Peyronie’s disease is treated based on which phase it’s in and how severe the curvature is. During the early inflammatory phase, treatment focuses on managing pain and preventing progression. Once the disease stabilizes, options range from injections that break down scar tissue to surgical correction for more significant curves. The right approach depends on how much curvature you have, whether you can still get firm erections, and whether calcification has formed in the plaque.
Why the Phase of Disease Matters
Peyronie’s disease has two distinct phases, and treatment during the wrong one can backfire. The acute phase lasts roughly 3 to 6 months from when symptoms first appear. During this window, the scar tissue (plaque) is actively forming and changing. You may notice pain during erections, and the curvature may still be shifting. Surgery during this phase risks operating on a moving target, since the plaque hasn’t finished developing.
The chronic or stable phase begins once pain has resolved and curvature hasn’t changed for at least three months. This is when more definitive treatments, like injections or surgery, come into play. European urology guidelines emphasize distinguishing between these phases before choosing a treatment path, since it directly affects what will work and when.
Treatment During the Acute Phase
During the early inflammatory stage, the goal is symptom control and limiting progression rather than correcting curvature. Most of this management happens outside of a specialist’s office. Low-dose erectile dysfunction medications taken daily have shown the ability to reduce pain during the active phase, with some modest improvements in curvature as well.
Oral supplements like vitamin E and tamoxifen are sometimes mentioned, but clinical evidence does not support recommending them. One oral medication that does have some data behind it is potassium paraaminobenzoate (sold as Potaba). In a placebo-controlled trial of 103 men with early-stage disease, 74% of those on the medication responded to treatment compared to 50% on placebo. Plaque size roughly halved in the treatment group. However, it did not meaningfully improve curvature that was already present. Its main benefit was preventing the disease from getting worse, not reversing it. The dosing schedule (four times daily for 12 months) also makes it difficult to stick with.
Injections for Moderate Curvature
For men in the stable phase with moderate curvature, injections directly into the plaque are a non-surgical option. The most studied is collagenase clostridium histolyticum (brand name Xiaflex), which is the only FDA-approved injection for this condition. It works by breaking down the collagen that makes up the scar tissue.
A treatment cycle consists of two injections given 1 to 3 days apart, followed by a manual modeling procedure where the penis is gently bent in the opposite direction of the curve. This cycle can be repeated every six weeks, up to four times. In clinical data, the median curvature improvement at three months was about 54%.
One important factor that predicts how well injections work is whether the plaque has calcified. Ultrasound imaging can reveal this. Men with noncalcified plaques and curvature of 60 degrees or more were the strongest responders, achieving an average curvature reduction of about 28 degrees. Men with any degree of calcification responded poorly, with improvements closer to 10 degrees. If imaging shows significant calcification, your urologist may recommend skipping injections and going directly to surgery.
Other injectable options include verapamil (a calcium channel blocker) and interferon. These are used off-label. Clinical studies of verapamil have consistently shown positive results, though the evidence is lower quality. Interferon results are more mixed: five of seven published studies showed benefit, while two showed none.
Surgical Options for Significant Curvature
Surgery is considered the most reliable way to straighten the penis and is typically reserved for men with stable disease who haven’t responded to other treatments, or whose curvature is too severe for injections to make enough difference. There are three main surgical approaches, and the choice depends on curvature severity, erection quality, and how concerned you are about length.
Plication
This is the simplest surgical approach. Rather than touching the plaque, the surgeon shortens the longer side of the penis by placing permanent sutures on the opposite side of the curve, pulling it straight. It works best for curves under 60 degrees in men who have solid erections. Recovery is relatively quick and complication rates are low. The tradeoff is some degree of penile shortening, since you’re essentially tucking the longer side.
Plaque Excision With Grafting
For more severe curvature (generally above 60 degrees), complex curves, or ventral curvature, the surgeon removes or cuts into the plaque and patches the area with graft material. This approach better preserves length. In a long-term study following patients for an average of five years, about 80% of men who underwent grafting were able to have penetrative sex afterward (with or without medication). Recurrent curvature occurred in roughly 11 to 12% of cases. Interestingly, men in this study actually gained a small amount of length on average (about half a centimeter), rather than losing it.
The main risk with grafting is reduced sensation at the tip of the penis, which occurred in 6 to 13% of patients depending on the complexity of the procedure.
Penile Implant
When Peyronie’s disease coexists with erectile dysfunction that doesn’t respond to medication, an inflatable penile prosthesis is considered the gold standard. The implant itself can correct mild to moderate curvature. After the device is placed, manual modeling (bending the penis over the implant) can straighten residual curves under about 30 degrees. For curves still above 30 degrees after implant placement, additional plication or grafting can be done during the same surgery.
Shockwave Therapy: Pain Only
Low-intensity shockwave therapy is widely marketed for Peyronie’s disease, which can create the impression that it corrects curvature. It does not. High-quality clinical studies consistently show discouraging results for curvature improvement. Where shockwave therapy does have value is in pain reduction. If you’re in the acute phase with persistent pain that over-the-counter medications aren’t controlling, it may help. But if your primary concern is curvature, this is not the treatment for it.
How Calcification Changes the Treatment Path
An ultrasound of the penis can reveal whether the plaque has calcified, and this finding significantly affects which treatments are likely to work. Men with calcified plaques are 1.75 times more likely to eventually need surgery. Those with the most severe calcification (visible shadowing on ultrasound or plaques larger than 1 centimeter) have a higher chance of needing a grafting procedure specifically, rather than a simpler plication.
Calcification essentially makes the scar tissue harder and more resistant to breakdown by injections. If your urologist identifies significant calcification on imaging, they’ll likely steer the conversation toward surgical options rather than spending months on injection cycles that are unlikely to produce meaningful improvement.