Peyronie's Disease: What a New Curve Means and Treatment Options

Some curvature of the erect penis is normal, and many men have had a slight bend all their lives. Peyronie's disease is different: it's an acquired change, something new. If you've noticed a curve that wasn't there before, a firm spot along the shaft, or pain with erections, this guide explains what may be happening and what a urologist can offer. It's written plainly, because this is a medical condition, not something to be embarrassed about.

What Peyronie's disease is

The penis has a tough, elastic sheath around its erectile chambers called the tunica albuginea. In Peyronie's disease, scar tissue (a plaque) forms in that sheath. During an erection, the scarred area doesn't stretch like the surrounding tissue, so the penis bends toward the plaque or develops a narrowing, dent or "hourglass" shape. NIDDK, part of the National Institutes of Health, emphasizes that the plaque is benign: it's not cancer and not a tumor.

The exact cause isn't fully understood. Experts think it may follow injury to the penis, including small injuries during sex, sports or accidents that most men can't recall, or be related to autoimmune or connective-tissue conditions. It is not contagious and not caused by any known sexually transmitted infection.

Signs and symptoms

• A new curve, with or without an erection.
• A hard lump or band you can feel along the shaft.
• Pain during erections or intercourse, and sometimes at other times.
• Narrowing, indentation or shortening.
• Erectile dysfunction, which may come before or after the curve.

Symptoms can develop slowly or appear quickly, and range from mild to severe.

Who's at higher risk

NIDDK lists several risk factors: vigorous sexual or non-sexual activity that causes micro-injuries, connective-tissue or autoimmune disorders such as Dupuytren's contracture (thickening in the palm that bends the fingers), family history, older age, prostate cancer surgery, and diabetes with ED. Risk rises with age and is lower in men in their 20s and 30s.

The two phases

When to see a urologist

See a clinician if you notice a new curve, lump, indentation, shortening, or pain with erections, or if a curve makes intercourse difficult. Early evaluation helps document the starting point and rules out other causes. Your primary care clinician can refer you; men with Peyronie's disease are usually managed by a urologist.

The AUA guideline says diagnosis starts with a history and a genital exam, covering deformity, effects on intercourse, pain and distress. Before any invasive treatment, the guideline recommends an in-office test in which an erection is induced with an injection, sometimes with a Doppler ultrasound, so the urologist can measure the curve and check blood flow. Taking photos of your erect penis from a few angles at home can also help the conversation.

Treatment options

Not every man needs treatment. If the curve is small, painless, and doesn't interfere with sex, watchful waiting is reasonable. When treatment is needed, the goals are less pain, a straighter penis, and the ability to have intercourse.

Pain relief

During the active phase, the AUA guideline says clinicians may offer NSAIDs for pain.

Injections into the plaque

• Collagenase clostridium histolyticum (Xiaflex) — NIDDK describes it as currently the only FDA-approved treatment for Peyronie's disease, for curvature over 30 degrees. The AUA guideline supports it, combined with modeling, for stable disease with curvature between 30 and 90 degrees and intact erections, and requires counseling about bruising, swelling, pain and the risk of corporal rupture (a penile fracture).
• Interferon alpha-2b — the AUA says it may be offered, with counseling about flu-like symptoms, sinusitis and minor swelling.
• Verapamil — a blood pressure drug that may be injected into the plaque; the AUA gives it a conditional recommendation.

Traction and vacuum devices

Penile traction or vacuum devices aim to stretch the penis and reduce curvature. NIDDK lists them among options still being studied; ask your urologist whether one fits your situation.

What the AUA recommends against

The AUA guideline says clinicians should not offer oral vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or vitamin E with L-carnitine, and should not use radiotherapy. Shock wave therapy should not be used to reduce curvature or plaque size, though the guideline allows it as an option for penile pain. Be wary of clinics that sell supplements or shockwave packages as a cure for the curve.

Surgery

Surgery is generally reserved for men whose disease has stabilized and whose curve or deformity still prevents satisfying intercourse. Options include:

• Plication — tightening the side opposite the plaque. Less likely to cause numbness or ED, but it doesn't restore length.
• Plaque incision or excision with grafting — may restore some length, with more risk of numbness or ED.
• Penile prosthesis — for men with both Peyronie's disease and ED that doesn't respond to medication, sometimes combined with straightening procedures.

See our ED treatment escalation ladder for more on implants and other options when pills aren't enough.

The emotional side

Peyronie's disease commonly causes distress, relationship strain and anxiety about sex. That's a recognized part of the condition, and the AUA guideline includes distress in the initial assessment. Talking with a partner, and with a counselor if needed, is part of good care. If anxiety about performance has started to feed into erection problems, Performance Anxiety vs ED may help you sort out what's going on. Our guide to partner conversations may help.

Getting started

If you can't easily see a urologist, a general telehealth visit can help you document symptoms, discuss next steps, and get a referral where needed. Peyronie's evaluation and procedures themselves need in-person specialist care.