PD in men most commonly refers to Peyronie’s disease, a condition where scar tissue forms inside the penis, causing it to curve or bend during erections. It affects an estimated 0.5% of adult men in the United States based on diagnosed cases, though the true number is likely higher since many men don’t seek treatment. Among men with erectile dysfunction, the rate climbs to nearly 8%.
What Happens Inside the Penis
The penis contains a tough, elastic layer of tissue called the tunica albuginea. In Peyronie’s disease, flat patches or bands of scar tissue (called plaques) build up inside this layer. These plaques don’t stretch the way healthy tissue does, so when the penis becomes erect and fills with blood, the scarred area can’t expand evenly. The result is a curve, bend, or indentation at the plaque site.
The curve can go upward, downward, or to either side depending on where the plaque forms. A doctor can often feel the hardened plaque through the skin whether the penis is erect or not. The condition is related to other connective tissue disorders. Men with Dupuytren’s contracture, which causes thickening and tightening in the palm of the hand, are more likely to develop Peyronie’s disease. There’s also evidence the condition may run in families.
What Causes It
The most widely accepted explanation is repeated minor injury to the penis during sex, physical activity, or even sleep. Most men never notice these micro-injuries because the tissue heals normally. In men who develop Peyronie’s disease, the healing process goes wrong. Instead of flexible tissue forming at the injury site, the body lays down rigid scar tissue that accumulates over time. Genetics, age, and individual differences in wound healing all play a role in why some men develop plaques and others don’t.
The Two Phases of the Disease
Peyronie’s disease progresses through two distinct stages, and knowing which phase you’re in matters because it affects treatment options.
The Acute Phase
This is the active, changing period. Plaques are forming and growing, curvature often worsens over time, and erections can become painful. Some men experience pain even without an erection early on, caused by inflammation around the developing scar tissue. Once the plaque solidifies, pain tends to shift to erections only, as the rigid scar gets pulled during arousal. This phase typically lasts up to 12 months but can stretch to 18 months.
The Chronic Phase
Starting around 12 to 18 months after symptoms first appear, the disease stabilizes. The plaque and curvature stop getting worse but generally don’t improve on their own either. Pain usually lessens or disappears entirely during this phase. However, erectile dysfunction can develop or worsen as the chronic phase sets in. Between 20% and 30% of men with Peyronie’s disease have erectile dysfunction that doesn’t respond to oral medications.
Symptoms to Recognize
The hallmark symptoms are a noticeable curve in the erect penis and a hard lump or band that you can feel under the skin. But Peyronie’s disease can show up in several ways:
- Curvature: a bend that wasn’t there before, sometimes subtle, sometimes severe enough to make intercourse difficult or impossible
- Palpable plaque: flat lumps or a ridge of hard tissue felt through the penile skin
- Pain: aching or sharp discomfort during erections, which typically improves within one to two years
- Shortening: the penis may become shorter as scar tissue contracts
- Erectile dysfunction: difficulty getting or maintaining erections firm enough for sex
- Indentation or narrowing: an hourglass shape where the plaque pinches the shaft
Not every man has all of these symptoms. Some notice only a mild curve with no pain, while others experience significant pain and difficulty with intercourse.
How It’s Diagnosed
Diagnosis starts with a physical exam and a detailed conversation about your symptoms: when the curve appeared, whether it’s changing, whether sex is affected, and whether there’s pain. A doctor can often confirm the diagnosis just by feeling the plaque through the skin. Before any invasive treatment, an injection that produces an erection in the office (sometimes combined with ultrasound imaging) is used to measure the exact degree and direction of the curve and assess blood flow.
Treatment Options
Treatment depends on how severe the symptoms are, whether the disease is still in the active phase, and how much the condition interferes with sex and quality of life. Many men with mild curvature and no pain don’t need treatment at all.
Injection Therapy
The only FDA-approved medication for Peyronie’s disease is an injectable enzyme (sold as Xiaflex) that breaks down the collagen in the scar tissue. It’s approved for men whose curvature exceeds 30 degrees. Treatment involves up to four cycles, each consisting of two injections spaced a few days apart, followed by a manual straightening procedure performed in the office. Cycles are spaced about six weeks apart. In clinical trials, men receiving the injections saw their curvature decrease by roughly 34% over a year, compared to about 20% improvement with placebo. If the curve drops below 15 degrees during treatment, additional cycles aren’t needed.
Traction Devices
Penile traction therapy uses a device worn on the penis for several hours a day to gently stretch the tissue. Research shows that men who use traction for three or more hours daily can gain a small but meaningful increase in stretched penile length. Traction is often used alongside injection therapy rather than as a standalone treatment.
Surgery
Surgery is reserved for the chronic phase, once the disease has stabilized and the curve is no longer changing. There are three main approaches, chosen based on the severity of curvature and whether erectile function is intact:
- Plication: shortening the longer side of the penis to straighten it. This is simpler and preserves erectile function but can reduce penile length slightly.
- Grafting: cutting into or removing the plaque and patching the area with tissue. This is used for more severe curvature and preserves more length, but carries a higher risk of new erectile difficulties.
- Penile implant: for men who have both significant curvature and erectile dysfunction that doesn’t respond to medication, a prosthetic device can address both problems at once.
The Psychological Impact
Peyronie’s disease affects more than physical function. Many men experience anxiety, embarrassment, depression, or relationship strain. The visible change in the penis, combined with pain and sexual difficulties, can erode confidence and lead men to avoid intimacy altogether. These psychological effects are a recognized part of the condition, not a separate problem, and they’re a valid reason to seek treatment even when the curvature itself is moderate.