treatment should not cause severe pain, bruising or skin injury.
6. Protect erectile function
Peyronie’s disease and erectile dysfunction commonly occur together. Erections may become less reliable because of reduced blood flow, pain, anxiety, altered penile shape or difficulty maintaining pressure within the penis.
A partially rigid penis may also be more likely to buckle during sexual activity.
Medications such as tadalafil or sildenafil may be considered when erectile dysfunction is present.[1,2]
One retrospective study found less curvature progression among men with active Peyronie’s disease and erectile dysfunction who used daily low-dose tadalafil compared with observation.[9]
This does not prove that tadalafil prevents progression. It should not be started solely as a scar treatment without medical assessment.
7. Avoid relying on supplements
Vitamin E, pentoxifylline, colchicine, carnitine, coenzyme Q10 and antioxidant combinations are frequently promoted for Peyronie’s disease.
Research has produced inconsistent results, and a systematic review found insufficient evidence that oral therapies reliably improve curvature, pain, plaque size or penile length.[10]
Supplements can also cause side effects or interact with prescribed medicines. They should not replace proper assessment and monitoring.
8. Be careful during sexual activity
Men do not usually need to stop all sexual activity. The aim is to avoid further buckling or bending injury.
Practical precautions include:
Avoid penetration with an insufficiently firm erection.
Use adequate lubrication.
Choose positions that allow better control of depth and angle.
Stop if the penis bends unexpectedly or becomes painful.
Seek treatment if unreliable erections increase the risk of buckling.
A sudden injury associated with a popping sound, immediate loss of erection, marked swelling or bruising requires urgent medical assessment. These symptoms may indicate a penile fracture.
9. Address the psychological impact
Peyronie’s disease can affect confidence, body image, relationships and sexual performance. Reviews have identified high levels of distress and depressive symptoms among affected men.[12]
These reactions are understandable. Anxiety can also worsen erection difficulties and lead to avoidance of intimacy.
Open discussion with a partner and, where appropriate, counselling or sexual therapy may help.
Are injections used during the first six months?
Intralesional treatment involves injecting medication into the plaque. Options described in the literature include collagenase, interferon, verapamil and hyaluronic acid.
Whether injections are appropriate depends on:
Whether the disease is active or stable
The direction and degree of curvature
Plaque location and calcification
The presence of an hourglass or hinge deformity
Erectile function
Treatment availability
The likely benefits, costs and risks
Collagenase has the strongest evidence among injection treatments for suitable dorsal or lateral curvature greater than 30 degrees. Much of the original randomised evidence involved stable disease, although more recent observational studies suggest selected men with active disease may also respond.[1,2,10]
Hyaluronic acid may be discussed in some regions, but European guidelines classify the recommendation as weak because the supporting evidence remains limited.[1]
Injections should be selected after specialist assessment rather than automatically offered to every man with early disease.
Is surgery needed during the active phase?
Surgery is generally avoided while the penile deformity is still changing.
International guidelines recommend waiting until the condition is stable and the deformity is interfering with sexual function. Stability usually means that curvature and other changes have remained unchanged for at least three to six months, often after the disease has been present for approximately 9 to 12 months or longer.[1,2,5]
Operating too early may lead to an inaccurate correction because the penis may continue to change after surgery.
For most men in the first six months, treatment focuses on monitoring, conservative therapy, pain control and erectile function.
A practical first-six-month plan
First few weeks
Arrange an assessment if the change is painful, progressing or affecting sexual activity. Record when symptoms began and take standardised erection photographs.
Months one to three
Monitor pain, curvature, indentation, length and erection quality. Discuss whether traction, vacuum treatment or erectile dysfunction medication is appropriate.
Months three to six
Compare your symptoms and photographs with the baseline. Review whether the deformity is improving, stable or continuing to progress.
This timeline is a general framework. Some men require earlier review, while others can be safely monitored.
Frequently asked questions
Can early Peyronie’s disease go away by itself?
Pain often improves, but complete spontaneous resolution of curvature is less common. Some men remain stable, while others develop increasing curvature, narrowing or shortening.[4,5]
Does pain mean the curvature is getting worse?
Not necessarily. Pain may occur during active inflammation but does not reliably predict how much the penile shape will change. Curvature can progress without pain.[1,4]
Should I start traction immediately?
Traction may be considered during the active phase, but the device and treatment schedule should suit your deformity and circumstances. An early assessment can confirm the diagnosis and help ensure traction is used safely.[1,6-8]
Can massage break down the plaque?
There is no strong evidence that forceful massage breaks down a Peyronie’s plaque. Aggressive manipulation may cause further injury.
When should I see a specialist?
Seek assessment if the curvature is new, changing, painful, causing shortening or indentation, reducing erection quality or making sexual penetration difficult.
You do not need to wait until the condition becomes severe.
Take home message
The first six months of Peyronie’s disease should not simply be a period of waiting.
Early care can help you:
Confirm the diagnosis
Document any progression
Manage pain
Protect erectile function
Consider supervised traction or vacuum therapy
Avoid ineffective or potentially harmful treatments
Plan future treatment if the condition becomes stable
Early treatment cannot guarantee that curvature will improve or stop progressing. However, a structured plan can help preserve function and reduce uncertainty.
Peyronie’s disease assessment in Brisbane
Dr Jack Crozier is a Brisbane urologist and andrology surgeon with a subspecialty interest in Peyronie’s disease, erectile dysfunction and penile reconstructive surgery.
A confidential consultation provides an opportunity to document the deformity, assess erectile function and discuss observation, penile traction therapy, medication, injections or future surgical treatment where appropriate.
This article provides general information and does not replace personalised medical advice. Treatment suitability, benefits and risks vary between patients. Seek urgent medical care after an acute penile injury associated with marked bruising, swelling, a popping sensation or sudden loss of an erection.
References
European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. Arnhem, The Netherlands: EAU Guidelines Office; 2026.
Salonia A, Capogrosso P, Boeri L, et al. European Association of Urology guidelines on male sexual and reproductive health: 2025 update on male hypogonadism, erectile dysfunction, premature ejaculation, and Peyronie’s disease. Eur Urol. 2025;88(1):76-102. doi:10.1016/j.eururo.2025.04.010.
Bella AJ, Lee JC, Grober ED, Carrier S, Bénard F, Brock GB. 2018 Canadian Urological Association guideline for Peyronie’s disease and congenital penile curvature. Can Urol Assoc J. 2018;12(5):E197-E209. doi:10.5489/cuaj.5255.
Di Maida F, Cito G, Lambertini L, et al. The natural history of Peyronie’s disease. World J Mens Health. 2021;39(3):399-405. doi:10.5534/wjmh.200065.
Douroumis K, Kotrotsios K, Katsikatsos P, et al. Acute phase Peyronie’s disease: where do we stand? Cureus. 2024;16(8):e67054. doi:10.7759/cureus.67054.
García-Gómez B, Aversa A, Alonso-Isa M, et al. The use of penile traction devices for Peyronie’s disease: position statements from the European Society for Sexual Medicine. Sex Med. 2021;9(4):100387. doi:10.1016/j.esxm.2021.100387.
Ziegelmann MJ, Savage J, Toussi A, et al. Outcomes of a novel penile traction device in men with Peyronie’s disease: a randomized, single-blind, controlled trial. J Urol. 2019;202(3):599-610. doi:10.1097/JU.0000000000000245.
Joseph J, Ziegelmann MJ, Alom M, Savage J, Köhler TS, Trost LW. Outcomes of RestoreX penile traction therapy in men with Peyronie’s disease: results from open-label and follow-up phases. J Sex Med. 2020;17(12):2462-2471. doi:10.1016/j.jsxm.2020.10.003.
Spirito L, Manfredi C, La Rocca R, et al. Daily low-dose tadalafil may reduce the penile curvature progression rate in patients with acute Peyronie’s disease: a retrospective comparative analysis. Int J Impot Res. 2024;36(2):129-134. doi:10.1038/s41443-022-00651-8.
Hayat S, Brunckhorst O, Alnajjar HM, et al. A systematic review of non-surgical management in Peyronie’s disease. Int J Impot Res. 2023;35(6):523-532. doi:10.1038/s41443-022-00633-w.
MacDonald LP, Armstrong ML, Lehmann KJ, Acker MR, Langille GM. Outcome analysis of patients with Peyronie’s disease who elect for vacuum erection device therapy. Can Urol Assoc J. 2020;14(9):E428-E431. doi:10.5489/cuaj.6205.
Terrier JE, Nelson CJ. Psychological aspects of Peyronie’s disease. Transl Androl Urol. 2016;5(3):290-295. doi:10.21037/tau.2016.05.14.
