Peyronie's Disease - Diagnosis and Treatment

Diagnosis

Doctors usually begin with a physical examination of the penis. They look for hard areas or lumps under the skin, which often signal plaque or scar tissue in the tunica albuginea.

They also check for visible curvature of the penis and may measure its length to see if it has shortened over time.

Doctors may ask patients to bring photos showing the penis when erect. Photos taken at home help measure the angle of penile curvature and show the problem’s location.

This makes it easier to understand how serious the condition is. In some cases, doctors use ultrasound imaging. This test uses sound waves to create pictures of tissues inside the penis.

Ultrasound can show fibrosis, calcification, and the exact location of scar tissue. It also checks blood flow in the penis, which can be affected if inflammation or scar tissue narrows blood vessels.

Before the test, a doctor may inject medicine so the penis becomes erect for better imaging.

Doctors rarely use other tests, such as dynamic infusion cavernosometry or cavernosography, but these can help if the diagnosis is unclear. Biopsies are also uncommon unless another cause is suspected.

Summary Table

Diagnostic Method	What It Checks For
Physical Examination	Plaques, lumps, curve, length
Home Photographs	Degree/location of bend
Ultrasound	Scar tissue, blood flow, fibrosis
Other Tests (rare)	Blood flow, tissue details, diagnosis

Doctors watch for symptoms like pain, difficulty with intercourse, lumps, or new curvature. These symptoms may appear after penile trauma or injury.

Treatment

Treating the Early Stage

During the initial or “active” phase, the penis may still change in shape or size. This stage usually lasts up to 18 months.

Treatments aim to slow changes, manage pain, and prevent loss of length.

Penile Traction Devices: Using a device that gently stretches the penis each day can help reduce the curve and maintain or restore some length. People may need to use these devices from 30 minutes up to several hours daily. Traction works best if started early.
Medications: Doctors may prescribe pills or injections. These medicines aim to reduce scar tissue, pain, and curvature.
Surgery Not Advised: Doctors usually avoid surgery until the penis stops changing and pain mostly goes away. Operating too soon increases the chance of needing more surgery later.

Treatments for the Stable Stage

Once Peyronie’s disease stops getting worse (the “chronic” phase), treatment changes.

The shape of the penis is stable, and pain is usually less or gone.

Observation: If symptoms are mild, doctors may suggest close monitoring with no active treatment.
Injections: Doctors can inject medicines directly into the scar tissue. Several sessions are often needed over months.
Traction Therapy: Stretching devices can still help, alone or with other methods.
Surgical Repair: Doctors may suggest surgery when curvature is severe, prevents sex, or causes distress.
Oral Medicines: Pills are not usually recommended in the stable stage as they rarely help.

Medicines for Peyronie’s Disease

Doctors have studied several drugs, but most pills do not help, especially in later stages.

Injections given directly into scar tissue include:

Name	How it works	Who might benefit
Collagenase enzyme	Breaks down collagen in scar tissue.	Adults with a noticeable curve.
Calcium channel blocker	Interrupts scar tissue formation, may ease pain.	Both early and stable stages.
Immunomodulator (Interferon therapy)	Stops scar tissue growth and may break up existing tissue.	May reduce pain and curvature.

Collagenase enzyme is the only FDA-approved drug for Peyronie’s

Doctors usually give injections in a series, with rest periods between them. Sometimes, they combine injections with stretching or modeling (bending the penis the other way).

Side effects may include:

Swelling
Bruising
Pain
Rarely, infection

Pills sometimes discussed include:

Drug	Typical Outcome
Vitamin E	Not proven effective.
PDE5 Inhibitors	Help erections rather than curve.

Always talk to your healthcare provider about side effects and expected results.

Using Devices to Stretch the Penis

Penile traction therapy uses a mechanical device to gently stretch the penis. This non-surgical option is often started early but may help during the stable stage too.

How it works:

Most devices are worn daily, from 30 minutes up to several hours.
Regular use helps keep length and may reduce the curve.
Some devices allow adjustments for comfort.

Benefits:

Only non-surgical approach proven to increase or maintain penis length.
May be combined with injections or used after surgery.

Drawbacks:

Requires daily effort and patience.
Some people feel discomfort or develop skin irritation.

Tips for success:

Follow all device instructions.
Keep regular appointments with your healthcare team.

Surgical Options

Doctors consider surgery when other treatments do not help and the curve or shape problems make sex difficult or impossible. The condition should remain stable for at least 3–6 months before surgery.

Key Surgical Techniques

1. Suturing or Plication Procedures
The surgeon shortens the longer, unaffected side of the penis to straighten it. Different stitching techniques can offer similar results. This works best for less severe curves.

2. Incision and Grafting
The surgeon cuts into or removes scar tissue and then straightens the penis. A patch (graft) from the patient or a donor covers the gap. Doctors use this for more serious curves or dents.

3. Penile Implants
Doctors suggest implants for men with Peyronie’s and erectile dysfunction.

There are two main types:

Semirigid (always somewhat firm, bendable by hand)
Inflatable (pumped up for an erection, otherwise soft)

The surgeon may add straightening techniques during implant surgery.

Surgery Recovery

Most surgeries are outpatient, but some require an overnight hospital stay. Mild pain, swelling, or bruising are common for a few days.

Most men return to work in a few days but should avoid sex for 4–8 weeks. Risks include loss of sensation, erection problems, further shortening, infection, or recurring curve.

The Nesbit procedure is a well-known plication surgery.

Points to Discuss Before Surgery

Ask about the surgeon’s experience with Peyronie’s repairs.
Discuss recovery time and when you can resume regular activities.
Ask if you might need circumcision if uncircumcised.
Review the risks and benefits of each option.

Exploring Additional Treatments

Some options outside standard treatments exist, but results are not always clear.

Iontophoresis: This method uses a mild electric current to help deliver verapamil and steroids through the skin to scar tissue. Research shows mixed results on effectiveness.
Shockwave Therapy: Low-intensity shockwave therapy sends pulses of energy into tissue. The goal is to break up scar tissue and possibly reduce pain. Results can vary, and it is not widely proven.
Radiation Treatment: Doctors sometimes use radiation to try to decrease pain or scarring. There is limited evidence for success, and radiation is not a first choice due to possible side effects.
Other Investigational Techniques: Researchers are studying stem cell therapy and platelet-rich plasma injections. Safety and effectiveness are not yet established.
Vitamin E and Oral Therapies: Many people use these, but strong evidence for benefit is lacking.
Other Nonsurgical Choices: Counseling or support for sexual or emotional concerns can help some men. Devices like vacuum pumps may ease related symptoms, especially when used with other treatments.

Coping and Support

People living with Peyronie’s disease may face stress and relationship issues, especially around sexual function.

Open conversations about painful erections, impotence, or trouble with penetration can help reduce tension.

Ways to find support:

Share your feelings about changes in your penis and how it affects sexual intercourse.
Discuss ways to stay physically and emotionally close with your partner, even if there are challenges with erection or sexual activity.

If you and your partner are struggling, consider meeting with a mental health professional who understands sexual health and relationships.

Tip: Being honest about issues like soft erections or pain can strengthen trust and help both partners adjust.

Getting Ready for Your Visit

Steps You Can Take Before Seeing Your Doctor

Taking time to plan before your appointment can help. Bring important notes to share with your doctor.

Consider including:

Any symptoms you have noticed, even if they do not seem linked to Peyronie’s disease.
Major life events or stress that may affect your health.
List of medications you take, including vitamins and supplements.
Past injuries to the penis that you remember.
Family medical history, focusing on anyone with Peyronie’s disease.
Questions you want to bring up.

Writing out a list of topics or questions can help.

Here are some ideas:

Possible Questions for Your Doctor
What tests might I need?
What treatment choices do I have?
Will my symptoms likely change over time?
Are there trusted resources or handouts I can take home?

Bringing a partner may also help support you during the visit.

What Your Health Care Professional May Ask

The doctor wants to get a clear picture of your symptoms and health history.

Expect questions like:

When did you first notice changes, such as a curve or lump?
Has the curve gotten worse?
Do you have pain with erections? Has the pain changed?
Have you had any injuries?
Is sexual activity more difficult because of your symptoms?

Sometimes, your provider may ask you to fill out a survey, such as the International Index of Erectile Function.

This helps your provider understand how the condition affects your daily life. Be ready to answer questions honestly and openly.

This helps your health care team give better advice and support. You can bring up anything else you want to discuss.

Peyronie’s Disease – Diagnosis and Treatment