Peyronie’s disease is a condition where scar tissue, called plaque, forms inside the penis and causes it to curve or bend during erection. It affects roughly 0.4% to 9% of men, though the true number is likely higher because many don’t report it. The condition can cause pain, make sex difficult or impossible, and take a significant psychological toll.
How Plaque Forms Inside the Penis
The penis contains a tough, flexible sheath called the tunica albuginea that surrounds the erectile tissue. This sheath has two layers: an inner layer with fibers running in a circular pattern and an outer layer with fibers running lengthwise. During an erection, these layers stretch and expand evenly, keeping the penis straight.
Peyronie’s disease starts when this sheath gets damaged, usually from bending or buckling forces during sex. Even minor, repeated trauma can cause tiny tears where the internal structural strands attach to the sheath. Blood leaks into the damaged area, and the body launches an inflammatory response to repair it. In most men, this heals normally. But in some, the repair process goes wrong. The body can’t clear the initial clot material fast enough, and chemical signals that promote scarring go into overdrive. Scar-promoting cells called myofibroblasts multiply and deposit excessive amounts of collagen, the protein that forms scar tissue. The normal self-destruct signal that tells these cells to stop working gets disrupted, so they keep building. The result is a dense, inelastic plaque that won’t stretch the way healthy tissue does. When you get an erection, the plaque acts like a stiff patch on a balloon, forcing the penis to bend toward or around it.
Who Is at Higher Risk
Several factors make some men more vulnerable. Diabetes is one of the strongest. Chronically elevated blood sugar promotes scarring throughout the body by ramping up the same chemical signals that drive plaque formation in Peyronie’s disease. In one study of men with a related connective tissue condition, 81.8% of those who also had Peyronie’s disease were diabetic, compared to 44.3% of those without it.
Dupuytren’s contracture, a condition where scar tissue forms in the palm and curls the fingers inward, shares overlapping genetics with Peyronie’s disease. Both conditions involve the same types of cells behaving abnormally and the same patterns of collagen buildup. Men with bilateral Dupuytren’s contracture (affecting both hands) are significantly more likely to develop Peyronie’s. The inheritance pattern appears to be autosomal dominant with incomplete penetrance, meaning you can carry the gene without necessarily developing the condition, but having a close relative with either disorder raises your risk substantially. Heritability estimates from twin studies reach as high as 80%.
Hypertension and smoking are also independent risk factors, likely because both damage small blood vessels and promote inflammation.
The Two Phases of the Disease
Peyronie’s disease progresses through two distinct phases. The first is the acute (or active) phase, which typically lasts 6 to 18 months. During this time, inflammation is ongoing, the plaque is still forming, and the curvature may be changing. Pain during erections is common in this phase, and the degree of bending can worsen from month to month. Some men also notice the plaque getting larger or harder.
The second is the chronic (or stable) phase. Pain usually fades, the curvature stops progressing, and the plaque calcifies or stabilizes. This distinction matters because treatment options depend heavily on which phase you’re in. Most doctors won’t recommend surgery until the disease has been stable for at least three to six months.
Without any treatment, only about 3% to 13% of men see spontaneous improvement. Meanwhile, 30% to 48% of untreated men get worse within the first 12 to 18 months. The disease rarely resolves on its own.
Symptoms Beyond the Curve
The curvature itself gets the most attention, but Peyronie’s disease affects men in several other ways. The plaque can create an indentation, hourglass shape, or significant shortening of the penis even without dramatic bending. Erectile dysfunction occurs in about 37.5% of men with the condition, partly because the plaque interferes with the mechanics of trapping blood inside the penis and partly because of the psychological weight of the diagnosis.
That psychological burden is substantial. In a study of 309 men with Peyronie’s disease, 62.4% had a depressive disorder. Among those who also had erectile dysfunction, the rate climbed to 91.4%. The combination of visible deformity, sexual difficulty, and the feeling that something is fundamentally wrong with your body creates a cycle that feeds on itself.
How It’s Diagnosed
Diagnosis usually starts with a physical exam. Many plaques can be felt through the skin as a firm or hard lump along the shaft. Your doctor will likely ask you to describe or photograph the curvature during an erection at home, since curvature is only visible when the penis is erect.
Ultrasound is the standard imaging tool. A high-frequency probe can measure the plaque’s length and width and determine whether it’s calcified. Calcified plaques show up clearly on ultrasound, appearing as bright spots that block the sound waves. Non-calcified plaques are subtler, appearing as slightly thickened areas along the sheath. In cases where ultrasound is inconclusive, MRI offers better contrast for detecting non-calcified plaques, which appear as dark areas on imaging. Ultrasound is also used with an injection that produces an erection, allowing the doctor to measure the exact angle of curvature and assess blood flow.
Non-Surgical Treatment Options
During the active phase, the goal is to limit plaque progression and manage pain. The most established injectable treatment uses an enzyme (sold as Xiaflex) that breaks down collagen in the plaque. In clinical use, men with Peyronie’s disease typically see curvature improvements of 20 to 25 degrees, or roughly a 33% to 35% reduction. The treatment involves a series of injections directly into the plaque, spaced over several months, combined with gentle stretching exercises between visits.
Penile traction therapy uses a mechanical device worn on the penis for several hours a day over months. Study protocols vary widely, from 2 hours per day up to 12 hours, with treatment lasting 3 to 6 months. The optimal duration hasn’t been definitively established, but most protocols call for at least 2 to 4 hours daily for a minimum of 3 months. Traction can modestly reduce curvature and may help preserve or regain penile length, making it a useful addition to other treatments.
When Surgery Becomes the Best Option
Surgery is reserved for men in the stable phase whose curvature is severe enough to prevent satisfying sexual activity. There are two main approaches, each with trade-offs.
Plication (Shortening Procedures)
Plication involves placing stitches on the longer side of the penis, opposite the plaque, to straighten it. Think of it like taking a tuck in fabric. The procedure is simpler and faster, averaging about 71 minutes. About 82% of patients report good cosmetic results, and 71% report satisfactory function afterward. The main downside is penile shortening, reported in 41% to 90% of cases. Some men also notice palpable stitches under the skin, though only about 14% find this bothersome. Erectile dysfunction after plication occurs in 7% to 40% of cases, and changes in sensation affect 3% to 48%.
Grafting (Lengthening Procedures)
Grafting involves cutting into or removing the plaque and patching the gap with tissue, often taken from a vein. This approach preserves more length and works better for severe curvatures. Initial results are promising: 86% to 92% patient satisfaction and 59% to 96% straightening rates in the first year. But durability is a concern. Five-year follow-up data shows satisfaction dropping from 86% to about 60%, with 22.5% developing erectile dysfunction and 35% experiencing shortening over time. The surgery itself is more complex, averaging 234 minutes.
When studies have directly compared the two approaches, overall patient satisfaction, curvature correction, and shortening rates were not statistically different. Men who had grafting were more likely to lose sensation and erectile rigidity and more likely to be unable to have intercourse afterward. For men with severe curvature or significant pre-existing shortening, grafting may still be the better choice, but plication offers a simpler procedure with comparable outcomes for many patients.
Penile Implants
For men who have both Peyronie’s disease and erectile dysfunction that doesn’t respond to medication, a penile implant can address both problems at once. The implant provides rigidity, and the curvature can often be corrected during the same surgery through manual modeling or additional straightening techniques.