Penile Indentation When Erect: What Causes It and Could It Be Peyronie’s Disease?
A dent or indentation in the penis that becomes noticeable during an erection can be concerning, particularly when it is new.
Some men describe:
a dent on one side of the erect penis
a “waist” or narrowed section
loss of girth in one area
an hourglass-like shape
a weak point where the penis bends or buckles
indentation together with a new penile curve
shortening or reduced erection firmness
One important cause is Peyronie’s disease, in which scar tissue within the strong covering of the erectile chambers prevents part of the penis from expanding normally during an erection.[1,2]
However, not every penile indentation is Peyronie’s disease, and an indentation does not automatically mean that surgery is required.
The important questions are whether the indentation is new, whether it is changing, whether there is an associated curve or loss of length, whether erections remain firm, and whether the narrowed area makes sexual activity difficult.
Learn more about Peyronie’s disease.
What causes a dent in the penis when erect?
During an erection, the erectile chambers fill with blood and the strong outer layer of the penis — the tunica albuginea — stretches.
If one area does not expand normally, the surface of the penis may appear indented.
Peyronie’s disease is an important acquired cause. Scar tissue or a Peyronie’s plaque can make a section of the tunica less elastic. As the surrounding penis expands during erection, the scarred area may remain relatively fixed, producing a dent, narrowing or curve.[1,2]
Other possibilities can include previous penile injury, scarring following penile procedures or surgery, corporal fibrosis and, in some men, longstanding anatomical variation.
Assessment is particularly worthwhile when the change is new rather than something that has always been present.
Penile indentation is not the same as penile curvature
Peyronie’s disease is often described simply as a “bent penis”, but the condition can produce a much more three-dimensional change in shape.
International guidelines recognise deformities including:
curvature
penile shortening
unilateral indentation
narrowing
hourglass deformity
hinge instability
erectile dysfunction.[1,2]
A man can therefore have a fairly straight penis and still have a significant Peyronie’s deformity.
This distinction is important because treatment designed only to straighten a curve may not correct an area of lost girth or instability.[1]
See the dedicated guide to hourglass, indentation and hinge deformity.
What is the difference between an indentation and an hourglass deformity?
The terms are related but do not describe exactly the same thing.
Penile indentation
An indentation is usually a localised depression or dent, often predominantly affecting one side of the penis.
It may look like a section has been pushed inward during erection.
Hourglass deformity
An hourglass deformity involves more substantial narrowing around part of the penile shaft. The penis may look wider above and below a narrowed central segment.
Hinge deformity
A hinge deformity is a functional problem.
The narrowed segment becomes a weak point and the penis may bend or buckle there during penetration, even when the rest of the erection appears firm.
This mechanical instability can sometimes cause more difficulty than the degree of curvature itself.
Read more about Peyronie’s hourglass and hinge deformity.
How common is indentation in Peyronie’s disease?
Indentation and narrowing may be more common than many patients realise.
In a 2024 tertiary referral-centre study of 1,263 men with Peyronie’s disease, penile duplex assessment identified indentation or narrowing in 76%, hourglass deformity in approximately 10%, and a hinge effect in approximately 33%.[3]
These figures come from a specialist referral population and should not be interpreted as prevalence estimates for all men with Peyronie’s disease. They do, however, demonstrate why assessing penile shape involves more than simply measuring the angle of curvature.
Does an indentation always mean Peyronie’s disease?
No.
A longstanding indentation that has been present for as long as you can remember may represent normal or congenital anatomy.
Peyronie’s disease becomes more likely when there has been an acquired change, particularly when accompanied by:
a new curve
a firm plaque or lump
erection pain
loss of penile length
increasing narrowing
altered erection firmness
difficulty with penetration
buckling during intercourse.
Peyronie’s disease is a benign scarring disorder. It is not a sexually transmitted infection and is not penile cancer.[1,2]
Can Peyronie’s disease cause indentation without much curvature?
Yes.
This is an important point.
Some men focus on the fact that their penis remains relatively straight and therefore assume they cannot have Peyronie’s disease.
A plaque can instead restrict expansion across the width or circumference of the penis, producing loss of girth rather than a major bend.
An indentation can therefore be the dominant feature of Peyronie’s disease.
Why does the penis look normal when soft but indented when erect?
This is also possible.
Peyronie’s deformity is often most obvious when the penis is fully erect because the difference in tissue elasticity becomes apparent as the erectile chambers expand.
A plaque may sometimes be felt during a flaccid examination, but the true shape, narrowing and mechanical stability are best assessed during erection.[1,2]
For this reason, photographs of a full erection can be useful during assessment.
Does penile indentation get worse?
Peyronie’s disease frequently goes through an active phase, during which the shape or symptoms can change, followed by a more stable phase.[1,2,4]
During the active phase, a man may notice:
increasing indentation
progressive curvature
changing penile length
erection pain
a new plaque
increasing narrowing.
The eventual course varies considerably.
Pain commonly improves with time, but the structural deformity does not necessarily disappear.[4]
If the indentation has appeared recently, documenting the shape can help determine whether it is continuing to change.
Read what to do during early-stage Peyronie’s disease.
Should I take photographs?
Photographs can be particularly useful because an indentation may be difficult to appreciate when the penis is flaccid.
If you are comfortable doing so, photographs of a fully rigid erection from several angles can help demonstrate:
the position of the indentation
associated curvature
loss of girth
an hourglass shape
changes over time.
Photographs can remain on your own phone and be shown during the consultation.
Do not deliberately bend or buckle the penis to demonstrate an unstable area.
How is penile indentation assessed?
Assessment typically considers much more than whether a plaque can be felt.
1. When the change started
It is useful to establish whether the indentation has always been present or represents a new change.
2. Whether it is still changing
New pain, increasing curvature or progressive indentation may suggest active disease.
3. The shape of the erect penis
The location and depth of indentation, associated curvature, hourglass narrowing and any hinge instability are considered.
4. Penile length
Peyronie’s disease can cause measurable or perceived shortening.
5. Erection quality
This is particularly important.
A structurally abnormal penis with strong erections may require a very different treatment strategy from one where significant erectile dysfunction is also present.[1,5]
6. Examination
The penis may be examined for plaques, fibrosis and other anatomical abnormalities.
7. Selected investigations
Not every patient needs penile ultrasound.
In selected men, a pharmacologically induced erection and/or penile Doppler ultrasound may help assess the deformity and erection haemodynamics. Current EAU guidance notes that an induced erection provides a particularly useful objective assessment of penile deformity before invasive treatment.[1]
Learn about erectile dysfunction assessment.
Does penile indentation need treatment?
Not always.
Treatment is generally guided by function rather than appearance alone.
If the indentation is mild, stable, painless and does not interfere with sexual activity, observation may be reasonable.
Treatment becomes more relevant when there is:
progressive deformity
significant loss of penile girth
difficulty with penetration
painful intercourse
hinge instability or buckling
important shortening
associated curvature
significant distress
erectile dysfunction.
An early consultation does not mean that an operation will be recommended.
Can penile traction help an indentation?
Penile traction therapy uses controlled mechanical stretching over time.
Studies suggest traction can improve curvature and penile length in selected men with Peyronie’s disease, and contemporary EAU guidance allows traction or vacuum devices to be considered as part of conservative treatment.[1]
However, the evidence specifically examining hourglass deformity, focal indentation and hinge instability is much more limited.[1]
Traction should therefore not be presented as a guaranteed way of restoring normal girth to a substantial established indentation.
Read the evidence for penile traction therapy.
Can injections repair the dent?
Injection treatments used for selected patients with Peyronie’s disease are primarily studied for penile curvature rather than reliably restoring girth to an isolated indentation.
Treatment eligibility, evidence and availability also differ between countries.
For patients with a substantial hourglass or indentation deformity, it is particularly important to understand what component of the deformity a proposed treatment is intended to correct.
No injection should be considered capable of guaranteeing restoration of normal penile shape.
When is surgery considered?
Current international guidance generally reserves Peyronie’s reconstructive surgery for men whose disease has become stable and whose deformity causes meaningful functional difficulty.[1,2]
Before choosing an operation, assessment should consider:
erection quality
penile length
severity of curvature
depth and location of indentation
hourglass narrowing
hinge instability
previous treatment
individual priorities.[1]
There is no single “best” Peyronie’s operation for every penile indentation.
Penile plication
Penile plication straightens the penis by shortening the longer side.
It can be an effective treatment for selected men with good erectile function and a relatively straightforward curvature.
However, plication does not restore the missing girth at an indentation.
For this reason, EAU guidance generally favours shortening procedures for men without substantial hourglass or hinge deformity.[1]
If indentation is the main problem, simply producing a straighter penis may not solve it.
Plaque incision and grafting
Plaque incision and grafting is a tunical reconstructive procedure that may be considered in selected men with:
good underlying erectile function
significant or complex curvature
substantial narrowing
hourglass deformity
concerns about further shortening with plication.[1,6]
Rather than shortening the longer side, the tight side of the tunica is released and the resulting defect reconstructed.
This is a larger reconstructive operation than standard plication.
Potential risks include recurrent or residual deformity, change in penile sensation and postoperative erectile dysfunction. Available grafting studies are heterogeneous, and no graft material or technique has been demonstrated to be universally superior.[1,6]
What is extra-tunical grafting?
Another reconstructive concept is extra-tunical grafting, sometimes abbreviated to ETG.
Instead of cutting into the erectile tunica, graft material is positioned outside it to provide additional structural support and fill an indentation or hourglass defect.
The approach has attracted interest because it attempts to correct a concavity while avoiding some of the dissection involved in traditional tunical incision and grafting.[5,7,8]
Recent EAU guidance discusses extra-tunical grafting for hourglass and hinge-type deformity.[1]
A 2024 retrospective series involving 35 men treated with extra-tunical grafting and plication reported persistent correction in 89.6% at a median follow-up of almost two years.[7]
However, ETG remains supported mainly by relatively small, non-randomised surgical series. These results should therefore not be interpreted as proof that ETG is superior to other reconstructive techniques.[1,5,7]
Explore treatment of hourglass and indentation deformity.
What if I also have erectile dysfunction?
This changes the treatment discussion significantly.
A straightening or grafting procedure can improve penile shape, but it cannot compensate for an erection that is not sufficiently rigid.
Current international guidelines recommend considering penile prosthesis surgery when Peyronie’s disease occurs together with significant erectile dysfunction that has not responded adequately to appropriate non-surgical treatment.[1,2]
The implant provides erectile rigidity, while modelling, plication, tunical incision or grafting can sometimes be added when necessary to address residual deformity.
Learn about penile implant surgery.
Could the indentation make the penis buckle during sex?
Yes.
A sufficiently deep area of narrowing can produce a hinge effect.
Imagine bending a tube that becomes much narrower at one point. Even though the rest of the structure is strong, force becomes concentrated through the weak segment.
Something similar can occur during penetration.
A man may have a firm erection yet find that the penis repeatedly bends or collapses at the indented area.
This is why penile stability can be as important as penile straightness when evaluating Peyronie’s disease.
Should I avoid sex?
Peyronie’s disease does not automatically mean that sexual activity needs to stop.
However, avoid situations where the erect penis is repeatedly buckling, slipping out and bending sharply or being forced through significant pain.
This is particularly relevant when there is a pronounced hinge deformity or erection rigidity is reduced.
Read whether sex or masturbation can worsen Peyronie’s disease.
When is a penile injury an emergency?
A gradual indentation from Peyronie’s disease is different from a penile fracture.
Seek urgent medical assessment after an injury to an erect penis if there is:
a sudden pop or crack
immediate severe pain
rapid loss of the erection
marked swelling or bruising
a sudden new deformity
blood from the urethra
difficulty passing urine.
Do not wait for a routine Peyronie’s appointment after a suspected penile fracture.
When should I see a urologist about penile indentation?
Consider assessment if you have developed:
a new dent in the erect penis
progressive narrowing
an hourglass appearance
new penile curvature
loss of length
painful erections
a palpable plaque
buckling during intercourse
difficulty with penetration
worsening erection quality.
The early question is usually “What is causing the change and is it stable?” rather than “Which operation do I need?”
The Peyronie’s Treatment Explorer may also help organise the features that are useful to discuss during a consultation.
Penile indentation assessment in Brisbane
Dr Jack Crozier is a Brisbane urologist and fellowship-trained andrologist whose practice includes Peyronie’s disease, penile deformity, erectile dysfunction, penile reconstructive surgery and penile prosthetic surgery.
His advanced andrology fellowship at University College London Hospitals included assessment and surgical management of Peyronie’s disease and reconstructive andrology.
Patients can request assessment at Greenslopes or Springwood, or discuss whether an initial remote consultation may be appropriate.
Request a Peyronie’s assessment.
Interstate patients
Patients travelling from elsewhere in Queensland or interstate do not necessarily need to organise travel before the likely assessment pathway has been clarified.
Where clinically appropriate, existing reports, previous treatment information and photographs can be reviewed as part of planning.
A physical examination or additional investigations may still be required before definitive treatment can be recommended.
View information for travelling patients.
International patients with Peyronie’s disease
Patients considering travelling to Brisbane from overseas can review the dedicated international Peyronie’s disease pathway.
Useful information before assessment can include:
when the indentation first appeared
whether it is progressing
photographs documenting the erect deformity
erection quality
previous Peyronie’s treatment
previous penile surgery
penile Doppler or ultrasound reports where already performed
relevant medical history.
An initial review may help clarify what further assessment could be required before major travel arrangements are made.
International assessment does not replace urgent or necessary medical care in your own country.
Frequently asked questions
Why is there suddenly a dent in my penis when erect?
An acquired indentation can occur when part of the tunica albuginea does not expand normally during erection. Peyronie’s disease is an important potential cause, particularly when there is an associated plaque, curve, shortening or change in penile shape.
Can Peyronie’s disease cause a dent but no bend?
Yes. Peyronie’s disease may produce indentation, narrowing or hourglass deformity with relatively little curvature.
Will the dent disappear by itself?
The natural history varies. Pain often improves during the course of Peyronie’s disease, but an established structural deformity does not reliably disappear.[4]
Is an indentation the same as an hourglass penis?
Not exactly. An indentation is usually a focal concavity, whereas an hourglass deformity describes broader narrowing around a segment of the penile shaft.
What is a hinge deformity?
A hinge occurs when a narrowed section becomes mechanically unstable and bends or buckles during penetration.
Can penile traction restore the missing girth?
Evidence for traction is stronger for curvature and penile length than for correction of a significant established indentation or hourglass defect.[1]
Will plication fix an indentation?
Plication can correct associated curvature but does not restore lost girth. Significant indentation or hourglass deformity may require a different reconstructive discussion.[1]
Can grafting correct an indentation?
Grafting techniques may be considered for selected Peyronie’s deformities. Traditional tunical incision and grafting and extra-tunical approaches have different indications, advantages and risks.[1,5-8]
What if my penis is indented and erections are also weak?
Erectile function should be assessed as part of the same problem. Significant erectile dysfunction can change which treatment pathway is appropriate.[1,2]
Do I need an ultrasound?
Not necessarily. Ultrasound may be useful in selected cases, particularly when information about plaque characteristics, calcification or penile blood flow is likely to affect management.[1]
Take-home message
A penile indentation that appears during erection can be a form of Peyronie’s disease even when there is very little curvature.
The most important issue is not simply how the penis looks. Assessment should establish:
whether the deformity is new or longstanding
whether it is still changing
whether penile girth has been lost
whether a hinge or unstable segment has developed
whether erections remain sufficiently firm
whether sexual function is being affected.
Mild deformity may require only observation.
More significant disease may lead to discussion of traction, management of associated erectile dysfunction or — once the condition is stable — reconstructive options such as plication, grafting, extra-tunical reconstruction or penile implant surgery in appropriately selected patients.
There is no single operation that is right for every penile indentation, and treatment outcomes cannot be guaranteed.
International Peyronie’s pathway
References
European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Penile Curvature. Arnhem, The Netherlands: EAU Guidelines Office; 2026.
Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, et al. Peyronie’s disease: AUA guideline. J Urol. 2015;194(3):745-753. doi:10.1016/j.juro.2015.05.098.
Roadman D, Wang V, Beer A, Levine L. A contemporary assessment of the evaluation and management of patients presenting to a tertiary medical center with Peyronie’s disease. Int J Impot Res. 2024;36(2):118-124. doi:10.1038/s41443-023-00738-w.
Mulhall JP, Schiff J, Guhring P. An analysis of the natural history of Peyronie’s disease. J Urol. 2006;175(6):2115-2118. doi:10.1016/S0022-5347(06)00270-9.
Ceballos B, Baumgarten AS, Krug AM, Morey AF. Extratunical grafting for minimally invasive management of complex Peyronie’s disease deformities. J Sex Med. 2024;21(6):579-581. doi:10.1093/jsxmed/qdae049.
Natsos A, Tatanis V, Kontogiannis S, Waisbrod S, Gkeka K, Obaidad M, et al. Grafts in Peyronie’s surgery without the use of prostheses: a systematic review and meta-analysis. Asian J Androl. 2024;26(3):250-259. doi:10.4103/aja202358.
Roadman D, Quesada-Olarte J, Langbo W, Mossack S, Levine L. Experience with extra-tunical grafting and tunica albuginea plication for correction of indentation deformity in men with Peyronie’s disease. Urology. 2024;186:17-22. doi:10.1016/j.urology.2023.11.040.
Reed-Maldonado AB, Alwaal A, Lue TF. The extra-tunical grafting procedure for Peyronie’s disease hourglass and indent deformities. Transl Androl Urol. 2018;7(Suppl 1):S1-S6. doi:10.21037/tau.2017.12.03.
Medical disclaimer
This article provides general educational information only and does not provide individual medical advice, diagnosis or a treatment recommendation.
Penile indentation, curvature and erectile dysfunction can have different causes, and appropriate investigation and treatment depend on the individual clinical situation. Observation, traction, medicines, medical devices, injections and surgical procedures each have potential benefits, limitations, contraindications and risks. Individual outcomes cannot be guaranteed.
Do not start, stop or change prescribed treatment based on this article without appropriate medical advice.
Seek urgent medical assessment after a significant injury to an erect penis associated with a popping or cracking sensation, sudden loss of erection, marked swelling or bruising, severe pain, blood at the urinary opening or difficulty passing urine.
