Peyronie's Disease: Symptoms, Causes and Treatment

A slight bend in an erection is normal and causes no trouble for most men. What matters is whether the curve is new.

For most men, a curve under 30 degrees does not get in the way of sex1.

• A bend in the erect penis, upward, downward or to one side
• A firm lump or band you can feel under the skin of the shaft
• A dent, or an hourglass narrowing, in the erect penis
• Pain with erections, mostly in the early months
• A shorter erect penis than before
• Erections that are softer past the plaque, or that buckle
• Difficult or painful penetration, for you or a partner

Upward curves are the most common. In the largest study of untreated men, 72% bent upward, 17% downward and 11% to the side, and 32% already had some erection problems when first seen4.

It is not only physical. Using a standard depression scale, one study found that 48% of men with Peyronie's disease had depression worth medical attention, and this did not ease with time since diagnosis5. Tell your doctor if it is affecting your mood or your relationship.

The largest study of untreated men followed 246 men from within six months of their first symptoms for an average of 18 months4.

Average stretched length also fell, from 12.2 cm to 11.4 cm4. A later study of 176 untreated men found the curve unchanged in 67%, worse in 21% and better in 12%6.

In plain terms: the pain usually takes care of itself, but the curve usually does not. That is why the Canadian guideline advises talking about treatment when the curve affects sex or causes distress1.

The exact cause is not known. The leading explanation is an abnormal healing response to injury in the sheath of the penis, often from small, repeated strain during sex that a man may not remember2.

Men are more likely to develop it if they:

• Have Dupuytren's contracture, a thickening in the palm that pulls the fingers inward1
• Have a family history of Peyronie's disease or Dupuytren's contracture1
• Are older
• Have erection problems, since a penis that buckles during sex is more easily strained

Many men have none of these. Not finding a cause does not change how it is treated.

There is no blood test. A doctor diagnoses Peyronie's disease from your history and an examination of the penis. Photos taken at home at your firmest erection are part of the diagnosis in the Canadian guideline, and repeat photos are a simple way to track change1. Before any procedure, a specialist may give an injection in the clinic to produce an erection, measure the curve and sometimes check blood flow with ultrasound1.

Start with your family doctor or a nurse practitioner, who can refer you to a urologist. Not every urologist treats Peyronie's disease often, and the Canadian guideline says a referral on to one who does is entirely appropriate1.

Treatment depends on the phase, how much the curve affects sex, and how firm your erections are. Many men combine approaches, for example traction alongside injections1.

A traction device holds the penis in a gentle, steady stretch for hours at a time. Over weeks, the stretch is thought to remodel the scar tissue, the same idea used for Dupuytren's contracture in the hand. The Canadian guideline recommends traction as part of Peyronie's care, noting its low cost and few side effects1.

The trials behind it are encouraging. In a multicentre randomized trial, 80 men in the stable phase completed 12 weeks of either traction or no treatment. The traction group's curve fell by 31 degrees on average, a 41% improvement, and men who wore the device more than 6 hours a day did best, with an average drop of 38 degrees. Mild side effects such as local discomfort or numbness of the glans affected 43%7.

Traction also helped in the active phase. In 55 men who used a device for 6 months, the average curve fell from 33 degrees to 15, pain scores more than halved, and the share of men who could not have penetrative sex dropped from 62% to 20%. In 41 men who did not use one, the curve got worse11. A shorter-wear device of a different design was tested in a randomized trial of 110 men: 30 to 90 minutes a day for 3 months improved the curve in 77% of users12.

A vacuum erection device uses a cylinder and pump to draw blood into the penis. It is a standard treatment for erection problems, and some urologists also use it as a short daily stretch for Peyronie's disease. In a Canadian clinic, 20 men who used one for 10 minutes twice a day improved by 23 degrees on average, against 4 degrees in 33 men who did not8. The study was small and looked back at records, so treat it as encouraging rather than proven.

Injections go directly into the plaque, usually in the stable phase. The best-studied drug, collagenase (Xiaflex), reduced the curve by 34% compared with 18% on placebo in two large trials1. Its maker withdrew it from the Canadian market, so it is no longer an option here9. Verapamil is the injection most often used in Canada. Interferon is used less because of cost and flu-like side effects1.

Low-intensity shockwave therapy sends gentle acoustic pulses into the plaque from outside the body. It is done in a clinic over a few short sessions, with no needles or incisions. Both the Canadian and American guidelines support it for painful erections1,2.

A 2024 meta-analysis of 7 controlled studies and 475 men found that men treated with shockwaves were more likely to have their pain relieved and more likely to have it go away completely, 38 percentage points more often than without treatment. They were also 27 points more likely to see the plaque shrink. Slightly more men saw their curve improve too, though that result was borderline10.

Because its strength is pain relief, many clinics pair shockwave therapy with traction, which works on the curve. Read more about shockwave therapy for Peyronie's disease, or find a clinic that offers it.

Surgery gives the fastest and most predictable result, and is reserved for a stable curve that makes sex difficult. Plication shortens the long side to match the short side; it suits men with good erections and enough length. Grafting cuts into or partly removes the plaque and patches the gap; it suits severe or complex curves. A penile implant is used when erection problems are also present. Some surgeons add traction afterwards to help protect length1.

Vitamin E, tamoxifen and other pills have not been shown to help. Verapamil gel rubbed on the skin does not reach the plaque. Radiation and platelet-rich plasma (PRP) injections are not recommended1.

We think you should know. Most Peyronie's research is small, and the Canadian guideline describes the overall quality as low1. The traction trials used several different devices, worn for different lengths of time, and none of them tested the device we sell. A 2023 meta-analysis of randomized trials found a significant effect of traction on the curve, but not on length or erections13. Results depend on wearing the device for enough hours each day. That is a good reason to plan traction with a urologist who can measure your curve before and after.

Your urologist should set your plan. The outline below is typical, and it does not replace their advice or the device instructions.

These devices are used as part of a Peyronie's plan. They work best with a urologist's guidance.

Browse all Peyronie's disease and penile curvature products and erectile dysfunction devices.