What is Peyronie’s disease? It is a build-up of flat scar tissue, called plaque, inside the penis that makes it curve, dent or shorten, usually during an erection. The plaque is benign, not cancer. The Urology Care Foundation estimates it affects about 4 in 100 men aged 40 to 70, and it rarely clears up without treatment.
Quick answer: Peyronie’s disease is scar tissue in the lining of the penis that pulls it into a bend. It is thought to start with small injuries that heal badly. An early active phase brings pain and a changing curve, then it settles. About 13 percent of cases resolve on their own. A urologist diagnoses it, and treatment depends on the curve, pain and erections.
What Peyronie’s disease actually is
The penis has a tough, elastic sleeve around its two erection chambers, called the tunica albuginea. When an erection fills the chambers, that sleeve stretches evenly. In Peyronie’s disease, a patch of the sleeve turns into scar tissue that does not stretch. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes it plainly: the plaque pulls on the tissue around it, and the penis curves toward the plaque. The plaque has nothing to do with the fatty plaque that clogs arteries.
Most men notice one of these first:
- A firm lump or band under the skin, usually on the top of the shaft
- A new bend, often upward or to one side, during erections
- Pain with erections or during sex
- An hourglass narrowing, a dent, or loss of length
- Erections that are softer than they used to be
Some curvature is normal. Plenty of men have had a slight bend since puberty, and that is not Peyronie’s. The tell is change: a curve that was not there before, or one that is getting worse, especially with a lump you can feel.
How common it is depends on who is counting. NIDDK says roughly 1 in 100 US men over 18 have been diagnosed, while studies based on symptoms suggest the real figure is more than 1 in 10. A 2016 literature review in Translational Andrology and Urology by Al-Thakafi and Al-Hathal put the worldwide range at 0.3 to 13.1 percent. The largest general-population study in that review, by Schwarzer and colleagues in 2001, surveyed 4,432 men and found a palpable plaque in 3.2 percent, rising from 1.5 percent in men in their 30s to 6.5 percent in men over 70.
Our read is that it is badly underreported. Men do not bring it up.
What causes Peyronie’s disease?
Nobody has pinned down a single cause. The leading explanation is a wound-healing problem: the penis takes a small injury, often a bend during sex that nobody noticed at the time, and in some men the repair goes wrong and lays down stiff scar instead of normal elastic tissue. The Urology Care Foundation names vigorous sex as the most common source of that injury, with sports and accidents behind it.
The injury theory has a hole in it, though. Cleveland Clinic notes that up to 80 percent of people with Peyronie’s do not remember any specific injury. That is why researchers think susceptibility matters as much as trauma. The Translational Andrology and Urology review describes a signaling protein, TGF-beta 1, that drives scar formation, blocks the enzyme that would break collagen down, and then triggers more of itself. Once that loop gets going in a susceptible man, the scar keeps building.
The risk factors that NIDDK and the Urology Care Foundation list fall into a few groups:
- Connective tissue conditions, above all Dupuytren’s contracture (the hand condition that curls fingers toward the palm), plus plantar fasciitis and some autoimmune diseases such as lupus and scleroderma
- A father or brother with Peyronie’s
- Older age
- Diabetes with erectile dysfunction, which NIDDK says carries a 4 to 5 times higher chance
- Tobacco use and past pelvic trauma
- Prostate cancer surgery; the review cites rates up to 16 percent after radical prostatectomy
The Dupuytren’s link is strong enough to be useful. The Urology Care Foundation says about 13 in 100 men with Peyronie’s develop similar scarring elsewhere, most often in the hands or feet. If you already have tight cords in your palm and you notice a new curve, mention both to the doctor in the same visit.
The review also flags low testosterone. In one study of 121 men with Peyronie’s, about 74 percent had testosterone below 300 ng/dL, but a later study found low levels did not track with how bad the curve was. It may be a marker of something rather than a cause. Nobody has settled it.
It is not contagious, and it is not cancer. The Urology Care Foundation says no case has ever been reported to turn into cancer.
The acute and stable phases
Peyronie’s moves through two stages, and almost every decision about it depends on which one you are in.
| Acute (active) phase | Chronic (stable) phase | |
|---|---|---|
| How long | Usually 5 to 7 months, sometimes up to 18 months | Usually begins 12 to 18 months after symptoms start |
| The plaque | Forming and growing | Stops growing; may calcify |
| The curve | Changing, often getting worse | Holds steady |
| Pain | Common, sometimes even without an erection | Often gone or much less |
| Erections | Painful, may be bent | ED may appear or worsen |
| What usually happens | Monitoring, pain control, some non-surgical options | Injections or surgery become options if the curve gets in the way of sex |
Sources disagree a little on the timing. The Urology Care Foundation says the acute phase usually lasts 5 to 7 months; NIDDK says it can run up to 18 months; the Translational Andrology and Urology review puts it at 18 to 24 months. Cleveland Clinic splits the difference at 6 to 12 months. What they agree on is the shape: pain and change first, then a plateau.
Pain fading is not the same as the disease healing. The review explains that pain usually eases because inflamed nerve endings in the plaque die off. The scar is still there.
Does Peyronie’s disease go away?
Sometimes, but do not count on it. The Translational Andrology and Urology review pooled what is known about the natural course and found that without treatment, the plaque fully resolved in about 13 percent of men, stayed the same in about 47 percent and got worse in about 40 percent. The Urology Care Foundation gives the same 13 in 100. NIDDK’s wording is blunter: it goes away on its own “in a very few cases.”
So waiting has a real chance of a stable result and a decent chance of a worse one. That is why the early months are worth watching closely rather than ignoring. Measure it, in other words. A photo of an erection from the side and from above, taken at home, gives a doctor a baseline to compare against later.
Men with a small plaque, a mild bend, no pain and normal sex may not need treatment at all. NIDDK and the Urology Care Foundation both say so. A curve that does not bother you or your partner is not a medical emergency.
Can Peyronie’s disease be cured?
Not in the sense of making the scar disappear and never come back. What treatment can do is straighten the penis enough for comfortable sex, ease pain and protect erections. For most men, that is the goal that matters.
The American Urological Association’s 2015 Peyronie’s guideline is useful here mostly for what it rules out. It tells clinicians not to offer oral vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or vitamin E with L-carnitine, because none has convincing benefit. It also says shockwave therapy should not be used to reduce curvature or plaque size, though it may be offered to ease pain. We offer shockwave at Proactive Choice, and we still think men deserve to hear that line before they pay for it. Our post on shockwave therapy for erectile dysfunction covers what it is studied for, and Peyronie’s curvature is not on that list.
The options the guideline does support are injections into the plaque for stable disease and, for severe cases, surgery. The one FDA-approved drug is collagenase (Xiaflex), approved for curves between 30 and 90 degrees in men whose erections still work. In the two IMPRESS trials, published by Gelbard and colleagues in the Journal of Urology in 2013, 832 men took part, and curvature improved by an average of 34 percent with collagenase against 18.2 percent with placebo, about 17 degrees against 9. Three men had a corporal rupture, a tear in the erection chamber, and needed surgery. Surgery itself is usually held until the curve has been stable for 9 to 12 months. A urologist who treats Peyronie’s regularly is the person to weigh those choices with you.
A 34 percent improvement is meaningful, but it is not a straight penis. Men going in should know that.
Can Peyronie’s disease cause ED?
Yes, and the two often travel together in both directions. The AUA guideline says erectile dysfunction is present in up to 33 percent of men with Peyronie’s, and more than half of those men say the ED came first. NIDDK lists ED as both a symptom and a complication, noting it may develop or worsen once the disease reaches the stable phase.
There are a few ways the link works. Scar tissue in the erection chambers can stop them from filling and holding blood well. Pain makes erections harder to keep. A curve can make penetration difficult, and the anxiety that follows makes everything worse. Going the other way, men with diabetes-related ED have a 4 to 5 times higher chance of developing Peyronie’s in the first place, according to NIDDK.
The emotional side gets too little attention. In a 2008 study in the Journal of Sexual Medicine, Nelson and colleagues assessed 92 men with Peyronie’s and found that 48 percent scored as depressed, 26 percent moderately and 21 percent severely. The rate did not improve with time since diagnosis. The authors recommended that every man with Peyronie’s be screened for depression. If that sounds familiar, say so at your appointment. It is part of the condition, not a side issue.
Whether treating ED early changes the course of Peyronie’s is something the studies do not answer.
What kind of doctor treats Peyronie’s disease?
A urologist. NIDDK names urologists as the specialists who diagnose it, and the AUA guideline says Peyronie’s should be managed only by clinicians with the experience and tools to evaluate, counsel and treat it. That rules out a lot of online clinics.
The evaluation is usually simple. A urologist takes a history, feels for the plaque, and before any invasive treatment, gives an in-office injection that produces an erection so the curve can be measured, sometimes with an ultrasound to look at blood flow and calcium in the plaque. Bring photos if you have them.
Your primary care doctor or naturopathic doctor still has a job. Several risk factors that travel with Peyronie’s, such as diabetes, smoking, high blood pressure and low testosterone, are things a whole-health workup can find and treat. That will not straighten a curve. It can protect the blood vessels that erections depend on.
If you are tracking men’s health issues as you get older, the prostate is the other common one. We cover what causes an enlarged prostate in a separate post.
Myth: Any bend in the penis means Peyronie’s disease.
Fact: Many men have a mild curve from birth. Peyronie’s is a new or changing curve caused by scar tissue, often with a lump you can feel or pain with erections.
Myth: Vitamin E or other supplements will dissolve the plaque.
Fact: The American Urological Association tells clinicians not to offer oral vitamin E, omega-3s or vitamin E with L-carnitine for Peyronie’s, because they have not shown convincing benefit.
Myth: If the pain goes away, the disease has healed.
Fact: Pain usually fades as the disease moves into its stable phase, but the scar and the curve often stay. In the pooled data, about 40 percent of men got worse without treatment.
Frequently asked questions
Is Peyronie’s disease serious?
It is not dangerous to your overall health. The plaque is benign, and the Urology Care Foundation says no case has been reported to turn into cancer. It can be serious for your sex life and mood, though. A curve can make intercourse painful or impossible, ED often comes with it, and a 2008 study found 48 percent of men with Peyronie’s scored as depressed. Those effects are worth treating.
How fast does Peyronie’s disease progress?
Most change happens in the acute phase, which the Urology Care Foundation says usually lasts 5 to 7 months and occasionally up to 18. During that time the plaque grows and the curve can worsen. After that the disease tends to stabilize. In pooled data, about 40 percent of men got worse, 47 percent stayed the same and 13 percent saw the plaque resolve without treatment.
Can you get Peyronie’s disease in your 20s or 30s?
Yes, though it is less common. In a survey of 4,432 men described in a 2016 review, 1.5 percent of men in their 30s had a palpable plaque, compared with 6.5 percent of men over 70. The same review notes it has been reported from the teens onward. Younger men who notice a new curve or lump should get it checked rather than assume they are too young.
Does Peyronie’s disease make the penis shorter?
It can. NIDDK lists narrowing and shortening among the symptoms, and Cleveland Clinic says severe disease can shorten the penis by about half a centimeter to a centimeter and a half. Some surgical repairs can also cost length, which is one reason men should go over the trade-offs of each option with a urologist before choosing one.
Should I see a doctor if the curve does not bother me?
One visit is worth it, mainly to confirm what it is and to get a baseline measurement. After that, NIDDK and the Urology Care Foundation both say men with a small plaque, a mild curve, no pain and normal sex may not need treatment. If the curve worsens, pain starts or erections weaken, go back.
If a new curve has you worried about your erections, start with a urologist for the diagnosis. The general health side, including blood sugar, smoking, blood pressure and testosterone, is where Dr. Drew Collins at Proactive Choice can help. You can read about erectile dysfunction treatment in Bend at our clinic, or book a free 15-minute call at +1 (858) 333-5196 to talk it through first.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases. Penile Curvature (Peyronie’s Disease).
- Urology Care Foundation. Peyronie’s Disease.
- Al-Thakafi S, Al-Hathal N. Peyronie’s disease: a literature review on epidemiology, genetics, pathophysiology, diagnosis and work-up. Translational Andrology and Urology, 2016.
- American Urological Association. Peyronie’s Disease: AUA Guideline (2015).
- Gelbard M, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of Peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. Journal of Urology, 2013.
- Nelson CJ, et al. The chronology of depression and distress in men with Peyronie’s disease. Journal of Sexual Medicine, 2008.
- Cleveland Clinic. Peyronie’s Disease.
Medically reviewed content from Proactive Choice. This article is for education and is not a diagnosis. Talk with a licensed clinician about your own symptoms and treatment options.
Want to talk this through for your own health? Book a visit with Dr. Drew Collins, ND at 601 NW Harmon Blvd in Bend, or call (858) 333-5196.
