Peyronie’s Disease
Peyronie’s Disease: Symptoms, Causes & Diagnosis
What is Peyronie’s disease?
Peyronie’s disease is a condition where scar tissue (a plaque) forms in the tunica albuginea (the firm sleeve around the erectile tissue). This can cause penile curvature, shortening, narrowing (“hourglass”), pain, and sometimes erectile dysfunction (ED).
Common symptoms
Curvature or bend during erection (up, down, left or right)
A firm lump or plaque felt under the skin
Pain with erections, especially early on
Penile shortening or loss of girth
Indentation / hourglass deformity
Difficulty with intercourse (mechanical problems, discomfort, loss of confidence)
Erection problems (ED), sometimes due to reduced rigidity or anxiety
What causes it?
Often, Peyronie’s starts after minor injury or repeated micro-trauma to the penis (sometimes unnoticed), leading to abnormal healing and scar formation. Factors that may increase risk include:
Increasing age
Family history / genetic tendency
Diabetes, smoking, cardiovascular disease
Conditions affecting connective tissue (e.g., Dupuytren’s contracture)
Prior penile surgery or injections (less commonly)
The phases: active vs stable
Active (acute) phase (often first 6–18 months): changing curvature, more pain, plaque forming.
Stable (chronic) phase: curvature and plaque stop changing; pain usually improves.
How is it diagnosed?
Diagnosis is usually based on:
History: onset, pain, progression, effect on sex
Examination: feeling for plaque, checking length/girth changes
Photos at home (optional): a safe way to document curvature (only if you’re comfortable)
Penile ultrasound (sometimes): helps assess plaque, calcification, and blood flow—especially if treatment is being planned
When should you seek help?
Curvature is worsening, painful, or affecting sex
You have significant distress, relationship impact, or ED
You notice hourglass deformity or “hinge” instability
You want to discuss treatment options early (even if mild)
What you can do now
Avoid “aggressive stretching” or unproven devices/online cures
If pain is present: simple anti-inflammatories may help (if safe for you)
Address erection quality (sleep, stress, cardiovascular risk factors)
Early review with a specialist can clarify phase and options
When to Treat Peyronie’s Disease: Indications & Timing
Do all cases need treatment?
No. Many men have mild curvature that doesn’t interfere with sex and can be managed with reassurance, monitoring, and symptom management.
Indications for treatment
Treatment is usually considered when one or more apply:
Intercourse is difficult or impossible due to curvature, narrowing, hinge, or pain
Curvature is significant or progressing
Bothersome deformity (hourglass, indentation, instability)
Persistent pain with erections (especially if function is affected)
Erectile dysfunction that is limiting sexual activity
High distress or relationship impact
Timing: active vs stable phase matters
Active phase (changing curve / pain): the focus is often on pain control, stabilising the condition, and preserving length/function. Some non-surgical strategies may be discussed.
Stable phase (no change for ~3–6 months): this is generally when definitive corrective treatments, particularly surgery, are considered.
Red flags that warrant earlier review
Rapid progression
Hourglass deformity or hinge effect
New significant ED
Severe pain or major psychological distress
What to expect at your assessment
Confirm diagnosis and phase
Discuss goals: straighten enough for sex vs cosmetic “perfectly straight”
Review erection quality (this strongly influences best treatment choice)
Consider ultrasound if helpful for planning
Create a plan tailored to your priorities (function, length, rigidity, recovery time)
Peyronie’s Disease Treatment Options: Non-Surgical vs Surgical
Treatment goals
Make intercourse comfortable and possible
Improve curvature/deformity enough for function
Preserve or improve erectile function
Minimise loss of length and reduce distress
Non-surgical options (often first-line in suitable cases)
Observation / monitoring
Appropriate if curvature is mild and sex is still possible
Pain management (active phase)
Anti-inflammatories if safe for you
Supportive measures and reassurance (pain usually improves over time)
Erection support
If erections are not firm: treatments for ED (e.g., PDE5 inhibitors such as sildenafil/tadalafil) may help sexual function and confidence.
Traction therapy
A medical traction device may help length and curvature in selected cases, especially early or as an adjunct. Requires consistent use and guidance.
Vacuum device
Sometimes used to support penile health and length; may be recommended in specific circumstances.
Intralesional injections (into the plaque)
In certain cases, injections can reduce curvature and improve function. Suitability depends on curvature type, stability, plaque characteristics, and local availability.
Surgical options (typically for stable disease with functional limitation)
Surgery is usually considered when curvature is stable and intercourse is impaired.
1) Plication (straightening stitches)
Best for: good erections, moderate curvature, minimal hourglass/indentation
Pros: shorter operation, quicker recovery
Cons: may cause some perceived shortening
2) Plaque incision/excision with grafting
Best for: more severe curvature, complex deformity, hourglass/hinge with good erections
Pros: can better address complex deformity and preserve length
Cons: higher risk of ED compared with plication; longer recovery
3) Penile implant (prosthesis) ± straightening
Best for: Peyronie’s with significant ED not responding to tablets/injections
Pros: restores rigidity and can correct curvature
Cons: implant surgery is more involved; device-specific considerations
Choosing the right approach
The “best” option depends on:
Curvature severity and complexity
Whether disease is stable
Erectile rigidity (key factor)
Your goals (function vs appearance, preserving length, recovery time)
Does Peyronie’s Disease Go Away? Expected Outcomes & Prognosis
Will it resolve on its own?
Sometimes symptoms improve, but complete spontaneous resolution is uncommon. Typical patterns:
Pain often improves over time (especially after the active phase)
Curvature may stabilise, improve slightly, or worsen—most commonly it becomes stable
What outcomes can you realistically expect?
Most treatments aim to improve functional straightness, not necessarily achieve “perfectly straight.” Success is measured by:
Ability to have sex comfortably
Improved confidence and reduced distress
Acceptable curvature and stability
Preserved or improved erections
Expected outcomes by treatment type (general guide)
Observation: many men remain stable and adapt well if curvature is mild
Traction / selected non-surgical options: may provide modest curvature improvement and help preserve length with consistent use
Injections: in suitable candidates may improve curvature and bother
Plication surgery: high rates of functional straightening; some men notice shortening
Grafting surgery: can improve complex curvature and preserve length; higher ED risk than plication
Penile implant: best option when ED is a major issue; can restore rigidity and straighten effectively
Common concerns: length and sensation
Some men experience penile shortening from the disease itself and/or certain treatments.
Sensation changes can occur but are usually temporary; significant permanent sensory loss is uncommon but possible with surgery.
Recurrence/progression
After stabilisation or surgery, major progression is less common, but minor changes can occur. Ongoing attention to erection health and cardiovascular risk factors helps.
Peyronie’s Disease and Erectile Dysfunction: What’s the Link?
Why can ED happen with Peyronie’s?
ED can occur due to:
Reduced rigidity from changes in penile blood flow or tissue elasticity
Venous leak (difficulty maintaining firmness)
Pain or anxiety leading to reduced arousal/avoidance
Severe curvature causing mechanical difficulty despite adequate rigidity
Assessing ED is essential
Your treatment plan changes significantly depending on erection quality. A specialist assessment may include:
Questions about firmness, duration, and response to tablets
Review of cardiovascular risk factors (blood flow to the penis reflects overall vascular health)
Ultrasound in selected cases (especially if surgery is being considered)
Treatment strategies when ED is present
Optimise general health: weight, exercise, sleep, smoking cessation, diabetes control, blood pressure and cholesterol management
Tablets (PDE5 inhibitors): often first-line (if safe and appropriate)
Vacuum device: may help some men
Penile injections: effective for many men when tablets fail (requires training)
Penile implant: strongest option for men with Peyronie’s + significant ED not responding to other treatments; can correct both rigidity and curvature
A key principle
If erections are poor, “straightening-only” surgery may not give a satisfying result. In these cases, treating rigidity first(often with an implant) can be the best path.
Peyronie’s Disease Treatments: Risks, Side Effects & Complications
General risks across treatments
All treatments vary in risk depending on your anatomy, severity, and erectile function.
Observation / conservative care
Risk: condition may progress before stabilising
Traction / vacuum
Discomfort, skin irritation, bruising
Overuse can cause pain; correct technique matters
Tablets for erections (if used)
Headache, flushing, nasal congestion, reflux
Not suitable with certain heart medications (e.g., nitrates)
Injections into the plaque (where used)
Bruising, swelling, pain
Rarely: skin injury, worsening deformity
Very rarely: penile fracture-type injury (requires urgent assessment)
Surgical risks (vary by procedure)
Plication
Perceived penile shortening
Recurrence of some curvature
Palpable sutures/knots, discomfort
Rare: sensory change, infection, bleeding
Grafting procedures
Higher risk of postoperative ED than plication
Changes in sensation
Residual curvature or contour irregularities
Longer recovery and rehabilitation
Penile implant
Infection (uncommon but important)
Mechanical device failure over years
Erosion or pain (rare)
May still need additional straightening manoeuvres during surgery
Important notes about expectations
“Perfect straightness” is not always achievable or necessary.
A realistic goal is functional straightness with reliable erections and comfort.
When to seek urgent medical help
Sudden severe pain with a “popping” sensation during sex
Significant swelling/bruising or deformity after trauma
Fever, worsening redness, discharge after surgery
Inability to pass urine after an operation (rare)