Peyronie's Disease: When to Watch and When to Treat
Peyronie's disease is a condition in which scar tissue (plaque) forms inside the penis, causing curvature, shortening, pain, and in many cases erectile dysfunction. It affects an estimated 5–10% of men — a figure that is almost certainly an underestimate, given how rarely men seek medical advice for it.
For many men, Peyronie's disease develops quietly: a painless lump in the shaft of the penis, followed by a progressive bend that makes intercourse uncomfortable or impossible. The psychological impact — on self-image, relationships, and sexual confidence — is frequently severe and rarely acknowledged by healthcare professionals.
Understanding the Disease Course
Peyronie's disease has two distinct phases:
The active (inflammatory) phase typically lasts 12–18 months. During this period, the plaque is forming and evolving. Curvature may worsen, pain during erection is common, and the penis may feel tender. Surgical intervention during the active phase is generally not appropriate, as the deformity is still changing.
The stable (chronic) phase begins when the plaque has matured and the curvature has been unchanged for at least three to six months. Pain typically resolves at this stage. This is the window in which surgical correction is most effective.
Non-Surgical Treatment Options
Several non-surgical treatments have evidence supporting their use, primarily in the active phase or for men with mild to moderate stable deformity.
Collagenase clostridium histolyticum (CCH) injections — the only pharmacological treatment with a randomised controlled trial evidence base. CCH is injected directly into the plaque, where it breaks down the collagen causing the curvature. It is typically given in a series of injections over several months. It is most effective for men with curvature of 30–90 degrees and palpable plaque. In clinical trials, it reduced curvature by an average of 17 degrees.
Penile traction therapy — evidence supports daily use of a penile traction device in reducing curvature and preserving length. It is most effective when used consistently and is often combined with injection therapy.
Oral medications (vitamin E, colchicine, pentoxifylline) have limited evidence for curvature reduction, though some patients report symptomatic benefit.
Shockwave therapy may reduce pain in the active phase but has not been shown consistently to reduce curvature, despite widespread use.
Surgical Treatment Options
Surgery is the most effective treatment for stable Peyronie's disease causing significant deformity or difficulty with intercourse. The choice of procedure depends on the degree of curvature, penile length, and the presence or absence of co-existing erectile dysfunction.
Plication procedures (Nesbit and modified Nesbit) — the unaffected side of the penis is shortened to match the shorter, scarred side, straightening the shaft. Best suited for men with adequate penile length, moderate curvature, and preserved erectile function.
Plaque incision or excision with grafting — the plaque is incised or removed, and the defect is filled with a tissue graft. This preserves or restores penile length more effectively than plication and is preferred for severe curvature or significant penile shortening. It requires greater surgical skill and carries a small risk of worsening erectile dysfunction.
Penile prosthesis implantation — for men with Peyronie's disease and co-existing severe erectile dysfunction, a penile implant both straightens the penis and restores erectile function. This is the most definitive treatment for this combination and achieves very high patient satisfaction rates.
Seeking Help
Many men with Peyronie's disease suffer in silence for years. They assume the condition is untreatable, or they feel unable to discuss it with their GP. Neither assumption is necessary. Peyronie's disease is well understood, and effective treatments exist at every stage.
Professor Minhas and Professor Yap have extensive experience in the management of Peyronie's disease, including complex surgical reconstruction and prosthetic surgery. Contact London Andrology to arrange a confidential consultation.
