A slight curve to the penis is completely normal. Most penises aren’t perfectly straight when erect, and a mild bend in any direction rarely signals a problem. But if the curve is new, getting worse, or making sex difficult or painful, there are two main explanations: you were born with it (congenital curvature), or scar tissue has formed inside the penis over time, a condition called Peyronie’s disease. Peyronie’s is far more common than most men realize, affecting an estimated 11.8% of men in the United States.
Congenital Curvature vs. Peyronie’s Disease
If your penis has always curved the same way for as long as you can remember, you likely have congenital curvature, sometimes called chordee. This is a structural difference present from birth that results from how the penis formed during development. It doesn’t involve scar tissue or plaque, and it doesn’t get worse over time. Some men notice it during puberty when they start getting erections regularly, even though the anatomy was there all along.
Peyronie’s disease is different. It develops later in life, most commonly between the ages of 45 and 70, though it can happen at any age. The defining feature is a buildup of hard, fibrous plaque inside the penis. This plaque forms within the tunica albuginea, the tough elastic membrane that surrounds the erectile tissue and helps the penis stay rigid during an erection. When plaque hardens in one area, it prevents that section from expanding normally. The surrounding tissue stretches while the scarred section doesn’t, pulling the penis into a curve.
If your curvature appeared suddenly or has been gradually worsening over months, Peyronie’s is the more likely explanation.
What Causes Scar Tissue to Form
Peyronie’s disease most often starts with repeated minor injuries to the penis. Vigorous sex is the most common cause, but sports injuries or other physical trauma can also trigger it. During these injuries, small tears occur inside the tunica albuginea. In most men, these heal cleanly. In others, the healing process goes wrong: the body lays down excess scar tissue, forming a plaque that gradually hardens.
Several factors raise your risk. Family history is one of the strongest predictors. Diabetes, smoking, and connective tissue disorders also contribute, likely because they interfere with normal wound healing. Certain types of prostate surgery have been linked to Peyronie’s as well. Age plays a role too, since tissue becomes less elastic and heals less efficiently over time.
Two Phases of Peyronie’s Disease
Peyronie’s progresses through two distinct phases, and knowing which one you’re in matters for treatment decisions.
The first is the acute (active) phase, which typically lasts up to 12 months but can stretch to about 18 months. During this time, the plaque is still forming. The curve may be getting worse, and you might feel pain during erections or even when the penis is soft. The penis can also develop dents, indentations, or an hourglass shape. This phase is when the condition is most distressing because it feels like things keep changing.
The second is the chronic (stable) phase, which begins once the plaque stops growing. Pain usually fades, and the curvature stabilizes. It won’t get worse, but it also won’t improve on its own. Most men enter this phase 12 to 18 months after symptoms first appear.
How Treatment Differs by Phase
During the acute phase, treatment focuses on managing pain and trying to limit how much the curve progresses. Anti-inflammatory pain relievers help with discomfort. Injections that break down the scar tissue are an option for men in this phase or for those who want to avoid surgery. The FDA-approved injectable treatment works by dissolving collagen in the plaque. A full course involves up to eight injections spread over four cycles, each about six weeks apart. In clinical trials, men receiving the injections saw roughly a 34% improvement in curvature over a year, compared to about 20% with placebo.
Traction therapy is another non-surgical approach. This involves wearing a device that applies gentle, sustained stretching to the penis. Traditional devices require 2 to 9 hours of daily use to be effective, though newer designs have shortened that to around 30 minutes per day. Treatment typically continues for several months.
Surgery becomes an option once the disease has stabilized, usually at least a year after symptoms began, and only if the curve is severe enough to interfere with sex. There are two main surgical approaches, and the choice depends on how severe the curvature is.
Surgical Options for Severe Curvature
For curves under 60 degrees, the simpler procedure is plication. The surgeon places permanent stitches on the longer side of the penis (opposite the plaque) to even things out. This is effective and has a lower risk of complications, but it does shorten the penis slightly because it works by tightening the longer side rather than lengthening the shorter side.
For curves beyond 60 degrees, or when there’s significant indentation or shortening, a grafting procedure is used instead. The surgeon cuts into or partially removes the plaque, then patches the area with graft tissue. This allows the shorter side to expand again. In a study of 240 men who underwent grafting procedures, about 80% were able to have penetrative sex afterward, and on average men gained a small amount of length (roughly half a centimeter). Recurrence of curvature happened in about 12% of cases, and decreased sensation occurred in 6 to 13%.
For men who also have erectile dysfunction that doesn’t respond to medication, a penile implant with straightening during the same surgery is typically the recommended path.
When a Curve Is Worth Investigating
A curve you’ve had your whole life that doesn’t cause pain or interfere with sex generally doesn’t need treatment. Many men with congenital curvature live their entire lives without it causing any issues.
The signs that something has changed and warrants a visit to a urologist include: a new curve that wasn’t there before, a curve that’s getting progressively worse, pain during erections, difficulty with penetration, a hard lump you can feel under the skin of the penis, or significant shortening. Even in the absence of pain, a noticeable change in shape over weeks or months is worth getting evaluated, because treatments work better when started in the acute phase before the plaque fully hardens.