What Is Peyronie’s Disease?
Medically reviewed by Jamin Brahmbhatt, MD
Peyronie's disease (PD) is a condition in which the penis develops an abnormal curve. The bend is due to the buildup of scar tissue, called plaques, on the membrane surrounding the inner shaft of the penis. PD tends to affect older people and can cause painful erections, pain with intercourse, and erectile dysfunction (ED). Treatment includes medical-grade penile injections, penile traction therapy, and surgical correction.
PD is a benign (noncancerous) condition but one that can cause considerable stress and a loss of sexual function, affecting a person's self-esteem and relationships.
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This article describes the symptoms and causes of Peyronie's disease and what can be done to diagnose, treat, and cope with a condition that affects up to 11% of people with penises in the United States.
A Note on Gender and Sex Terminology
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same.
Sex refers to biology: chromosomal makeup, hormones, and anatomy. People are most often assigned male or female at birth based on their external anatomy; some people do not fit into that sex binary and are intersex.
Gender describes a person's internal sense of self as a woman, man, nonbinary person, or another gender, and the associated social and cultural ideas about roles, behaviors, expressions, and characteristics.
Research studies sometimes don't use the terminology in this way. Terms that describe gender (“woman,” “man”) may be used when terms for sex (“female,” “male”) are more appropriate. To reflect our sources accurately, this article uses terms like "female," "male," "woman," and "man" as the sources use them.
Peyronie’s Disease Symptoms
Penises can have some degree of curvature that you are born with and that is perfectly normal. Peyronie's disease refers to a change in the curvature of the penis that can either evolve over time or occur spontaneously.
Common symptoms of PD include:
An abnormal curve, usually upward but sometimes downward or to the side
A curve with or without an erection
A hardened divot or indentation at the junction of the bend
Pain with an erection and, less commonly, without an erection
Pain during intercourse
Difficulty with penetrative sex
Narrowing of the penis shaft around the junction of the bend
A shortening of the penis due to the contraction of tissues
Complications
Beyond the deformity of the penis itself, PD is associated with an increased risk of erectile dysfunction (ED). The loss of erectile function may occur with the onset of PD symptoms, develop months or years later, or make existing ED symptoms worse.
The penile plaques can stem the flow of blood needed to engorge the penis during an erection. It can also disrupt the function of smooth muscles around the penis that stiffen during an erection.
Risks of Erectile Dysfunction
Studies suggest that anywhere from 40% to 60% of people with Peyronie's disease have some degree of erectile dysfunction. However, as PD tends to affect older people who are already at risk of ED, it may be a contributing rather than the sole cause of ED.
In addition to physical symptoms, PD can cause psychological stress that further adds to a loss of sexual function. Emotional difficulty and depression are reported by roughly 50% of people with PD, which can further complicate ED symptoms.
While PD doesn't directly interfere with male fertility, erectile dysfunction associated with the physical and psychological effects of PD can. As an independent risk factor, ED can lead to infertility in 1 out of 6 people with the condition.
Related: The Facts About Age and Male Fertility
What Causes Peyronie’s Disease?
Peyronie's disease is thought to be caused by repeated mild sexual trauma or prior injury to the penis during sexual intercourse or physical activity. Over time, these injuries can cause tiny fibrous scar tissue, called plaques, to develop on a thick sheath of tissue called the tunica albuginea.
The tunica albuginea surrounds and encases three spongy columns that make up the shaft of the penis, called the corpus cavernosa and the corpus spongiosum. It maintains an erection after the corpus cavernosa and corpus spongiosum engorge with blood.
The plaques compromise the stability of the tunica albuginea, causing it to collapse at the junction of weakness either spontaneously or over time.
After that, PD will progress into the following two stages:
Acute stage of PD: This is the period during which the body will respond to an acute injury with inflammation and an overload of fluid (edema). Both can directly irritate nerves and cause pain. As the scarring progresses, the curve of the penis can worsen.
Chronic stage of PD: After six to 12 months, the scarring will have stopped, and the plaques will have hardened. While the penile curve may not worsen, nerves trapped inside the plaques can still cause pain during an erection and even chronic pain when you don't have an erection.
Risk Factors
Older age is considered the primary factor contributing to Peyronie's disease Most people with PD develop symptoms after the age of 50.
With that said, PD can affect people of any age, including those in their early 20s. This may be explained, at least in part, by the following three factors that can independently increase a person's risk of PD:
Each affects the body's ability to respond to penile injuries by restricting blood flow to the penis. Diabetes and smoking both cause inflammation that narrows blood vessels, while obesity causes high blood pressure and progressive hardening of the arteries (atherosclerosis).
While study results vary, other conditions may increase the risk of PD, including heart disease, hypogonadism (low testosterone), and family genetics. PD is also more common in people with other connective tissue disorders, like Duputyren’s contracture.
Related: Facts and Statistics About Peyronie's Disease
Is Peyronie’s Disease Permanent?
Peyronie's disease is usually a permanent condition, but that doesn't mean the severity of symptoms or complications won't improve. For some, the curvature and pain may resolve over time. In others, the curvature and shortening of the penis may persist. Pain during erections may improve within one to two years.
Can a Bent Penis Unbend?
According to a 2020 review in F1000 Research, around 12% to 13% of people with PD will experience an improvement in the curvature of their penises. Of the remaining 87% to 88%, around 40% to 47% will have stable penile curvature, and 40% to 48% will have worsening penile curvature. The reasons for these differences are not clear.
It is also unclear how frequently erectile dysfunction improves in people with PD, although there is evidence that smaller plaque volumes and less severe penile curvature may play a role.
Talking With a Healthcare Provider About Peyronie’s Disease
Talking with a healthcare provider about Peyronie's disease may seem awkward and embarrassing, but avoiding the conversation may cause more harm than good.
For one thing, early diagnosis and treatment may help to halt the progressive curvature of the penis with nonsurgical means. The diagnosis may also reveal a more serious condition entirely unrelated to PD, such as a penile fracture or penile cancer.
If you feel uncomfortable speaking with your primary care provider, you can schedule an appointment with a urologist. These doctors are specialists in diseases of the male reproductive organs and urinary tract. They are trained to deal with conditions like PD and may be best suited to dispense advice and treatment.
To make the conversation easier, open with general statements like:
"I've noticed changes in the shape of my penis when I get an erection."
"I have pain whenever I get an erection."
"I'm having difficulty with intercourse."
A urologist can pick up on these cues and start asking questions to get closer to what you are actually experiencing. Come prepared with relevant information, such as when symptoms first started, when the pain occurs, and whether you had erectile dysfunction before or after the bend.
The more the healthcare provider knows, the better able they will be to prescribe the appropriate treatment.
Related: How Peyronie's Disease Is Diagnosed
Peyronie’s Disease Treatment
The treatment of Peyronie's disease has evolved, with more tools, medications, and procedures at a healthcare provider's disposal. The treatment will be individualized based on the characteristics and severity of your symptoms as well as the impact of PD on your well-being and quality of life.
PD is treated conservatively during the acute stage, delaying surgery until the condition stabilizes to avoid repeat surgery. During the chronic stage, a combination of treatments may be considered, with surgery most often reserved for cases in which the penile deformity is severe or impacts your ability to have sex.
Penile Traction
Penile traction is a form of physical therapy in which a device is applied to the penis to improve the curvature and length of the penis. The device places opposing pressure against the bend to straighten it gradually and has an extender to maintain or improve the length of the penis.
Depending on the severity of the curve and the device used, penile traction may be prescribed anywhere from 30 minutes to eight hours per day for at least six months.
Penile traction is thought to be most effective during the acute phase but also has its place in the treatment of chronic PD when used in combination with locally injected medicines.
Do Penis Exercises Help?
Penile vacuum pumps, penile massage, and penile exercises (such as jelging) have all been proposed as treatments for Peyronie's disease, but the evidence supporting their use is lacking.
Related: How to Prevent Peyronie's Disease
Medications
One of the mainstays of PD treatment is intralesional injections, This is when medications are injected into plaques to gradually break up and loosen scar tissues. Depending on the drug used, injections may be given in cycles every two to six weeks, with or without penile traction.
Medications that can be used include:
Xiaflex (collagenase clostridium histolyticum): This is the only drug approved by the Food and Drug Administration (FDA) for the treatment of PD. With penile traction, Xiaflex has been shown to reduce penile curvature by an average of 34%.
Verapamil: This is a drug typically used for high blood pressure that is sometimes prescribed off-label for PD. When injected around the penis plaque, verapamil appears to slow the production of collagen, a naturally occurring compound that contributes to plaque formation.
Interferon alfa 2B: This naturally occurring protein appears to break up and prevent the progression of plaques. Even so, it has a high risk of side effects like fever, muscle and joint aches, and other flu-like symptoms.
Other topical, oral, and injectable drugs and supplements have been studied, but none has proven to be consistently effective in treating PD.
Can Viagra and Cialis Help?
PDE5 inhibitors are oral medications used to treat erectile dysfunction. With Peyronie's disease, drugs like Viagra (sildenafil) and Cialis (tadalafil) improve the quality and duration of erections and also reduce the inflammatory stress that promotes the progression of PD symptoms.
Extracorporeal Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment in which acoustic shock waves are delivered to injured tissues to promote healing. It is currently approved by the FDA for the treatment of a foot condition called plantar fasciitis.
With PD, the wand-like device is placed directly over the penile plaques. With repeated treatments, ESWT may help break up the scar tissues so that they can be reabsorbed by the body.
Despite evidence that ESWT can help ease PD pain, there is limited evidence that it can either decrease or prevent the worsening of the penile curve.
Surgery
Surgery may be considered if the penile curve is severe or interfering with your ability to have sex or conceive children.
Surgical options include:
Plication: For this procedure, a series of internal stitches are made on the side of the penis opposite to the plaques. The "cinching" of tissues can help straighten less severe curves.
Grafting: For this procedure, one or more cuts are made into plaques to open and release them. Tissue (taken from your own body, from an animal, or made in the lab) is then sewn into the opening to stabilize the penile membrane.
Penile implants: These are inflatable or semirigid devices that are implanted into the penis to help you achieve an erection suitable for sex. During the implant procedure, the surgeon may "mold" the curvature on the penis to straighten the curvature.
Emotional Impact of Peyronie’s Disease
Peyronie's disease is more than a physical condition. It is one that can seriously undermine the quality of your life and relationships. Because of this, your treatment plan may involve counseling to better deal with the emotional and intimacy issues faced by many individuals and couples with PD.
Mental Health
Many people with PD experience depression, low self-esteem, and emotional distress as a result of their condition. These can lead to social isolation (to avoid anyone noticing or hearing about your symptoms) and feelings of stigmatization (both real and perceived).
A 2013 analysis published in the Journal of Sexual Medicine revealed that these emotions are far more common than many people think. According to the investigators, among people living with PD:
81% report "emotional difficulties" as a direct result of their condition
48% report clinically meaningful depression
21% report severe depression
Moreover, these emotions did not appear to improve with time.
Treatment with a therapist or counselor is commonly advised for people faced with clinically significant Peyronie's disease. Options include education along with cognitive behavioral therapy (CBT) to identify and adjust negative thought patterns related to self-esteem and sexual self-identity.
Intimacy
With Peyronie's disease, depression, and anxiety are often fueled by changes in a couple's sexual relationship. Embarrassment, a loss of confidence, and concerns about how your partner sees you sexually can amplify these feelings, leading to a loss of intimacy and other relationship problems.
The same study in the Journal of Sexual Medicine reported that no less than 54% of people with PD report relationship difficulties due to their condition.
Not only are people with PD more likely to express dissatisfaction with sex and their relationships, but so will their partners. A 2016 study from McGill University reported that among the female partners of men with Peyronie's, the loss of intimacy and changes in their partner's mood accounted for these negative thoughts and feelings.
Improving Intimacy in Couples With PD
Because PD affects couples as well as individuals, education and counseling are advised early on in treatment. This may involve couple sex therapy, emotionally focused therapy (EFT) to strengthen emotional bonds in couples, and sensate focus to increase a couple's responsiveness to touch irrespective of sexual intercourse.
Related: How to Cope With Erectile Dysfunction
How to Deal With Pain From Peyronie's Disease
During the first year or two of developing Peyronie's disease, it is not uncommon to experience pain with an erection and even without one. In some cases, the pain may be persistent and require strategies to cope better.
The important thing to remember is that the pain associated with acute PD tends to improve over time and may eventually resolve altogether.
Things you can do include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter painkillers like Advil (ibuprofen) and Aleve (naproxen) can reduce inflammation and pain but are only intended for occasional use.
Heat therapy: Heating pads can improve circulation, promote healing, and help ease pain. If you don't have a heating pad, you can heat a moist washcloth in the microwave or take a hot bath.
Personal lubricant: Using extra lube can reduce friction during sex and make penetration easier and less painful.
Adjust sexual positions: Experiment with positions that don't ram the penis against bone or other hard structures. Examples include the doggy position (a person with a penis is behind the sex partner) or a sideway position (in which partners lie on their sides during vaginal or anal sex).
Living With Peyronie’s Disease
It can take time before you see or feel any changes from Peyronie's disease treatment. In some cases, the results may fall short of your expectations. Even so, it is important to remain positive and not make any assumptions while undergoing treatment.
By educating yourself, working with your partner, and communicating openly, you can reduce stress and focus on living well on a day-to-day basis. By doing so, you'll improve both your physical and mental health, which, in turn, can improve your sexual health.
To better cope with Peyronie's disease:
Keep consistent with your treatment, including the proper use of penile traction.
Exercise regularly, which can improve your mood and lower blood pressure.
Eat a healthy diet, which can help you lose weight and manage your blood sugar.
Quit smoking, which independently increases the risk of ED.
Avoid other risk factors for ED, like heavy alcohol use or illicit drugs.
Manage stress with mind-body therapies like meditation and yoga.
Explore other forms of sexual activity, such as mutual masturbation, role play, and sex toys.
If you are unable to cope, do not hesitate to seek a referral to a sex therapist or psychiatrist. This is especially true if you have persistent feelings of despair, hopelessness, or sadness. Medications can be prescribed if needed to help you better manage your moods.
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