Peyronie’s Disease: Why the Penis Bends, and What Can Be Done About It

Last updated: August 29, 2026

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Peyronie’s disease is scar tissue forming in the wall of the erectile bodies, producing a bend on erection, a palpable lump, and often pain. It was described by François Gigot de la Peyronie in 1749, and men still find it as difficult to raise now as they did then — which is why the true prevalence is uncertain, with estimates ranging widely and the higher ones coming from anonymous self-report rather than examination.

The distress it causes is out of proportion to how it reads on paper, and that distress is a legitimate part of the condition rather than an overreaction to it. It frequently occurs alongside erectile dysfunction, and which of the two is the dominant problem changes the whole plan.

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The two phases, and why they decide everything

1. The active phase, usually the first six to eighteen months. The plaque is still forming, the bend is still changing, and pain — particularly with erection — is the dominant complaint.
2. The stable phase. Pain has gone, and the curvature has stopped changing.

Two things follow, and the second was missing from the earlier version of this article.

Surgery is not performed during the active phase. Operating on a deformity that is still changing produces an unreliable result, so correction waits — conventionally until the disease has been stable and pain-free for several months and around a year has passed since onset.

And: the pain resolves by itself in most men as the disease stabilises, whether or not anything is done about it. That matters when judging any treatment offered during the painful phase — improvement may be the natural course rather than the treatment — and it is genuinely reassuring for a man in the middle of it. The curvature is different: left alone it stays the same in most men, improves in a minority, and worsens in some. It does not reliably resolve the way the pain does.

What raises the risk

• Injury to the erect penis — most often during intercourse, sometimes without the man registering it at the time. Also perineal trauma and, occasionally, instrumentation.
• Connective tissue conditions, particularly Dupuytren’s contracture of the hand, which shares the same scarring behaviour and is worth asking about.
• Family history, which appears to increase susceptibility after injury.
• Diabetes, which impairs healing generally and is reported more often in men with the condition.
• Low testosterone — inconsistently reported alongside more significant disease. A systematic review of six studies found five supporting an association and one finding none, and studies since then still disagree. It is worth measuring, for the reason given in the next section, but it is not an established cause.
• Smoking, alcohol and increasing age — associations rather than established causes.

The earlier version gave a five-fold figure for diabetes and a precise testosterone threshold. Those have been softened to the direction of the association, which is what the data supports.

A correction: the oral supplements are not recommended

This is the most important change to this page.

The earlier version stated that NSAIDs, oral vitamin E and omega-3 are recommended per American Urological Association guidelines, with a photograph captioned to the effect that oral medications show benefit. The guideline says the opposite. Oral vitamin E and omega-3 are among the treatments urologists are advised not to offer for Peyronie’s disease, because trials found them no better than placebo.

That statement has been removed. It matters beyond the supplements themselves: a man who takes vitamin E for a year in the belief that it is guideline-recommended has spent the window in which the disease was still modifiable doing nothing.

Simple painkillers for pain during the active phase remain reasonable. That is pain relief, not treatment of the disease.

Low testosterone: what it does and does not change

This section is new, and it exists because the obvious inference from the risk list above turns out to be wrong.

If low testosterone travels with more significant Peyronie’s disease, it seems natural to conclude that correcting it should help the curvature. There is no established evidence that it does.

The most directly relevant work is a 2026 multicentre analysis in The Journal of Sexual Medicine from the group I worked with at Baylor College of Medicine, looking at men treated with collagenase injections. Men with testosterone deficiency saw less improvement in curvature than men without it — and, importantly, giving testosterone therapy did not change that: among the deficient men, those who received it did no better than those who did not.

Two practical points follow, and they pull in different directions, which is why it is worth measuring testosterone rather than ignoring it.

• It is useful for setting expectations. A man with low testosterone considering a course of collagenase should know that his likely gain in straightness is smaller, before he commits to months of injections.
• It is not a reason to start testosterone in the hope of straightening the penis. Testosterone therapy is treatment for symptomatic testosterone deficiency on its own merits — low libido, fatigue, erectile symptoms — and it carries its own trade-offs, including suppression of sperm production. Those merits are the reason to consider it, discussed in low testosterone: what the evidence actually supports. Curvature is not.

What does address the curvature

• Injection into the plaque. Collagenase has the best evidence for reducing curvature in stable disease within a defined range of severity; other injectable agents have weaker support. This is a course of treatment over months rather than a single procedure, and as above, a low testosterone level predicts a smaller gain.
• Traction therapy, which was absent from the earlier version. It demands real persistence — hours a day over months — and is often combined with injection rather than used alone.
• Surgery in stable disease: shortening the opposite side, or grafting the affected side. It is the most reliable way to straighten, and its trade-offs are real — loss of length, altered sensation, and a risk to erectile function, particularly with grafting.
• A penile implant, where erectile dysfunction and curvature coexist and the erection is the limiting problem — this addresses both at once and is often the right answer for that man rather than a last resort.
• Shockwave therapy has a place, and it is a narrow one: it may relieve penile pain but is not used to reduce curvature.

Which applies depends on the phase, the degree and direction of the bend, whether erections are adequate, and what actually bothers you — a man untroubled by a modest bend needs no correction at all. Assessment involves examining the penis both flaccid and erect and measuring the curvature, since a described bend and a measured one are frequently different. See Peyronie’s disease treatment for how staging and measurement are carried out.

What treatment can realistically achieve

No treatment restores the penis to exactly how it was, and men told otherwise are being misled. The realistic aim is straight enough for satisfactory intercourse, with pain resolved and erections adequate. Set against that, most men do well — and setting the expectation early is most of the work.

Symptoms that need attention rather than a routine appointment

In an emergency in Thailand, call 1669.

• A sudden cracking or popping sensation during intercourse with immediate pain, swelling and loss of the erection. That is a penile fracture and needs emergency surgical assessment the same night — a different event from Peyronie’s disease, though it can lead to it.
• An erection lasting more than four hours.
• A penile lump that is ulcerating, bleeding or growing quickly — not the behaviour of a Peyronie’s plaque.
• Curvature appearing over days rather than months, or in a young man, which warrants prompt assessment rather than watchful waiting.

Frequently Asked Questions About Peyronie’s Disease

Should I take vitamin E or omega-3 for it?

No. An earlier version of this article said these were recommended under AUA guidelines; the guideline in fact advises against offering them, since trials found no benefit over placebo. Painkillers for pain during the active phase are reasonable, but that is pain relief rather than treatment of the disease.

Will the pain go away?

In most men, yes — it resolves on its own as the disease moves into the stable phase, whether or not treatment is given. The curvature behaves differently: left alone it usually stays as it is, improves in a minority and worsens in some.

I have low testosterone as well. Will treating it straighten the bend?

No — there is no established evidence that it does. A 2026 multicentre study of men treated with collagenase found that those with testosterone deficiency improved less than those without, and that giving testosterone therapy did not change that outcome. The level is still worth measuring, because it helps set realistic expectations before committing to months of injections. But testosterone therapy is considered on its own merits — symptomatic deficiency with low libido, fatigue or erectile symptoms — and not as a treatment for curvature.

When can I have surgery?

Once the deformity has been stable and pain-free for several months, conventionally with around a year having passed since onset. Operating while the curvature is still changing gives an unreliable result. The trade-offs — length, sensation, and a risk to erectile function — are discussed beforehand.

I have curvature and poor erections. Which is treated first?

They are considered together, because straightening a penis that will not become rigid does not solve the problem. Where erectile dysfunction is the limiting factor, a penile implant addresses both at once, and for that man it is the appropriate operation rather than a last resort.

Does it turn into cancer?

No. Peyronie’s disease is a scarring condition and is not malignant. A lump that ulcerates, bleeds or grows quickly is behaving differently and should be examined.

Will any treatment make it exactly as it was?

No, and it is better to hear that early. The realistic aim is a penis straight enough for satisfactory intercourse, with pain resolved and adequate erections.

Arranging a consultation

Dr. Soarawee Weerasopone completed an andrology fellowship at Chang Gung Memorial Hospital Kaohsiung, Taiwan, where Peyronie’s disease and penile prosthetic surgery formed a substantial part of the training. He sees patients at Bangkok Hospital Headquarters and at Samitivej Sriracha Hospital in Chonburi on 088-022-1445. It helps to note roughly when the bend started and whether it is still changing — that, more than anything, determines what can be offered.

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. Assessment requires examining the penis both flaccid and erect, so an in-person visit is needed before treatment is planned. Samitivej Sriracha is in-person only. Enquiries about cost are answered by the hospital, not by this website.

References

• Hernandez BS, Walia A, Coady P, et al. Impact of testosterone therapy and hypogonadism on treatment outcomes in Peyronie’s disease: a multicenter retrospective analysis of collagenase Clostridium histolyticum therapy. J Sex Med. 2026;23(7):qdag185.
• Aditya I, Grober ED, Krakowsky Y. Peyronie’s disease and testosterone deficiency: is there a link? World J Urol. 2019;37(6):1035–1041.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters, and is intended for education only. It is not medical advice, diagnosis or a prescription for any individual, and no advice, diagnosis or prescription is given through personal messaging channels or social media. Dr. Soarawee operates no public social media account; any account offering private consultation in his name is fraudulent. In an emergency in Thailand, call 1669.