Peyronie’s disease is treated based on which phase it’s in: the active phase, when the plaque is still forming and the penis may be painful, or the stable phase, when the curvature has stopped changing. During the active phase, treatment focuses on managing pain and slowing progression. Once the disease stabilizes, options range from injections to traction therapy to surgery, depending on how severe the curvature is and whether it interferes with sexual function.
Active Phase vs. Stable Phase
Getting the right treatment starts with understanding where you are in the disease’s timeline. The active phase is the inflammatory period when scar tissue (plaque) is forming inside the tough outer layer of the penis. During this phase, you may notice worsening curvature, new indentations or narrowing, and pain during erections or even at rest. This phase can last anywhere from a few months to over a year, though there’s no universally agreed-upon cutoff. Many clinicians consider the disease stable once symptoms have been unchanged for at least 3 to 12 months.
The stable (chronic) phase begins when inflammation subsides. Pain typically resolves on its own in most patients, and the curvature stops progressing. This is the point at which more aggressive treatments, including surgery, become appropriate. Jumping to invasive treatment while the disease is still active risks correcting a curvature that hasn’t finished changing.
What Doesn’t Work
A number of oral therapies have been studied and found ineffective for reducing curvature or plaque size. The American Urological Association specifically recommends against vitamin E, tamoxifen, omega-3 fatty acids, and the combination of vitamin E with L-carnitine. None of these have shown meaningful benefit in well-designed studies. Pentoxifylline, an oral medication that targets inflammation and scarring, has also fallen out of favor. A recent review found the scientific literature does not consider it sufficiently recommendable, partly because roughly 16% of patients experienced side effects involving blood pressure, circulation, or gastrointestinal problems.
Radiation therapy and a technique called electromotive therapy with verapamil (which uses electrical current to push medication into the plaque) are also recommended against. These carry risks without reliable benefit.
Pain Management in the Active Phase
If pain is your primary concern during the active phase, over-the-counter anti-inflammatory medications are a reasonable first step. The AUA supports offering oral NSAIDs for pain management during active disease. For most men, penile pain resolves naturally as the disease transitions to the stable phase, so treatment during this window is largely about comfort and monitoring.
Extracorporeal shockwave therapy (ESWT) has shown some ability to relieve pain. In one prospective study, pain ceased entirely in 70% of affected patients and decreased in another 5%, for an overall 76% pain improvement rate. However, the same study found no significant effect on plaque size or overall curvature. The AUA recommends against ESWT for the purpose of reducing curvature or plaque, so it’s best understood as a pain treatment only, not a correction for the bend itself.
Penile Traction Therapy
Traction devices apply a gentle, sustained stretch to the penis with the goal of reducing curvature and preserving length. Older protocols required wearing the device for three to eight hours daily for up to six months, which was a significant barrier for most men. A 2019 randomized controlled trial from Mayo Clinic tested a newer traction system (RestoreX) and found that using it for just 30 to 90 minutes daily over three months produced measurable results.
Traction therapy is often used alongside other treatments or as a standalone option for men who want to avoid surgery. It can also be used after surgery to help maintain penile length. The commitment is real, though. Consistency matters, and results tend to be modest rather than dramatic.
Surgical Options
Surgery is reserved for men with stable disease whose curvature significantly interferes with intercourse. Before any surgical procedure, your urologist will perform an in-office injection to produce an erection and precisely measure the curvature, sometimes combined with an ultrasound to assess blood flow and plaque characteristics.
There are three main surgical approaches, and the right one depends on the degree of curvature and the quality of your erections.
Plication (Shortening Procedures)
Plication works by placing stitches on the longer side of the penis to straighten it. It’s a fast, minimally invasive procedure best suited for men with mild to moderate curvature (typically under 60 to 70 degrees) and good erectile function. Compared to more complex surgeries, plication results in less perceived loss of rigidity and sensation. The trade-off is some degree of penile shortening on the longer side, which most men notice but many find acceptable given the simplicity and lower complication rate.
Recovery is quick. Most men return to work and normal activities within two to three days. Sexual activity of any kind, including masturbation, needs to wait a full six weeks.
Plaque Incision and Grafting
For more severe curvatures or complex deformities like hourglass narrowing, the surgeon cuts into or removes the plaque and patches the gap with a graft. This allows correction without shortening the longer side of the penis. However, comparative studies show that men who undergo grafting are more likely to experience loss of rigidity, reduced sensation, and difficulty with intercourse afterward compared to those who have plication. This approach is typically reserved for men with significant curvature who still have strong natural erections, since the procedure itself can affect erectile function.
Penile Implant
When Peyronie’s disease coexists with significant erectile dysfunction, a penile implant can address both problems at once. An inflatable prosthesis straightens the penis when inflated and can be combined with plication for curvatures between 30 and 90 degrees. Some surgeons use a technique called penile modeling, which involves manually bending the penis over the inflated implant to break through the plaque, though this carries a small risk of urethral injury and some clinicians consider it unreliable.
How Curvature Is Measured
Accurate measurement matters because it determines which treatments are appropriate. The gold standard is photographic documentation during a full erection. You can do this at home by photographing a natural erection from multiple angles (top, side, and base), which many urologists prefer as a starting point. In the office, an injection of a medication that triggers an erection gives the doctor a controlled, reproducible measurement. The European Association of Urology considers the injection method superior because it produces an erection comparable to or better than what occurs during arousal, giving a more accurate picture of the true curvature.
Choosing the Right Approach
The treatment path depends on a few key factors: whether the disease is still active or has stabilized, how severe the curvature is, whether you can achieve and maintain erections, and how much the condition interferes with intercourse or causes distress. During the active phase, the priority is pain control and monitoring. Once stable, the choice between traction, injection therapy, and surgery comes down to the degree of curvature and your erectile function.
Men with mild curvature that doesn’t prevent intercourse may not need any intervention at all. For moderate curvature with good erections, traction or plication offers a straightforward path. Severe curvature with good erections points toward grafting. And when erectile dysfunction is already in the picture, an implant addresses both issues simultaneously. Each option involves trade-offs between correction, sensation, length, and recovery, so the decision is highly individual.