Peyronie’s disease, a condition where scar tissue forms inside the penis and pulls it into a curve, is the most common cause of acquired penile bending, and it responds to several treatments backed by clinical evidence. Collagenase injections, traction therapy, shockwave treatment, and surgery can all reduce curvature, though which one fits depends on how severe the bend is, how long you’ve had it, and whether erectile function is affected. The condition is more common than most people realize, and the research on correcting it has advanced considerably in the past decade.
What Causes the Bend
Peyronie’s disease starts with damage to the tunica albuginea, the tough, fibrous sheath that surrounds the erectile tissue. The damage is usually from repeated minor trauma during sex, though many men don’t recall a specific injury. In response, the body lays down scar tissue, forming a hard plaque that doesn’t stretch the way normal tissue does. When the penis fills with blood during an erection, the plaque acts like a hinge, pulling the shaft toward the scarred side.1International Journal Of Medical Science And Clinical Research Studies. Understanding Peyronie’s Disease: From Microtrauma to Fibrotic Plaque Formation The result can be a curve in any direction, an hourglass narrowing, or a shortening of the erect penis, often accompanied by pain and difficulty with intercourse.
It’s worth noting that not every bent penis is Peyronie’s disease. Some men have congenital curvature, a condition present from birth that has nothing to do with scarring. Congenital curves are typically stable, painless, and only noticed once erections begin during puberty. The distinction matters because treatments are different. What follows focuses on Peyronie’s disease, since that’s the condition where curvature develops or worsens over time and where most treatment research has been done.
Why Timing Matters
Peyronie’s disease has two phases, and knowing which one you’re in shapes every treatment decision. The acute (active) phase usually lasts six to eighteen months from onset. During this time, pain is common, the plaque is still forming, and the curvature may still be changing. The stable (chronic) phase follows: the pain has resolved, and the curvature hasn’t changed for at least three months. Most urologists won’t recommend surgery during the active phase because the target is still moving. Injections and traction therapy, on the other hand, can begin earlier. One retrospective study found that collagenase injections were effective and safe in both phases, with no difference in curvature improvement or complication rates between men treated during the active phase and those treated in the stable phase.2PubMed Central. Acute Phase Peyronie’s Disease: Where Do We Stand?
Collagenase Injections
The only FDA-approved drug specifically for Peyronie’s disease is collagenase clostridium histolyticum, sold under the brand name Xiaflex. It’s an enzyme injected directly into the plaque that breaks down collagen, the main structural protein in the scar tissue. Treatment typically involves a series of injections given in cycles, with gentle penile modeling (a stretching maneuver) performed between injections.
The landmark clinical trial, known as IMPRESS, showed that men receiving collagenase injections had roughly a 34% reduction in curvature, with an average improvement of about 17 degrees, compared to about 9 degrees in the placebo group.3PubMed Central. Peyronie’s disease – outcomes of collagenase clostridium histolyticum injection: A systematic review A subsequent open-label study confirmed a similar degree of improvement, with curvature decreasing by about 34% from baseline by week 36, along with a meaningful reduction in the bother that men felt about their symptoms.4PubMed. Clinical safety and effectiveness of collagenase clostridium histolyticum injection in patients with Peyronie’s disease: a phase 3 open-label study
The injections are not without risk. Common side effects include bruising, swelling, and pain at the injection site. More serious but rare complications include corporal rupture, sometimes described loosely as a “penile fracture.” A large study of veterans found that among over 1,500 men who received at least one injection, about 0.7% experienced a corporal rupture, typically occurring around eight days after injection and usually triggered by an erection or sexual activity.5PubMed. Risk Factors for Penile Fracture After Intralesional Collagenase Clostridium histolyticum in Peyronie’s Disease There’s also been a case report of a dorsal penile artery being torn after injection, requiring surgical repair.6JU Open Plus. Dorsal Penile Artery Avulsion After Collagenase Clostridium histolyticum (Xiaflex) for Peyronie’s Disease: A Case Report These events are uncommon, but they’re the reason urologists tell patients to avoid sexual activity for a period after each injection.
Traction Devices
Penile traction therapy uses a mechanical device worn on the penis for a set number of hours each day. The concept is straightforward: sustained, gentle stretching over weeks or months remodels the scar tissue. Traction has been shown to improve curvature compared to baseline in some clinical series, and it may also help preserve or increase penile length, which is a concern many men have but few other treatments address.7PubMed Central. Penile traction therapy for Peyronie’s disease-what’s the evidence?
A systematic review and meta-analysis found that traction devices produced a significant improvement in curvature, but did not find a significant effect on penile length or erectile function when results were pooled across studies.8PubMed Central. The effect of penile traction device in men with Peyronie’s disease on penile curvature, penile length, and erectile dysfunction: a systematic review and meta-analysis That said, the most exciting evidence for traction may be when it’s combined with collagenase injections. A study comparing three groups found that men who used a specific traction device (RestoreX) alongside injections achieved about a 49% reduction in curvature and gained nearly 2 cm in length on average, far better than either injections or traction alone.9PubMed. Efficacy of Combined Collagenase Clostridium histolyticum and RestoreX Penile Traction Therapy in Men with Peyronie’s Disease The group using both treatments needed less than an hour of daily traction to get these results, compared to nearly two hours per day for men using traction without injections.
The downsides of traction therapy are mostly practical. Compliance is the biggest challenge. Wearing a device for an hour or more every day for months requires real commitment, and many men find it uncomfortable or difficult to fit into their routine. The devices are sold commercially and are not always covered by insurance.
Shockwave Therapy
Extracorporeal shockwave therapy, the same technology used to break up kidney stones (though at different energy levels), has been investigated for Peyronie’s disease. It works by directing focused pressure waves at the penile plaque. A single-arm observational study found significant reductions in plaque size, curvature, and pain after treatment.10PubMed Central. Extracorporeal Shock Wave Therapy in Peyronie’s Disease: Clinical Efficacy and Safety from a Single-Arm Observational Study A longer-term study using high-energy electromagnetic lithotripters reported that about three-quarters of patients became pain-free and roughly half experienced improvement in their curvature.11PubMed Central. Long-term experiences with high-energy shock wave therapy in the management chronic phase Peyronie’s disease using two different electromagnetic lithotripters
Where shockwave therapy excels is in pain relief. The evidence for curvature correction is more mixed, and many urologists view it as helpful for pain and plaque size but not a standalone solution for significant bends. It’s often used alongside other treatments or in the active phase when pain is the primary complaint. The American Urological Association has not given shockwave therapy a strong endorsement specifically for curvature correction.
When Surgery Makes Sense
Surgery is reserved for men whose disease has stabilized and who have curvature severe enough to interfere with sexual function. It offers the most reliable and immediate straightening, but it also carries the most significant trade-offs. There are three broad surgical approaches, and the choice depends on the degree of curvature, penile length, and whether erectile dysfunction is also present.
Plication Procedures
Plication is the simplest surgical option. Rather than removing or cutting into the plaque, the surgeon shortens the longer side of the penis opposite the curve, effectively evening things out. It’s best suited for men with curvatures that aren’t too extreme and who have adequate penile length to spare, because plication does shorten the penis modestly. The advantage is that plication carries minimal risk of causing new erectile problems and can be used for bends in multiple planes.12PubMed Central. Update on plication procedures for Peyronie’s disease and other penile deformities A large retrospective comparison of two common plication techniques found that complete straightening was achieved in roughly 88 to 90% of patients, with high satisfaction rates and low complication rates for both approaches.13PubMed. Comparison of Patient’s Satisfaction and Long-term Results of 2 Penile Plication Techniques: Lessons Learned From 387 Patients With Penile Curvature
Grafting Procedures
For men with more severe curvature, typically over 60 degrees, a short penis, or an hourglass deformity, grafting is the preferred approach. The surgeon cuts into or partially removes the plaque and patches the gap with a graft material, which can come from the patient’s own body (such as testicular tissue) or from processed animal tissue like bovine pericardium.14PubMed Central. Grafting techniques for Peyronie’s disease A comparative study found both graft types to be equally effective in correcting the deformity.15Asian Journal of Urology. Outcomes of surgical correction of Peyronie’s disease with plaque excision and grafting: Comparison of testicular tunica vaginalis graft versus bovine pericardium graft Grafting preserves more penile length than plication, but it carries a higher risk of affecting erectile function, which is why surgeons require that men have good erections before the procedure. Men with pre-existing erectile dysfunction are generally steered toward a penile prosthesis instead.
Penile Prosthesis
For men who have both Peyronie’s disease and erectile dysfunction that doesn’t respond to medication, an inflatable penile prosthesis solves both problems at once. The device provides rigidity for intercourse, and the inflation itself often straightens much of the curvature. When residual curvature remains after the prosthesis is placed, the surgeon can perform additional maneuvers like manual modeling or plication during the same procedure.16PubMed Central. Inflatable penile prosthesis placement in Peyronie’s disease: a review of surgical considerations, approaches, and maneuvers An older comparative study found that girth-expanding cylinders had better straightening properties, with all patients achieving complete correction from inflation and bending alone, while some patients with a different cylinder type needed an additional procedure.17PubMed. AMS 3-piece inflatable penile prosthesis implantation in men with Peyronie’s disease: comparison of CX and Ultrex cylinders
What About Pills
Men understandably want an oral medication they can take at home, and a number of pills have been tried for Peyronie’s disease over the years: vitamin E, potassium aminobenzoate (Potaba), colchicine, tamoxifen, and pentoxifylline, among others. The evidence for most of these is disappointing. The American Urological Association has not recommended most oral therapies for Peyronie’s, though a review noted that a couple of newer agents showed some promise during the acute phase.18PubMed Central. Oral therapy for Peyronie’s disease, does it work? In practice, many urologists still prescribe oral medications early in the disease, sometimes as a bridge while waiting for the condition to stabilize. Just don’t expect pills alone to straighten a significant curve.
Emerging Treatments on the Horizon
Researchers are actively exploring restorative therapies that aim not just to break down scar tissue but to help the body heal with normal tissue instead. Platelet-rich plasma (PRP), made by concentrating growth factors from your own blood and injecting them into the plaque, has been tested in a growing number of clinical trials. A large prospective study found that PRP injections reduced median curvature from 50 degrees to 40 degrees and shrank plaque size, with no adverse events reported.19PubMed. Platelet-rich plasma intra-plaque injections rapidly reduce penile curvature and improve sexual function in Peyronie’s disease patients: results from a prospective large-cohort study Stem cell therapy is at an earlier stage, with animal studies showing improvements in fibrosis and erectile function and some small human trials reporting reduced curvature and plaque size.20PubMed Central. Evidence of restorative therapies in the treatment of Peyronie disease: A narrative review These are promising directions, but neither PRP nor stem cells are standard of care yet, and more controlled trials are needed before they can be recommended broadly.
The Emotional Weight of Peyronie’s Disease
One of the most underappreciated aspects of penile curvature is how profoundly it affects mental health. Research consistently shows that about half of men with Peyronie’s disease experience depressive symptoms, and upward of 80% report significant distress related to the condition. Men describe themselves in strikingly harsh terms, feeling “abnormal,” “ugly,” or like a “half man,” and many lose the confidence to initiate sex or even talk about the problem with a partner or doctor.21PubMed Central. Psychological aspects of Peyronie’s disease A study of over 400 men seeking evaluation found that roughly 27% met a clinical threshold for depression, and those depressed men also scored worse on every measure of sexual self-esteem and disease-related bother.22PubMed Central. Predictors of Depression in Men With Peyronie’s Disease Seeking Evaluation
The impact extends to partners. Female partners of men with Peyronie’s disease report lower sexual function, satisfaction, and mood compared to population norms, with the degree to which the disease interferes with sex being the strongest predictor of how both partners are affected.23The Journal of Sexual Medicine. Female Partners of Men with Peyronie’s Disease Have Impaired Sexual Function, Satisfaction, and Mood, While Degree of Sexual Interference Is Associated with Worse Outcomes Encouragingly, treatment helps both people in the relationship. A study that tracked female partners before and after their partner’s surgery found significant improvements across every domain of sexual function, including desire, arousal, orgasm, and pain during intercourse.24PubMed Central. Peyronie’s disease may negatively impact the sexual experience of a couple and female sexual function: a single center study If you’re wrestling with whether treatment is “worth it,” the benefits clearly go beyond straightening alone.
Risk Factors and Related Conditions
Peyronie’s disease is fundamentally a fibrotic condition, and it doesn’t always exist in isolation. There’s a well-documented overlap with Dupuytren’s disease, a similar thickening of tissue in the hand that curls the fingers inward. In a study of men with Peyronie’s disease, about 29% also had Dupuytren’s, and among men initially treated for Dupuytren’s, roughly 12% turned out to have Peyronie’s as well.25The French Journal of Urology. When fibrosis intersect: Association and risk factors between Peyronie’s and Dupuytren’s diseases Separately, about a quarter of men with Dupuytren’s contractures reported symptoms consistent with Peyronie’s when specifically asked.26PubMed Central. Prevalence of Peyronie’s Disease-Like Symptoms in Men Presenting With Dupuytren Contractures High blood pressure, smoking, and daily alcohol consumption were all more common in men who had both conditions, suggesting shared vascular or inflammatory risk factors.25The French Journal of Urology. When fibrosis intersect: Association and risk factors between Peyronie’s and Dupuytren’s diseases If you have Dupuytren’s and notice changes in your erections, it’s worth mentioning both conditions to your doctor.
The Cost Problem
Even when effective treatments exist, getting them can be expensive. A study tracking treatment costs over a decade found that the average annual per-person cost of Peyronie’s disease treatment climbed from about $1,500 in 2007 to over $10,000 in 2018. The biggest driver was injectable therapy, whose per-person cost surged roughly 19-fold over that period.27PubMed Central. Peyronie’s Disease Treatment Trends and Cost Associated With Peyronie’s Disease Collagenase injections are particularly expensive because a full course requires multiple office visits and multiple vials of the drug. Insurance coverage for Peyronie’s treatments varies widely. A review of coverage policies found that differing reimbursement rates across treatment types can create real barriers, pushing some men toward treatments that happen to be covered rather than the treatment best suited to their condition.28PubMed Central. A review of Peyronie’s disease insurance coverage Surgery tends to be covered more consistently than injections, which is ironic given that injections are the less invasive option. If cost is a factor, it’s worth having a frank conversation with your urologist about which treatments are realistic within your insurance plan and what the out-of-pocket looks like for each approach.
How the Curve Is Measured
If you see a urologist about penile curvature, the evaluation typically involves a few components. You may be asked to bring photographs of your erect penis taken at home, since many men can’t achieve a full erection in a clinical setting. A goniometer, essentially a protractor, is used on the photographs to measure the angle of curvature.29Journal of Rehabilitation Therapy. Peyronie’s disease and the role of therapeutic ultrasound: A randomized controlled trial Ultrasound is the main imaging tool for evaluating the plaque itself, because it can identify even small or non-palpable lesions and show whether the plaque has calcified, which sometimes affects treatment choices.30PubMed Central. US Imaging in Peyronie’s Disease Questionnaires about erectile function and how much the disease bothers you are also part of the workup. The measurements matter because they set the baseline for tracking whether treatment is working, and the degree of curvature is one of the main factors guiding the choice between injections, traction, and surgery.