Peyronie's Disease: Expert Guidance on Penile Curvature and Treatment

It's completely understandable to feel anxious or distressed when you observe structural changes or discomfort in your penis. It’s a deeply personal experience. Some men I see in my clinic seek help straight away, while others, perhaps due to embarrassment or simply not knowing where to turn, wait months or even years. If terms like "lump in penis," "painful erection," "bent willy," or noticing a change in shape resonates with your experience, understanding Peyronie's disease is the crucial first step towards finding solutions and exploring available treatment. Remember, seeking advice sooner rather than later often leads to better outcomes and more treatment options.

As a Consultant Urological Surgeon specialising in men's health and andrology, I want to offer clear, honest guidance. Peyronies disease fundamentally involves the development of fibrous plaque within the tunica albuginea – the specialised fibrous sheath surrounding the erectile chambers (corpora cavernosa) of the penis. This layer is crucial for erections; its relative inelasticity helps contain the increased blood pressure, creating penile rigidity. In Peyronie's disease, the inelastic plaque disrupts this normal physiological process, preventing symmetrical expansion and causing the characteristic bent penis that many find distressing.

It's far more common than most men realise, yet frequently under-diagnosed, often due to embarrassment or a lack of awareness about available Peyronie's disease treatment options. My focus isn't necessarily on a "Peyronie's disease cure" that eliminates every trace of the plaque, but on effectively managing your symptoms – the pain, the curvature, the ED – to significantly improve function and quality of life. Early intervention regarding treatment is key, as it offers the best chance of success and potentially minimising the impact of the condition.

Understanding the Cause: Tunica Albuginea, Plaque, and Mechanisms

The tunica albuginea is the key structure involved. Plaque formation – essentially abnormal collagen deposition resulting in fibrous scar tissue – within this layer disrupts its normal function during erection. Instead of expanding evenly, the scarred area tethers the tissue, causing the bend, penile nodules, narrowing ('hourglass deformity'), or even penile shortening. Recent research confirms Peyronie's affects roughly 5-10% of men globally, increasing significantly after age 50, though I suspect the true figure might be higher given how many men delay seeking help.

What causes Peyronie's disease?

The development involves a complex cascade of pathophysiological events. Key mechanisms identified by scientific research include:

• Trauma-Induced Inflammation: The leading theory suggests microscopic injuries or repetitive micro-trauma during sexual activity trigger an abnormal wound healing response in susceptible individuals, leading to excess scar tissue.
• Myofibroblast Proliferation: Specialised cells multiply excessively, producing excessive scar tissue components.
• Dysregulated Collagen Production: Abnormal deposition of Type I and III collagen creates the dense, inelastic plaque, which can sometimes become calcified (hardened).
• Autoimmune Factors: Some evidence suggests the immune system might mistakenly contribute to the inflammation and plaque formation.

Triggers and Risk Factors

While the exact trigger often remains unclear, several factors contribute:

• Penile Trauma: Both acute injuries and repetitive microtrauma to the penis.
• Genetic Predisposition: A strong link exists with other fibrotic conditions like Dupuytren's contracture (hand) and Ledderhose disease (foot), suggesting a genetic component.
• Cardiovascular Risk Factors: Hypertension, hypercholesterolemia, diabetes, and smoking significantly increase risk, likely by affecting blood vessel health and wound healing. Can diabetes cause Peyronie's disease? While not a direct cause, it's a major risk factor.
• Injection-Related Factors: Repeated use of intracavernosal injections for ED is occasionally implicated.
• Can circumcision cause Peyronie's disease? There is no established link.

Often, it's likely a combination of these factors at play in the development of this disease.

The Two Phases: Acute vs. Stable - Why Timing Matters

Recognising the disease phase is crucial for determining the appropriate Peyronie's disease treatment strategy:

1. Acute (Active) Phase:
   • Initial inflammatory period (lasts ~6-18 months) with active plaque formation. This is often called the acute phase.
   • Penile pain during erections is common (present in 35-45% of patients).
   • Penile curvature may progressively worsen or change during this time. Penile shortening can also occur.
   • This phase is often the optimal timing for considering non-surgical treatment options aimed at minimising progression and managing pain (e.g., penile traction therapy, oral medications, potentially Li-ESWT for pain).
2. Stable (Chronic) Phase:
   • Follows the active phase once inflammation subsides and plaque formation ceases.
   • Plaque typically stabilises without further progression; the fibrous scar tissue matures.
   • Penile pain usually resolves spontaneously by this stage.
   • The established penile curvature becomes fixed.
   • Surgical treatment interventions to correct curvature are generally considered only once this phase is reached.

Is Peyronie's disease permanent? The plaque itself often persists, but the symptoms are manageable, and the curvature can frequently be corrected surgically once stable. Can Peyronie's disease heal itself or go away? While pain often subsides, significant spontaneous improvement in curvature is rare (estimated around 10-15%). Most men find their curvature either stabilises or worsens without specific treatment.

Peyronie's typically manifests with a combination of these symptoms, known as the clinical triad plus associated features:

• Penile Curvature / Deformity: The hallmark symptom. The bend can be upwards, downwards, or sideways (why does it curve to the left? just depends on where the plaque forms). Some men develop indentations, narrowing ('hourglass' shape), or a generally odd shaped penis. Viewing bent penis pictures or curved penis pictures online may prompt men to recognise their own condition.
• Penile Pain: Particularly pain during erection or intercourse, common in the early (acute) phase. Often described as an ache or soreness within the penile shaft. Thankfully, this penile pain usually resolves spontaneously as the condition stabilises.
• Erectile Dysfunction (ED): Difficulty achieving or maintaining an erection sufficient for sexual activity affects a large proportion of men with Peyronie's disease (up to 80% in some studies). This dysfunction penile can stem from the pain, the mechanical difficulty caused by the curve, impaired blood flow (venous leak), associated erectile dysfunction nerve damage symptoms in some, or the psychological impact. ED significantly impacts sexual function.
• Palpable Plaque: Many men (or their partners) can feel a distinct hard lump, nodule, or thickened area under the skin – this is the Peyronie's plaque itself, composed of fibrous scar tissue. While finding a lump can be worrying, in this context, it's characteristic of the condition.
• Penile Shortening: Unfortunately, contraction of the plaque can pull on surrounding tissues, leading to a gradual loss of penile length, which can be very distressing. Some men also notice a loss of girth.

The severity and combination of symptoms vary greatly. For some, the visual appearance of the bent penis is the primary concern; for others, it's the functional limitation or pain associated with this disease.

An accurate diagnosis is the foundation for effective treatment planning for this disease.

• Your Consultation: We'll have a detailed discussion about when symptoms started, what bothers you most (curve, pain, ED, shortening, lump), whether things are changing, the impact on your sex life and confidence, and any relevant medical history or risk factors (like diabetes, previous trauma, Dupuytren's). Understanding each symptom is crucial.
• Physical Examination: I will perform a careful examination of your penis in its flaccid state. Feeling for the characteristic palpable plaque – its location, size, texture – is key. While finding a lump can cause anxiety, in the context of Peyronie's symptoms, it's rarely sinister.
• Objective Curvature Assessment: Your description is helpful, but objective measurement is essential, especially for planning potential surgical treatment and assessing stability.
  • Self-Photography (Preferred Method): Taking clear photographs of your fully erect penis from specific angles (top-down, side-on, front-on) at home is usually the best approach. Comparing photos taken at least three months apart is the gold standard for determining if the disease has reached the stable phase – a critical factor before considering surgery. (See detailed instructions in the How to Take Photos Section).
  • In-Clinic Intracavernosal Injection (ICI) Test: If self-photography isn't possible or clear, we can induce an erection medically in the clinic using a small injection (e.g., prostaglandin E1). This allows me to directly measure the curvature degree with a goniometer and assess rigidity.
  • Penile Doppler Ultrasound: This advanced imaging is particularly valuable, especially if erectile dysfunction is a concern. Using sound waves during an induced erection, it can: clearly visualise the plaque(s) (size, location, calcification), provide precise curvature measurements, and critically, assess penile blood flow dynamics (arterial inflow and venous outflow/leak) to help diagnose the cause of ED. This helps evaluate the overall health of the penile tissue.

Many men hope Peyronie's disease will "go away on its own"—while pain often does, significant curvature improvement is rare. Starting the diagnostic process early allows for timely intervention, potentially preventing worsening and reducing the need for later, more complex treatment.

Erection photography might feel awkward, but it's an invaluable and standard diagnostic tool for Peyronie's disease. Comparing two sets taken ≥3 months apart is the most reliable way to see if the curvature is stable, guiding treatment decisions, particularly regarding surgery.

• Why Take Photos? To objectively measure the degree and direction of curvature, identify other deformities (narrowing), and assess stability over time.
• When? Take the first set as soon as possible after noticing changes. Take the second set ≥3 months later, replicating conditions (rigidity, angle, lighting) as closely as possible.
• How to Take Medically Useful Photos:
  1. Achieve a Full Erection: Must be maximum rigidity, similar to intercourse. Partial erection masks the true curve.
  2. Capture Three Clear Angles: Use timer or trusted partner. Get shots from: Top-down (bird’s eye), Side-on (lateral - showing curve best), and Front-on (anterior). Ensure the entire penile shaft is clearly visible in each.
  3. Use Good, Consistent Lighting: Natural light preferable. Avoid flash/shadows. Use a plain, neutral background.
  4. Frame Clearly: Show only the erect penis against the background. No hands, clothing, or distracting objects.
  5. Label or Date Images: Helps track timing (e.g., filename "PD_Photos_March_2025.jpg" or note in upload message).
• Uploading Securely - The ONLY Way: DO NOT use personal email - it's insecure. Use the encrypted, GDPR-compliant [Your Patient Portal Name, e.g., Carebit] patient portal provided to my patients. This ensures your images are stored securely within your confidential medical record, accessible only by me and authorised clinical staff. Contact my secretary if you need portal assistance. Contact Details.
• What Happens After Review? Assessing the photos allows us to determine stability, choose appropriate non-surgical or surgical options confidently, and monitor progress or treatment results.
• Respect & Clinical Purpose: I understand the sensitivity. Your images are treated with utmost respect and confidentiality, used solely for clinical assessment and planning your best care pathway. You're playing a key role in your diagnosis for this disease.

A fundamental principle is that while we might not eliminate the plaque itself non-surgically, we can significantly improve its functional consequences. The goal is realistic: better function, less distress, improved quality of life. Not everyone needs active treatment if symptoms are mild and non-bothersome. For those significantly affected by this disease, targeted therapies and treatment options offer real hope.

Managing Peyronie's-Related Pain (Primarily Acute Phase)

Pain during erection is common initially (in the acute phase) but usually resolves within 6-18 months as the condition stabilises. While waiting, relief strategies include:

• Simple analgesics (paracetamol) and anti-inflammatories (NSAIDs like ibuprofen).
• Oral medications like Potassium para-aminobenzoate (Potaba), Vitamin E, CoQ10 have limited/mixed evidence but are sometimes discussed.
• Low-Intensity Extracorporeal Shockwave Therapy (Li-ESWT): Good evidence supports its use primarily for reducing Peyronie's-related pain during the active phase. I offer this non-invasive treatment for appropriate patients focused on pain relief.

Treating Erectile Dysfunction (ED) in Peyronie's

Erectile dysfunction is common and requires a systematic approach, tailored to you:

1. Lifestyle & Risk Factor Management: Addressing underlying issues like diabetes, high blood pressure, cholesterol, and stopping smoking is crucial for vascular health.
2. Oral Medications (PDE5 Inhibitors): First-line therapy often includes sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), or avanafil (Spedra). Effective if underlying blood flow isn't severely compromised. Daily low-dose tadalafil might also have anti-fibrotic benefits in the active phase.
3. Intracavernosal Injections (ICI): If pills fail, injecting medication (e.g., alprostadil - Caverject, Viridal; or combination - Invicorp) directly into the penis reliably produces erections.
4. Vacuum Erection Devices (VEDs): Creates an erection mechanically using suction and a constriction ring. Also beneficial for penile rehabilitation, tissue oxygenation, and potentially preserving length alongside other therapies. How to use vacuum pump for Peyronie's disease? Requires specific instruction for optimal benefit.
5. Li-ESWT: Some studies suggest it might also improve blood flow and aid erectile function, potentially used adjunctively.
6. Penile Prosthesis (Implant) Surgery: A type of surgical treatment offering a definitive solution when Peyronie's coexists with severe, treatment-resistant ED. A penile implant addresses both issues simultaneously.

Correcting Penile Curvature: Non-Surgical Options

These aim to reduce curvature and minimise length loss, primarily used in the acute phase or for milder stable curves, or for those wishing to avoid surgery. Commitment is key:

• Penile Traction Therapy (PTT): Mechanical devices (e.g., RestoreX®, Andropenis®, PeniMaster® Pro) apply controlled, sustained stretching. Clinical studies show consistent daily use (often 3-8 hours/day for 3-6+ months) can achieve 10-30%+ curvature reduction and help preserve/regain length. Compliance is essential. Many of my patients have avoided surgery through dedicated use of penile traction therapy.
• Intraplaque Injections (Collagenase Clostridium Histolyticum - Xiapex®): The only approved drug treatment (US FDA approval as Xiaflex®). An enzyme injected into the plaque (fibrous scar tissue) breaks down collagen. Trials show ~34% average curve reduction vs placebo. Best for moderate dorsal curves (30-90°) with good ED. Involves multiple injection cycles plus specific penile modelling/stretching. Often combined with PTT. UK availability (as Xiapex®) has been limited due to cost/licensing. Requires administration by a trained specialist due to potential side effects (bruising, rare rupture).
• VEDs: Complementary role, potentially aiding tissue remodelling alongside traction.

Discuss PTT Devices Enquire About Xiapex® Suitability

Assessing Stability Before Surgery Remains Paramount

Surgery is generally reserved for the stable phase (no pain, curvature stable for ≥3-6 months, confirmed by photos). Operating earlier risks unpredictable results and recurrence.

Surgical Treatments for Peyronie's Disease (Stable Phase Only)

Considered when stable curvature significantly hinders intercourse or causes major distress, and non-surgical methods are insufficient/unwanted. Thorough pre-operative assessment of erectile function is critical. These surgical treatment options include:

1. Penile Straightening Procedures (Corporoplasty - Requires GOOD Pre-op Erections):
   • Tunical Shortening (e.g., Nesbit Procedure, Plication): Shortens the convex side opposite the plaque. High straightening success rate (~85-95%), very low risk of worsening ED. Main drawback: inevitable penile shortening (approx. 1cm per 15° corrected). Best for moderate curves (<60-70°) in men with good initial length accepting this trade-off. The Nesbit's procedure is a well-established example of this treatment.
   • Tunical Lengthening (Plaque Incision/Excision & Grafting): Aims to preserve length by cutting the plaque and filling the gap with graft material. Better for severe (>60-70°) or complex curves where length is a major concern. Main drawback: significantly higher risk of new or worsened post-op ED (15-25%+).
2. Penile Prosthesis (Implant) Implantation with Straightening Manoeuvres (for Concomitant ED):
   • The gold standard when significant Peyronie's *and* treatment-resistant ED coexist.
   • Surgically replaces damaged erectile tissue with cylinders (a penile implant), restoring reliable rigidity.
   • Allows simultaneous straightening via manual modelling or other techniques. High patient satisfaction. Penile implant surgery offers a combined solution.

My Patient-Centred Approach to Treatment

My philosophy is individualised, evidence-based, and built on shared decision-making. We focus on managing the functional impact – pain, ED, curvature. For curvature, we start conservatively where appropriate (traction, VEDs). If surgical treatment is needed (only when stable), meticulous evaluation of erections, curve severity, length, and *your* goals dictates the best approach (shortening vs lengthening vs implant). I ensure you fully understand the risks, benefits, and realistic outcomes of each treatment option. Success requires patience, realistic expectations, and collaboration.

It's vital to recognise that Peyronie's disease impacts more than just physical function. The psychological and emotional consequences can be profound for both the man and his partner:

• Emotional Toll: Anxiety about sexual performance, body image concerns, fear of pain, and worries about relationship impact are common. Studies report significant rates of anxiety and/or depression (up to 48%) among men with Peyronie's.
• Reduced Self-Esteem & Confidence: Changes in penile appearance or function can deeply affect self-worth.
• Relationship Strain: Difficulty with intercourse, avoidance of intimacy, communication breakdowns, and partner concerns can create significant tension.
• Sexual Avoidance: Fear of pain or embarrassment can lead to withdrawal from sexual activity, impacting overall sexual function.

Addressing these dimensions is integral to comprehensive care:

• Open Communication: I encourage open discussion about these sensitive issues during consultations. Talking openly with your partner is also key.
• Partner Involvement: Including partners in the process (with your consent) can be very beneficial.
• Psychosexual Counselling: Specialist therapy offers invaluable tools. I routinely provide referrals to trusted therapists.
• Support Resources: Connecting with others through patient support groups (like online forums associated with the British Dupuytren's Society or international Peyronie's organisations) provides emotional validation and reduces isolation.

These psychological effects can persist even after physical symptoms improve, highlighting the need for ongoing support.

Living with Peyronie's: Long-Term Outlook and Hope

The crucial message is one of hope. While challenging, Peyronie's disease is manageable with appropriate, specialist care. With the right approach – addressing both physical and psychological aspects – most men find significant improvement in function, confidence, and overall quality of life, allowing a return to satisfying intimacy. Effective treatment exists to manage the functional impacts, even if the underlying plaque persists. I've guided many patients through this journey successfully. Remember: it's not life-threatening, not an STI, and not your fault. Expert help is available.

Navigating Peyronie's disease benefits significantly from specialist input. Choosing a Consultant Urological Surgeon with a focus on Andrology ensures:

• Specialist Expertise: Deep understanding of the condition's nuances and the underlying disease process.
• Advanced Diagnostics: Proficiency with tools like Penile Doppler Ultrasound.
• Full Range of Treatment Options: Experience across non-surgical and all surgical treatment procedures, including intricate corporoplasty (plication, Nesbit's procedure, plaque incision/grafting) and penile prosthesis implantation (penile implant).
• Personalised Care: Plans tailored to your anatomy, disease phase, goals, and preferences.
• Holistic Approach: Integrating management of psychological and relationship impacts on sexual function.
• Compassionate & Confidential Setting: A supportive and discreet environment for discussing the penis and related concerns.
• Long-Term Management & Follow-up: Commitment to ongoing care.

Don't delay seeking help if you suspect you have Peyronie's disease. Early assessment, particularly during the acute phase, can make a difference. When you consult with me, you can expect:

• Careful Listening: I take the time to fully understand your history, symptoms, concerns, and goals. Each symptom matters.
• Thorough Examination: A detailed physical assessment is performed.
• Clear Explanations: I explain Peyronie's disease, your specific situation, and all relevant treatment options in understandable terms.
• Open Discussion: All your questions are welcomed and answered comprehensively.
• Collaborative Planning: We work together to create an evidence-based treatment plan tailored to you.

Peyronie's disease can be effectively managed, leading to significant improvements in physical function, sexual confidence, relationship satisfaction, and overall emotional well-being. Taking that first step to seek help is key.

References for Peyronie's Disease Guide

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Chung E. Peyronie's disease: a literature review on epidemiology, genetics, pathophysiology, diagnosis and work-up. Transl Androl Urol. 2016;5(3):280-289. doi:10.21037/tau.2016.04.05

Carson CC, Hakim LS. Peyronie's Disease: A Review. PMC Journal. 2003;1(2):62-67. doi:10.1111/j.1743-6109.2003.00033.x

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British Association of Urological Surgeons. Information about your penile condition: Peyronie's disease. BAUS Leaflet No: A24/088. Review due: Sep 2026.

Sullivan J, Moskovic D, Nelson C, Levine L, Mulhall J. Prevalence of Peyronie's disease among urologists. J Sex Med. 2015;12(7):1581-1587. doi:10.1111/jsm.12932

Levine LA, Burnett AL. Standard operating procedures for Peyronie's disease. J Sex Med. 2013;10(1):230-244. doi:10.1111/j.1743-6109.2012.03003.x

Ralph D, Gonzalez-Cadavid N, Mirone V, et al. The management of Peyronie's disease: evidence-based 2010 guidelines. J Sex Med. 2010;7(7):2359-2374. doi:10.1111/j.1743-6109.2010.01850.x

Gelbard MK, Dorey F, James K. The natural history of Peyronie's disease. J Urol. 1990;144(6):1376-1379. doi:10.1016/s0022-5347(17)39746-x