How’s it hanging? "To one side and slightly curved" is a pretty common answer among men. We joke about this, but Peyronie's disease can be a serious issue.

Every penis is different, of course, and a certain amount of penile curvature when erect is completely normal. But how much curve is too much?

The answer: it depends. Some penises are pretty curvy and totally healthy. As long as you’re not experiencing any pain, discomfort, or noticing a negative impact on your sexual performance due to penile curvature, you’ve got nothing to worry about.

But if you are experiencing any of the above negative symptoms, it could be a sign of a problem that needs addressing.

One common cause of problematic penile curvature is Peyronie’s disease, in which tough, fibrous plaques form under the skin of the penis, stiffening the tissue and leading to a curved erection.

According to the Cleveland Clinic, experts estimate that between six and ten percent of men between 40 and 70 have Peyronie’s disease. While it can affect men of all ages, it’s less common among younger men. Here’s everything you need to know about Peyronie’s disease and how you can get treatment.

What causes Peyronie’s disease?

The jury is still out on this one. Researchers are trying to understand why the disease develops, and one leading theory is that it may be the result of scar tissue forming after a prior injury, such as the penis being bent during sex (see our blog on penile fractures), but this doesn’t explain all cases.

What are the common symptoms of Peyronie’s disease?

The most common symptoms of Peyronie’s disease include the following:

  • A hard lump or bump in the shaft of the penis – this is the plaque that forms under the skin
  • A curve or bend while the penis is erect (the penis typically curves in the direction of the lump)
  • Pain or discomfort with erections.  Pain in the penis while flaccid is not generally associated with Peyronie’s disease
  • The penis may appear misshapen, taking on a squeezed, narrowed, or hourglass shape
  • Loss of length or girth of the penis
  • In some cases, Peyronie’s disease may lead to erectile dysfunction

Although Peyronie’s disease is not dangerous to your health or your fertility, the associated pain, difficulty having sex, and the appearance of the penis are reasons enough for many men to seek treatment.

What are the treatment options for Peyronie’s disease?

In about ten percent of cases, the curvature will improve without treatment. However, for most men, the plaques will stabilize and become permanent, like scar tissue from an injury.

Depending on the severity of the condition, there are several treatment options:

Oral Medication

 Several different oral medications have been used to help inhibit inflammation and the development of scar tissue, but not all of them have demonstrated efficacy in curing or resolving the symptoms.

Penile Traction Therapy

Penile stretching with a penile traction device can help reduce the curvature of the penis.

Verapamil Injection

Verapamil, a medication often used to treat high blood pressure, can be injected directly into the plaque and may help soften it and reduce pain during the acute phase of Peyronie’s disease (while the plaque is forming)

Xiaflex Injection

Collagenase clostridium histolyticum (Xiaflex) is the only FDA-approved medication for Peyronie’s disease. These injections improve penile curvature by helping to break down the plaques or scar tissue.

Penile Surgery

In severe cases of Peyronie’s disease (or if a patient is not a candidate for injection therapy), surgery may be necessary to correct the penile curvature. Surgery is only considered an option during the chronic phase of the disease once the plaques have stabilized and stopped growing.

There are three broad surgical options for treating the condition:

  • Penile plication:  This surgery involves placing sutures on the side of the penis opposite the curve/plaque to straighten it. This is a good option for men with adequate erections who have not lost much length due to Peyronie’s disease.
  • Plaque excision and grafting: Another option is to lengthen the side of the penis with the curve/plaque. This is a good option for men with very severe plaques that have shortened the length of the penis significantly. During this procedure, a surgeon may remove part of the plaque and replace that area with a substitute tissue called a graft.
  • Penile implants: a penile implant can treat men with both erectile dysfunction and Peyronie’s disease. The penile prosthesis will help straighten the penis. This is the best option for men with poor erectile function and penile curvature. The implant allows a man to control his erections by squeezing a pump hidden inside the scrotum between the testicles.

Before any surgical option is considered, your urologist will perform a penile ultrasound to evaluate the plaques and degree of curvature to determine the best possible treatment course.

What other options do I have?

Some healthcare providers recommend shockwave therapy to reduce the pain caused by Peyronie’s disease. This involves directing low-intensity electroshock waves at the plaque. However, there is no definitive evidence that shockwave therapy is effective for Peyronie’s disease.

If you have concerns about Peyronie’s disease, penile curvature, or if you’re experiencing any of the symptoms described above, talk to your doctor, or better yet, make an appointment to see a urologist. They’ll be sure to help you with this particular curveball.

Peak’s board-certified urologist, Dr. Philip Cheng, provides the full spectrum of care to his men’s health and LGBTQ+ patients and regularly offers Peyronie’s disease treatment.