What is not Peyronie's disease?

A bend that appears suddenly during intercourse, especially with an audible crack or pop followed by pain and rapid swelling, is a penile fracture. That is a surgical emergency and needs repair the same night, not an outpatient appointment. A curve present since adolescence is congenital curvature, a different condition. A lump that is growing, ulcerating or bleeding needs assessment in its own right rather than being assumed to be plaque.

Does Peyronie's disease ever improve on its own?

Pain during the active phase settles on its own in most men, and a minority see the curve itself improve, but complete resolution is uncommon. Most curves stabilise rather than progress. Observation is a legitimate choice: the decision to treat is driven by whether the curve interferes with intercourse or causes distress, not by the measured angle alone.

How effective is collagenase clostridium histolyticum injection therapy?

The IMPRESS trials demonstrated approximately 30 to 40% improvement in curvature with a structured four-cycle injection regimen, and it is most studied in stable curvature between 30 and 90 degrees without hourglass deformity. Results vary between patients. If you are interested in collagenase, email the Urology department at bhquro@bdms.co.th to enquire first.

Are intralesional verapamil or hyaluronic acid offered here?

No. Intralesional verapamil and hyaluronic acid appear in the international literature but are not among the injections performed at Bangkok Hospital Headquarters. A referral can be arranged if they are appropriate for you.

Peyronie's Disease Treatment Bangkok

Q: When is surgery recommended for Peyronie's disease?

Surgery is considered when the disease has stabilised, typically after 12 months, the curvature is significant, intercourse is functionally impaired, and the patient has not responded to or has declined medical therapy. A curve you can live with is not on the surgical list. The choice of procedure depends on severity and on erectile function.

Q: Will surgery shorten the penis?

Penile plication may result in some shortening. Grafting preserves length but carries a higher risk of postoperative erectile dysfunction and reduced sensation in the glans. The realistic goal of either operation is straight enough for comfortable intercourse, not perfectly straight.

Q: Is Peyronie's surgery permanent?

Correction performed during the stable phase lasts for most patients, but it is not a guarantee. A residual bend is normal rather than a failure, palpable knots may persist after plication, and a small number of men need revision surgery. A penile prosthesis gives definitive correction when severe erectile dysfunction is present as well, but implantation is irreversible and carries risks of infection and later revision.

Q: How long is recovery after Peyronie's surgery?

Most patients return to non-strenuous activity within one to two weeks, and sexual activity is typically restricted for six to eight weeks to allow healing. Full results are evident at three to six months. Increasing pain, spreading redness, fever, discharge or worsening swelling after surgery should be reported the same day rather than waited out.

Peyronie’s Disease Treatment in Bangkok

Comprehensive medical and surgical management of Peyronie’s disease (penile curvature) — from collagenase injections and traction therapy to penile plication and grafting surgery — at Bangkok Hospital Headquarters.

Medically reviewed by Dr. Soarawee Weerasopone, MD — Board-Certified Urologist · Research Scholar & Clinical Observer, Scott Department of Urology, Baylor College of Medicine

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What Is Peyronie’s Disease?

Peyronie’s disease is a connective tissue disorder characterized by the formation of fibrous scar tissue (plaque) within the tunica albuginea of the penis. This plaque causes curvatura anomala del pene, often with pain, shortening, narrowing, or erectile dysfunction. It affects an estimated 3–9% of men, with peak incidence in the 50s and 60s.

Two Clinical Phases

Acute (Active) Phase — first 6–18 months. Characterized by pain with erection, progressive deformity, and ongoing plaque formation. Best window for medical therapy.
Chronic (Stable) Phase — after 12–18 months. Plaque calcifies, curvature stabilizes, pain typically resolves. Surgical correction becomes the primary option.

Identifying which phase you are in determines the entire treatment plan and its timing. Read the full overview of Peyronie’s disease, including risk factors such as diabetes, low testosterone, and Dupuytren’s contracture.

Sintomi

Visible penile curvature (upward, downward, or lateral)
Palpable hard nodule or plaque along the shaft
Pain during erection (acute phase)
Penile shortening or narrowing (“hourglass” deformity)
Erectile dysfunction — occurring in 30–80% of Peyronie’s patients
Psychological distress, relationship difficulties

That last point deserves more than a bullet. Distress, low mood and avoidance of intimacy are documented in a large share of men with this condition, and they are a legitimate part of what is being treated rather than an overreaction to a physical problem. It is worth raising in consultation.

What Peyronie’s Disease Is Not

A sudden bend that appears during sex is a different problem and a genuine emergency. If there was a cracking or popping sound, immediate pain, rapid swelling and bruising, and the penis bent or went limp straight away, that is a suspected penile fracture — a tear of the same tunica albuginea — and it needs an emergency department the same night. Surgical repair within the first hours gives far better results than delayed treatment, and delay risks permanent curvature and erectile dysfunction. Peyronie’s disease, by contrast, develops gradually over weeks to months.

Two other things to exclude rather than assume: a natural curvature present since adolescence is congenital penile curvature, which behaves differently and is managed differently; and a hard lump that is growing, ulcerating or bleeding is not a plaque and needs assessment in its own right.

Valutazione diagnostica

Accurate staging is critical — the right treatment depends on disease phase and severity.

Detailed history — onset, progression, pain, sexual function impact
Physical examination — plaque palpation and mapping
Photographic curvature assessment with at-home erection photos or in-clinic ICI-induced erection
Penile Duplex Ultrasound — plaque measurement, vascular assessment, exclusion of concurrent disfunzione erettile
Standardized questionnaires — PDQ (Peyronie’s Disease Questionnaire), IIEF-5

Where an injection is used in clinic to produce an erection for assessment, the same rule applies as for any intracavernosal injection: an erection lasting more than four hours needs emergency care, and you are told this before you leave.

Opzioni di trattamento

Acute Phase — Medical Therapy

Oral therapy — Pentoxifylline, L-Carnitine, Vitamin E (limited evidence but widely used)
Intralesional Collagenase Clostridium Histolyticum (CCH / Xiaflex) — FDA-approved injectable treatment that breaks down collagen in the plaque. Studies show 30–40% improvement in curvature. If Xiaflex is something you are interested in, please email the Urology department at bhquro@bdms.co.th to enquire first.
Verapamil intralesionale — alternative injectable option for select patients
Penile Traction Therapy — mechanical devices used 2–8 hours daily; particularly effective combined with injections
Low-Intensity Shockwave Therapy — reduces plaque pain, less effective on curvature itself

A word on what does not work. Vitamin E and the other oral options are widely used precisely because they are harmless, not because the evidence is strong — expectations should be set accordingly. Creams, supplements and devices marketed online for “straightening” are unproven, and manual attempts to bend or stretch the penis without a prescribed traction protocol risk making the scarring worse rather than better.

Chronic Phase — Surgical Options

Penile Plication — minimally invasive correction of curvature by shortening the convex (opposite) side. Best for curvature less than 60° with adequate penile length and good erectile function.
Plaque Excision/Incision and Grafting — the plaque is excised or incised, and the defect is repaired with a graft (porcine SIS, dermal, or synthetic). Preferred for severe curvature, hourglass deformity, or short penile length.
Penile Prosthesis with Modeling — for patients with both severe Peyronie’s disease and refractory erectile dysfunction. Provides definitive correction of curvature and ED in one procedure. Scopri di più su IPP →

What Surgery Costs You — the Honest List

All three operations correct the deformity reliably. None of them is free of trade-offs, and these are discussed before consent rather than afterwards:

Shortening — expected with plication, usually under 1–2 cm. Grafting preserves length instead.
Erectile dysfunction after grafting — a recognised risk, which is why grafting is generally reserved for men whose erections are good to begin with, and why a man with poor erections is usually better served by a prosthesis.
Altered sensation — numbness of the glans can follow either operation and usually, but not always, recovers over months.
Palpable sutures or a residual bend — a small residual curvature is common and is not the same as failure; correction aims for a penis straight enough for intercourse rather than geometric perfection.
Prosthesis-specific — implantation removes the natural erectile tissue and is not reversible, and carries the risks of infection and later revision.

Recovery is discussed below, but one instruction matters more than the rest: seek care the same day for fever, spreading redness, a rapidly swelling or blackening wound, or inability to pass urine after surgery.

Why Choose Dr. Soarawee for Peyronie’s Treatment

🎓 Observership at Baylor College of Medicine under Prof. Mohit Khera — a world authority on Peyronie’s disease management
🌐 Familiar with global treatment protocols including Xiaflex (CCH) injection therapy and modern grafting techniques
🔬 Competenza in ecografia Doppler peniena — essential for accurate plaque mapping and pre-surgical planning
🏥 Ospedale di Bangkok Sede Centrale — internationally accredited surgical facility
🔒 Massima discrezione — confidential consultation in a stigma-free environment
📊 Comprehensive approach — evaluating concurrent ED and treating both conditions in coordinated care

Domande frequenti

Q1: What causes Peyronie’s disease?

The exact cause is unclear, but most cases follow repetitive microtrauma during sexual activity in genetically susceptible men. Risk factors include diabetes, connective tissue disorders (Dupuytren’s contracture), prostate surgery, and aging. It is not caused by sexually transmitted infection.

Q2: My penis bent suddenly during sex with a popping sound. Is that Peyronie’s?

No — that description suggests a penile fracture, which is a surgical emergency rather than Peyronie’s disease. A crack or pop, immediate pain, rapid swelling and bruising, and loss of the erection point to a tear in the tunica albuginea. Go to an emergency department the same night: repair within the first hours gives far better results, and delay risks permanent curvature and erectile dysfunction. Peyronie’s disease develops gradually over weeks to months instead.

Q3: Can Peyronie’s disease resolve on its own?

Spontaneous improvement occurs in less than 15% of cases, and complete resolution is rare. Most cases stabilize or progress without treatment. Early intervention during the acute phase offers the best chance of preventing severe deformity.

Q4: How effective is Xiaflex (collagenase) injection therapy?

The IMPRESS trials demonstrated approximately 30–40% improvement in curvature with a structured 4-cycle injection regimen. It is most effective for stable curvature between 30° and 90° without hourglass deformity. Results vary by patient. If Xiaflex is something you are interested in, please email the Urology department at bhquro@bdms.co.th to enquire first.

Q5: Do the creams and supplements sold online work?

No. There is no evidence that topical creams or oral supplements marketed for penile straightening alter an established plaque. Vitamin E, pentoxifylline and L-carnitine are used because they are harmless rather than because the evidence is strong. Manual stretching or bending outside a prescribed traction protocol is not harmless and can worsen the scarring.

Q6: When is surgery recommended for Peyronie’s disease?

Surgery is considered when the disease has stabilized (typically after 12 months), curvature is significant (greater than 30°), there is functional impairment of intercourse, and the patient has not responded to or declined medical therapy. The choice of procedure depends on the severity and the patient’s erectile function.

Q7: Will surgery shorten the penis?

Penile plication procedures may result in some shortening, typically less than 1–2 cm. Grafting procedures preserve length but carry a higher risk of postoperative erectile dysfunction. Numbness of the glans and a small residual bend are also possible after either operation. The choice involves balancing these trade-offs, which is discussed thoroughly during consultation.

Q8: Is Peyronie’s surgery permanent?

Yes, surgical correction provides lasting results in the vast majority of patients. Recurrence is uncommon when surgery is performed during the stable phase. Penile prosthesis with modeling provides definitive correction for patients with concurrent severe ED, though implantation is not reversible.

Q9: How long is recovery after Peyronie’s surgery?

Most patients return to non-strenuous activity within 1–2 weeks. Sexual activity is typically restricted for 6–8 weeks postoperatively to allow complete healing. Full results are evident at 3–6 months. International patients can return home within 7–10 days of surgery. Seek care the same day for fever, spreading redness, a rapidly swelling or blackening wound, or inability to pass urine.

Q10: Can I have a telemedicine consultation first?

Yes, through Bangkok Hospital. Telemedicine is available for patients who cannot attend in person, including international patients, and is arranged in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only. Plaque examination, penile duplex ultrasound and surgery all require an in-person visit, and a sudden injury is never a telemedicine matter.

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Don’t let Peyronie’s disease define your quality of life. Effective treatment is available.
All consultations conducted with complete discretion and privacy.

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. Samitivej Sriracha is in-person only.

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Samitivej Sriracha — Chiama 088-022-1445

This page is provided for patient education only and is not medical advice. It does not create a doctor-patient relationship. A sudden bend with a popping sound during sex is a suspected penile fracture and needs emergency care the same night. Dr. Soarawee does not provide medical assessment, advice, diagnosis or prescriptions through personal messaging channels, direct messages or social media.