Peyronie's Disease: Curvature & Treatment | Dr. Theodore Cisu

The short answer: Peyronie's disease is scar tissue, called a plaque, that forms inside the penis and causes a curve, dent, shortening or pain with erections. It isn't cancer and it isn't contagious. It usually has an early active phase, when pain and the curve can change, followed by a stable phase. Treatment depends on the phase and how much it affects your sex life, and ranges from watching and waiting to injections or surgery.

Written by Theodore Cisu, MD, board-certified urologist. Based on the American Urological Association (AUA) guideline on Peyronie's disease (2015). Last reviewed November 2026.

Ready to talk it through? Book a telehealth or in-person visit. No referral needed.

What is Peyronie's disease?

The erection chambers of the penis are wrapped in a tough, stretchy layer of tissue. In Peyronie's disease, a patch of that layer heals with scar tissue. Scar tissue doesn't stretch. During an erection, the penis bends toward the plaque or narrows around it.

Doctors think many cases start with small injuries to the penis, often during sex, that heal abnormally. Many men don't remember any injury. It is more common in men with erectile dysfunction or diabetes, and in men with Dupuytren's contracture, a similar scarring condition in the hand.

Symptoms of Peyronie's disease

• A curve or bend in the erect penis, upward, downward or to one side
• A firm lump or band you can feel under the skin
• A dent, narrowing or hourglass shape
• Shortening of the penis
• Pain with erections, mostly in the early phase
• Trouble with erections or with having sex

Peyronie's disease can also cause stress, embarrassment and strain in relationships. The AUA guideline asks clinicians to ask about this. It is a real part of the condition, and it deserves attention.

The two phases of Peyronie's disease

Active phase

In the early months, the plaque is still forming. Pain with erections is common, and the curve may change. For most men, pain eases over time.

Stable phase

The AUA describes the disease as stable when symptoms and the curve have not changed for at least three months. Most procedures to straighten the penis are done during this phase. Some men's curves improve on their own, many stay the same, and some get worse. There's no way to predict which will happen.

How is Peyronie's disease diagnosed?

• A careful history. When it started, whether it hurts, how the curve has changed, and how it affects sex and your well-being.
• A physical exam. Your urologist feels for the plaque and may measure the stretched length of the penis.
• Photos from home. Pictures of an erection from the top and side can help show the curve, especially at a first or telehealth visit.
• An erection test. Before any procedure, the AUA recommends producing an erection with an injection in a clinic setting. This lets the curve be measured accurately. An ultrasound may be done at the same time to check blood flow and the plaque. Your urologist can arrange this testing.

Treatment options

The AUA guideline asks clinicians to review all the options with you, including their benefits and risks. The right choice depends on your phase, the size and direction of the curve, the quality of your erections and your goals.

Watching and waiting

If the curve is mild and sex isn't a problem, you may not need treatment. Follow-up visits track any changes.

Pain relief in the active phase

Anti-inflammatory medicines such as ibuprofen may be used for pain. The AUA also says shock wave therapy may be offered for pain, though it does not straighten the penis.

Injections into the plaque

Collagenase (Xiaflex) is an FDA-approved enzyme that breaks down part of the plaque. Under the AUA guideline, it may be offered to men in the stable phase with a curve between 30 and 90 degrees and erections still good enough for sex. Treatment is a series of injections combined with gentle stretching, called modeling. Bruising, swelling and pain are common. A rare but serious risk is a tear inside the penis, so sex is paused for a period after each injection.

Verapamil or interferon injections may also be offered, though the evidence for them is more limited.

Penile traction

Traction devices gently stretch the penis over many weeks. The 2015 AUA guideline did not address traction. Newer studies and other guidelines discuss it, so your urologist can tell you whether it fits your situation.

Surgery

Surgery is usually reserved for men in the stable phase whose curve makes sex difficult.

• Plication. Stitches are placed on the side opposite the curve to straighten the penis. It works well for many curves when erections are good. Some loss of length is expected.
• Plaque incision or removal with a graft. The plaque is cut or partly removed and patched with a graft. This is used for more severe curves or dents in men with good erections. It carries a higher chance of weaker erections afterward.
• Penile implant. For men with both Peyronie's disease and erectile dysfunction, an implant can restore erections and help straighten the penis.

Your urologist can discuss whether injections or surgery make sense for you. Dr. Cisu offers Xiaflex injections. He also performs Peyronie's surgery, including plication and grafting, at Augusta Health. If a penile implant is the better fit, he can coordinate referral to a surgeon who specializes in implants.

Treatments the AUA does not recommend

The guideline advises against oral vitamin E, tamoxifen, procarbazine, omega-3 fish oils, vitamin E with L-carnitine, verapamil applied through the skin with electric current, shock wave therapy to reduce the curve or plaque, and radiation. Be cautious with supplements sold online as Peyronie's cures.

When to see a urologist

• A new curve, lump or dent in the penis
• Pain with erections
• A curve that makes sex difficult or painful for you or your partner
• Erectile dysfunction along with a curve
• Worry or distress about how your penis looks or works

An early visit helps set a baseline, even if you decide to wait.

When it's an emergency

Go to the emergency room if you feel a sudden pop or crack during sex, lose your erection quickly, and then notice swelling or dark bruising. This can be a penile fracture, which usually needs prompt surgery. Seek care the same way after a collagenase injection if you have these symptoms.

Seeing Dr. Cisu for Peyronie's disease

Dr. Theodore Cisu evaluates Peyronie's disease and talks through every option with you at his clinics in Charlottesville and Fishersville. You can start with a telehealth visit from anywhere in Virginia. Our office can gather any prior records or ultrasound reports so Dr. Cisu reviews them first. Second opinions are welcome, and no referral is needed. Book a visit.

Frequently asked questions

Can Peyronie's disease go away on its own?

Pain usually fades with time. The curve improves on its own in some men, but more often it stays the same or worsens. That's why follow-up matters.

Is Peyronie's disease cancer?

No. The plaque is scar tissue. It isn't cancer, and it isn't a sexually transmitted infection.

Does Peyronie's disease cause erectile dysfunction?

The two often occur together. The plaque can affect how well the penis traps blood, and stress about the curve can play a part. Both problems can be treated.

Does vitamin E help Peyronie's disease?

The AUA guideline advises against oral vitamin E and several other supplements because studies haven't shown they help.

How much curvature is normal?

Many men have a slight natural curve. A curve matters when it is new, changing, painful or gets in the way of sex.

Will treatment make my penis shorter?

Peyronie's disease itself can cause shortening. Some procedures, such as plication, can also reduce length a little. Your urologist can help you set realistic expectations.

Sources

• American Urological Association. Peyronie's Disease: AUA Guideline (2015).
• American Urological Association. AUA releases new clinical guideline on the diagnosis and treatment of Peyronie's disease.

This article is for general education and isn't a substitute for medical advice. If you feel a pop during sex followed by rapid swelling or bruising, go to the nearest emergency room.