Peyronie's Disease

Fibrous plaque causing penile curvature — assessment, non-surgical and surgical treatment

Note: This condition is often managed initially by a GP or other specialist. Dr Hadjipavlou accepts both GP referrals and self-referrals for complex or specialist cases. Please contact the secretary to discuss whether an appointment is appropriate.

Overview

Peyronie’s disease is a condition in which fibrous scar tissue (plaque) develops within the tunica albuginea — the fibrous sheath surrounding the erectile tissue of the penis. This plaque causes the penis to curve, shorten, or deform during erection, and may cause pain and difficulty with sexual intercourse.

The condition affects approximately 3–9% of men, with peak incidence in men aged 45–60, though it can occur at any age. It is not a cancer, is not contagious, and does not affect urination.

The exact cause is not fully established, but the leading theory is that repeated minor trauma or bending of the penis during sexual activity causes micro-injury at the tunica albuginea. In susceptible individuals, this triggers an abnormal healing response leading to fibrous plaque formation rather than normal tissue repair.

Peyronie’s disease is associated with Dupuytren’s contracture (thickening of the palmar fascia in the hand) in a proportion of men. A family history may be present.

Symptoms

Symptoms vary in severity and evolve over time. The main features include:

Penile curvature during erection — the most prominent feature; the direction and degree of curvature depend on the location and extent of the plaque
Penile pain — particularly during erection; most pronounced during the acute phase and tends to improve as the condition stabilises
Penile shortening — a common and distressing consequence of plaque formation and fibrosis
Deformity — including narrowing (waisting or hinging), which may make penetration difficult or impossible
Erectile dysfunction — may coexist, either due to the plaque itself affecting blood flow, or as a consequence of the psychological impact of the condition

The natural history is variable. The acute phase (active scarring) typically lasts six to eighteen months, during which pain and curvature may change. This is followed by the chronic (stable) phase.

Diagnosis

Diagnosis is clinical, based on history and examination. Investigations may include:

Penile ultrasound — visualises the plaque, assesses its location and calcification, and evaluates penile blood flow (arterial and venous function) using Doppler ultrasound; important in planning surgery
Photographs of erection — standardised photographs taken by the patient at home are used to document the degree and direction of curvature and monitor change over time
Erectile function assessment — using a validated questionnaire (IIEF) and, where indicated, pharmacological erection testing with duplex ultrasound

Treatment

Observation For mild, stable deformity that does not interfere significantly with sexual activity, observation without active treatment is appropriate. Many men choose this approach, particularly once they understand the natural history.

Non-surgical treatment

Intralesional collagenase clostridium histolyticum (CCH / Xiapex) — injections directly into the plaque that break down collagen fibres, reducing curvature; licensed for use in men with stable disease, measurable curvature, and without severe deformity; delivered as a series of injections paired with penile modelling exercises; not currently available in all healthcare settings
Oral medications — various agents have been studied (vitamin E, pentoxifylline, colchicine) but current evidence for efficacy is limited; they are not a substitute for injection therapy or surgery in significant disease
Vacuum erection therapy — may help with penile rehabilitation and length preservation but does not correct curvature

Surgical treatment Surgery is deferred until the chronic stable phase (curvature unchanged for at least three to six months, pain resolved). Options include:

Plication procedures (Nesbit / 16-dot) — sutures placed on the longer (convex) side of the penis to straighten the curvature; relatively straightforward with low complication rates, but results in some degree of penile shortening
Plaque incision or excision with grafting — for severe curvature or significant shortening; the plaque is incised or partially removed and the defect is covered with a graft (biological or synthetic)
Penile prosthesis implantation with modelling — the optimal approach for men with Peyronie’s disease and concurrent refractory erectile dysfunction; straightening of the penis is achieved at the time of prosthesis insertion

Frequently Asked Questions

: In some men, particularly during the acute phase, the condition may stabilise and pain may resolve without treatment. However, significant curvature rarely resolves spontaneously and often remains stable or worsens. Treatment is most effective when offered in the chronic (stable) phase, once the deformity has not changed for at least three to six months. Observation is a reasonable initial approach for mild deformity that does not interfere with sexual activity.
: The acute phase typically lasts six to eighteen months and is characterised by active scar formation, pain (particularly during erection), and potentially changing curvature. During this phase, the plaque and deformity are evolving. The chronic phase begins when the curvature has been stable for at least three to six months and pain has resolved or significantly reduced. Surgical correction is generally deferred until the chronic stable phase.
: Surgical options depend on the degree of curvature, penile length, and erectile function. For moderate curvature with preserved length and adequate erectile function, plication procedures (such as the Nesbit or 16-dot technique) shorten the longer side of the penis to straighten it. For severe curvature or when length preservation is important, grafting procedures replace the plaque with a patch to lengthen the shorter side. For men with both Peyronie's disease and refractory erectile dysfunction, a penile prosthesis with manual modelling of the curvature may be the approach of choice.

Need an assessment?

To arrange an appointment or discuss your situation, please contact the secretary.