Peyronie’s disease is typically diagnosed through a medical history and physical examination of the penis, often without any blood tests or advanced imaging. A doctor who can feel a firm plaque beneath the skin and confirm a curved or deformed erection generally has enough information to make the diagnosis. The process is straightforward, but understanding what to expect at each step can make the visit less stressful.
What Happens During the Initial Visit
The American Urological Association states that the minimum requirements for diagnosing Peyronie’s disease are a careful history and a physical exam of the genitalia. No lab work, biopsy, or scan is required in most cases. Your doctor will ask about four core things: the shape or curvature of your erection, whether it interferes with intercourse, whether you have penile pain, and how much distress the condition is causing you.
Expect detailed questions about when you first noticed something was off, whether the curve or lump has changed over time, and whether erections are painful. These details matter because they help determine whether your disease is still in its active (inflammatory) phase or has stabilized, which directly affects treatment options. Resolution of pain and a curvature that hasn’t changed for at least three months are the accepted criteria for stable disease.
Your doctor may also examine your hands and the soles of your feet. This isn’t random. Peyronie’s disease is associated with similar scarring conditions: Dupuytren’s contracture in the hands and Ledderhose disease in the feet. Finding thickened tissue in those areas supports the diagnosis.
The Physical Exam
During the exam, the doctor will feel along the shaft of the penis for palpable plaques, which are areas of hardened, fibrous scar tissue that form within the tough outer lining of the erectile chambers. These plaques can range from small, subtle nodules to large, firm patches. Their location, size, and number help the doctor understand the pattern of your disease.
The exam itself is done with the penis in a flaccid state and takes only a few minutes. It can feel awkward, but the palpation is typically not painful unless your disease is in its early inflammatory stage. The doctor is looking for the plaque’s position (top, bottom, or side of the shaft), its consistency, and whether there are multiple plaques.
Measuring the Curve
Knowing the exact degree of curvature is important for tracking the disease and planning any treatment. Since the curve only shows during an erection, your doctor needs to see or measure the erect penis. There are two common ways this happens.
The first is patient photography. You may be asked to take photos of your erect penis at home, from multiple angles, and bring them to your appointment. This is standard practice and gives the doctor a clear view of the deformity in a less clinical setting. The second method is an in-office injection. A medication is injected into the base of the penis to produce an erection on the spot. This allows the doctor to directly measure the angle of curvature, typically using a handheld protractor-like tool called a goniometer. The AUA recommends this injection test before any invasive treatment is considered.
Curvature is measured in degrees. The number matters because it influences treatment decisions. For example, curves of 60 degrees or more respond differently to certain therapies than milder curves.
When Ultrasound Is Used
Ultrasound is not required for a basic diagnosis, but it becomes useful in specific situations. A penile color duplex ultrasound can do two things: characterize the plaque in detail and assess blood flow to evaluate erectile function.
One of the most clinically valuable things ultrasound reveals is whether the plaque has calcified. About a third of men with Peyronie’s disease have some degree of calcification in their plaques. A large study of over 1,000 patients found that 34% had calcification, and those with the largest calcified plaques (greater than 1.5 cm, or multiple plaques over 1 cm) were significantly more likely to need surgery. Calcification also predicts how well nonsurgical treatments will work. In one study tracking patients receiving injections, men with noncalcified plaques saw curvature improve by about 28 degrees on average, compared to just 10 degrees in men with moderate to severe calcification.
The European Association of Urology notes that while ultrasound is a safe, low-cost, and rapid way to characterize the disease, measuring plaque size with ultrasound is considered inaccurate and operator-dependent. Guidelines recommend against using it for routine plaque measurement. Its real value lies in detecting calcification and evaluating blood flow when erectile dysfunction is a concern.
Erectile Function Assessment
Many men with Peyronie’s disease also experience difficulty getting or maintaining erections, and this is a separate but related issue the doctor will want to evaluate. You may be asked to fill out a short questionnaire called the IIEF-5, which scores erectile function on a scale based on five questions about your recent sexual experiences. This helps quantify the problem and track changes over time.
If erectile dysfunction is significant, the duplex ultrasound mentioned above can measure blood flow into and out of the penis during an induced erection, helping determine whether the erectile issues are caused by the Peyronie’s plaque itself, by vascular problems, or by both.
Distinguishing Peyronie’s From Congenital Curvature
Not every curved penis is Peyronie’s disease. Some men have a natural curve that has been present since puberty. This is called congenital penile curvature, and it results from uneven development of the penile lining rather than scar tissue formation. The distinction matters because the two conditions are managed differently.
The key differences are age of onset and symptoms. Congenital curvature is typically noticed in the teenage years when sexual activity begins, the curve has always been there, and there is no palpable plaque or pain. It most often bends downward (ventral), though lateral and upward curves occur. Peyronie’s disease, by contrast, usually appears in men between 50 and 60 (though it can occur earlier, with reported rates of 1.5% to nearly 17% in men under 40). It involves a new or worsening curve, a palpable hard spot, and often pain during erections in the early phase. A medical history alone is usually enough to tell the two apart.
Active vs. Stable Disease
One of the most important things your doctor will determine is whether your Peyronie’s disease is still active or has stabilized. This isn’t a separate test but rather a judgment based on your history and symptoms.
Active disease means the scar tissue is still forming and changing. Signs include pain during erections, a curve that is getting worse, and symptoms that started relatively recently. In this phase, the plaque is still inflamed and evolving, and most surgical options are off the table because operating on a moving target risks a poor outcome.
Stable disease means the inflammation has burned out. Pain has resolved, and the curvature has remained unchanged for at least three months. At this point, the full range of treatment options opens up, from continued monitoring to injections to surgery depending on severity. Your doctor will use your own timeline of symptoms to make this determination, which is why being specific about when changes happened is so helpful during your visit.