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Peyronie’s Disease: Causes, Symptoms & Treatments

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Geoffrey C. Whittaker

Published 08/12/2018

Updated 02/01/2024

When it comes to men’s health, most of our family’s concerns tend to focus on heart health, how much we drink, our smoking habits, stress and sleep. Our own concerns? Penis function.

If you’ve recently been diagnosed with Peyronie’s disease (or self-diagnosed it after a few anxious hours of Googling), you likely have lots of questions about what it is, what it could do to your sex life and the available treatment options.

We’ll answer these questions with the current medical wisdom. So let’s get this topic straight — no curveballs, no confusion.

In the simplest terms, Peyronie’s disease is a penile curvature. But while every guy’s penis may have a slight curve of some kind, a Peyronie’s disease diagnosis requires something a little more specific: fibrous plaques or flat scar tissue growing under the skin of the penis. 

These plaques form in the tunica albuginea — the layer of tough connective tissue surrounding the corpora cavernosa (the spongy tissues within the shaft). They can cause numerous problems, from changing the shape of the penis to shortening it.

Research shows that more than 10 percent of men may have the curves, bends and other deviations representative of Peyronie’s disease. However, severity varies from one penis to another.

The precise cause of Peyronie’s disease is still undetermined, but physical injuries affecting the erectile tissues are considered the most common.

Some experts also believe that Peyronie’s disease could potentially be caused by autoimmune diseases, connective tissue disorders and other health conditions.

Risk factors for Peyronie’s disease include:

  • Vigorous or intense sexual encounters that cause minor or serious injuries and the development of scar tissue

  • Sports injuries

  • Diabetes

  • Age

  • Family history of the condition

  • Prostate cancer surgeries like radical prostatectomy

Keep reading to learn about the signs and symptoms of Peyronie’s disease.

The most obvious symptom of Peyronie’s disease is plaques causing the penis to bend. But a curved penis can result in other symptoms, including:

  • “Bottle-necking” indentations that create an hourglass-like shape

  • Lumps that become hard and bone-like due to calcium buildup

Peyronie’s disease may also cause sexual performance and erectile function issues, like painful erections. If left untreated, these changes (and the problems they bring to the bedroom) can eventually result in more physical discomfort, stress, depression and a reduced quality of life.

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Erectile Dysfunction From Peyronie’s Disease

Peyronie’s disease may sometimes make it difficult to get hard, either physically or psychologically. For this reason, ED is common among guys with Peyronie’s disease — research notes that up to 54 percent of men with Peyronie’s disease also report ED.

What’s worse is that it’s hard to treat ED when Peyronie’s disease is the cause. Erectile dysfunction medications like sildenafil (generic Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) and avanafil (Stendra®) aren’t necessarily effective. 

These PDE5 inhibitors increase blood flow to the corpora cavernosa. So if Peyronie’s disease limits how much your penis can expand or still makes it too uncomfortable to get a hard erection, these medications may not be the best choice.

Peyronie’s disease occurs in two stages: the acute phase and the chronic phase.

  • Acute phase. Plaques develop on the fibrous membrane during this up-to-18-month phase. You may develop uncomfortable or painful erections and notice a bend or curve in your penis.

  • Chronic phase. At this point, plaques have developed, and your penis will have a clearly identifiable bend or curve — though discomfort may have waned, as the plaque is no longer developing.

Diagnosing Peyronie’s disease is a healthcare professional’s job, mostly because you won’t necessarily be able to tell the difference between normal and problematic curves yourself.

Men often have some degree of curvature, so no erect penis is 100 percent straight. That’s why it’s easy to mistake normal curvature for Peyronie’s disease.

It’s worth speaking to a healthcare provider or urologist, who can diagnose the condition following a physical exam. Your healthcare provider will look at your penis for hard plaques and other common signs of Peyronie’s disease. 

You might need to use medication to make your penis erect to help your healthcare provider check for penile curvature. Dynamic ultrasound imaging can also help a medical professional view plaques, blood flow and calcium buildup problems in your penis.

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Peyronie’s disease is treatable, though the treatment depends on your individual issues. Treatments may include injections, oral medications, supplements, surgery or lifestyle changes.

Injections for Peyronie’s Disease

Xiaflex® injections could address plaque buildup. The active ingredient in this medication is collagenase clostridium histolyticum, an enzyme that breaks down collagen forming within connective tissue.

When injected into scar tissue, it can weaken the toughened collection of proteins and reduce penile curvature. Right now, Xiaflex is the only medication FDA-approved specifically for the treatment of Peyronie’s disease.

Other medications currently being explored include:

  • Interferon. This protein-based medication may help to break down scar tissue that can develop in the penis.

  • Verapamil. This medication, which is typically used to treat angina and hypertension (high blood pressure), may help reduce penile curvature and discomfort. More controlled studies are needed. 

Oral Medications and Supplements for Peyronie’s Disease

More research is needed on oral medications for Peyronie’s disease treatment, but several have been studied. Most high-quality trials haven’t shown a significant difference in effects compared to placebo treatments.

That said, if you don’t respond to other treatment options, your provider might suggest:

  • Potassium para-aminobenzoate. This supplement may reduce the size of plaques.

  • Oral vitamin E. Some research suggests vitamin E pills could help prevent the progression of Peyronie’s disease.

Peyronie’s Disease Surgery

In severe cases, surgery can be performed to remove plaque and potentially reduce penile curvature. There are several possible types of surgery, including grafting and plication, and a healthcare provider will help determine which is best for your specific case. 

Surgery could also involve inserting a penile implant that can help cause an erection.

Other Treatment Options for Peyronie’s Disease

While the options above represent the best science has to offer right now, other treatments are currently undergoing trials for FDA approval.

Lifestyle changes — quitting smoking, reducing your alcohol intake and increasing the amount of exercise you do — can reduce your risk of ED.

Your healthcare provider may recommend at-home Peyronie’s disease exercises, traction device therapy or penile traction therapy (PTT) while using medications — but results can vary and these interventions rely on compliance.

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If you think you have Peyronie’s disease, you might be scared or anxious about it — that’s normal. Regardless of whether you have a history of prostate cancer, prostate surgery, ED or other erectile issues, a curved penis is a reasonable thing to be concerned about

That said, Peyronie’s disease is both treatable and possible to overcome. Overwhelmed? We’ve boiled down the essentials to help you feel informed:

  • Peyronie’s disease is a curvature of the penis that can form on the top, bottom or side of the shaft and cause problems for erections and sexual intercourse.

  • Experts aren’t sure why it forms, but injuries and a family history of the conduction are common explanations.

  • The curvature usually becomes more prevalent with age, with older men more likely to be affected than younger men. According to one study, Peyronie’s disease is most commonly seen in men in their 40s. In comparison, only about 8 percent of guys presenting with Peyronie’s disease are under 40.

  • Psychological effects of Peyronie’s disease can affect your comfort with sexual activity, confidence and physical appearance.

  • Currently, the only FDA-approved medication for Peyronie’s disease is collagenase clostridium histolyticum, which is available as Xiaflex.

  • Other treatments, such as oral medications or surgery, may help reduce penile curvature and treat issues like pain and discomfort. But they’re not typically used as first-line therapies.

Don’t let this problem stop you from enjoying intimacy. If you’re worried you may have Peyronie’s disease, talk to a healthcare provider today, get an assessment and get treatment moving. 

The sooner you take the first step, the sooner your penis will be back on the straight and narrow.

9 Sources

  1. Tefekli, A., Kandirali, E., Erol, H., Alp, T., Köksal, T., & Kadıoğlu, A. (2001). Peyronie’s disease in men under age 40: Characteristics and outcome. International Journal of Impotence Research, 13(1), 18-23. https://www.nature.com/articles/3900635.
  2. Hartzell R. (2014). Psychosexual Symptoms and Treatment of Peyronie’s Disease Within a Collaborative Care Model. Sexual medicine, 2(4), 168–177. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272248/.
  3. U.S. Department of Health and Human Services. (n.d.). Penile curvature (Peyronie’s disease) - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/penile-curvature-peyronies-disease.
  4. Savoca, G., Trombetta, C., Ciampalini, S., De Stefani, S., Buttazzi, L., & Belgrano, E. (2000). Long-term results with Nesbit’s procedure as treatment of Peyronie’s disease. International Journal of Impotence Research, 12(5), 289-293. https://www.nature.com/articles/3900612.
  5. Serefoglu, E. C., Smith, T. M., Kaufman, G. J., Liu, G., Yafi, F. A., & Hellstrom, W. J. (2017). Factors Associated With Erectile Dysfunction and the Peyronie’s Disease Questionnaire in Patients With Peyronie Disease. Urology, 107, 155-160. https://www.sciencedirect.com/science/article/pii/S0090429517305666.
  6. Cwikla, D. J., & Yafi, F. A. (2018). Intralesional collagenase Clostridium histolyticum in the management of Peyronie’s disease: current best practice. Therapeutic advances in urology, 10(4), 139–153. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851106/.
  7. HIGHLIGHTS OF PRESCRIBING INFORMATION: XIAFLEX® (collagenase clostridium histolyticum) for injection, for intralesional use . (n.d.-b). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/125338s109lbl.pdf.
  8. Dhaliwal A, Gupta M. PDE5 Inhibitors. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549843/.
  9. Levine, L. A., & Latchamsetty, K. C. (2002). Treatment of erectile dysfunction in patients with Peyronie’s disease using sildenafil citrate. International Journal of Impotence Research, 14(6), 478-482. https://www.nature.com/articles/3900912.
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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