Peyronie’s disease is an abnormal curvature of the penis caused by the formation of fibrous scar tissue (plaques) within the tunica albuginea, the elastic layer of the penile tissue. These plaques cause the penis to bend in a certain direction during erection. First described in 1743 by François Gigot de la Peyronie, this condition can lead to physical, psychological, and sexual dysfunction in men.
The main symptom of Peyronie’s disease is penile curvature during erection. Additional symptoms may include pain, palpable hard plaques in the penis, shortening of penile length, difficulty during sexual intercourse, and erectile dysfunction. The curvature may be upward, sideways, or in rare cases downward. In some patients, deformities such as a “hourglass” or “waisting” appearance of the penis may also develop.
Trauma-Related Causes: Repeated or microtraumas to the penis—often during sexual activity—can cause damage to the tunica albuginea. During the healing process, instead of normal elastic tissue, dense collagen fibers form, leading to plaque development and curvature. Many patients do not recall a specific injury, as these microtraumas may occur at a subtle level.
Genetic and Age Factors: Research suggests a genetic predisposition to Peyronie’s disease. Certain genetic markers such as HLA-B7 have been associated with the condition. In addition, with aging, reduced tissue elasticity and impaired healing mechanisms increase the risk of plaque formation.
Relationship with Erectile Dysfunction: Erectile dysfunction is seen in approximately 30–50% of patients with Peyronie’s disease. Plaques may restrict blood flow or impair normal penile rigidity. This can further increase psychological stress and negatively affect sexual function.
Peyronie’s disease is more commonly seen in men over the age of 40, although it can occur at any age. As age increases, connective tissue elasticity decreases, microvascular circulation deteriorates, and healing capacity declines. This creates a tendency for fibrosis rather than normal tissue repair after minor trauma.
Studies show a prevalence of 6% to 10% in men aged 50 to 60. However, this rate may exceed 20% among men seeking medical help for sexual dysfunction.
Genetic predisposition is also an important risk factor. Peyronie’s disease has been associated with other fibrotic conditions such as Dupuytren’s contracture (fibrosis of the palm),Ledderhose disease (plantar fibromatosis),and nodular formations in ear cartilage. Men with these conditions have a significantly increased risk of developing Peyronie’s disease.
Additionally, conditions that impair vascular health—such as diabetes, hypertension, dyslipidemia, and smoking—may contribute to the development of Peyronie’s disease.
Physical Examination: A urologist may detect palpable plaques in the penis during a physical examination. The degree and direction of penile curvature are assessed during erection.
Ultrasound and Imaging Methods: Penile ultrasonography is used to determine the location, size, and presence of calcification within plaques. In addition, penile Doppler ultrasound helps evaluate erectile dysfunction and penile blood flow.
The treatment approach for Peyronie’s disease depends on the severity of curvature, duration of the disease, presence of pain, and its impact on sexual function.
Treatment options are divided into two main categories: surgical and non-surgical (conservative) methods. In the early stage of the disease—typically within the first 12–18 months—when curvature and plaque characteristics are still evolving, non-invasive treatments are preferred. During this period, anti-inflammatory medications aim to slow plaque progression, reduce plaque development, or soften the plaque tissue to reduce curvature.
Among physical therapy-based approaches, penile traction devices play an important role. Clinical studies have shown that regular use of these devices may partially improve curvature and help preserve penile length. Low-intensity extracorporeal shockwave therapy (LI-ESWT) may help reduce pain in some patients; however, its effect on curvature correction is limited.
Surgical treatment is considered once the disease has stabilized and conservative treatments are insufficient. The direction and severity of curvature, as well as erectile function status, determine the choice of surgery. For mild to moderate curvature, techniques such as plication or the Nesbit procedure are used to straighten the longer side of the penis. In more severe deformities or complex cases, plaque excision with grafting may be performed. In patients with coexisting erectile dysfunction, penile prosthesis implantation is considered the most effective solution.
Treatment for Peyronie’s disease should be individualized. Non-invasive and medical therapies are prioritized in the early stage, while surgical intervention is considered for stable and severe curvature. A multidisciplinary approach is essential for both physical and psychological well-being.
Shockwave Therapy (ESWT): Low-intensity shockwave therapy is a non-invasive method used to soften plaques and reduce pain. However, its effect on correcting curvature is limited and it is mainly used in early stages.
Surgical Treatment: Surgery is indicated in cases where conservative treatments fail, curvature exceeds 60 degrees, or sexual intercourse becomes impossible. Options include the Nesbit procedure, plaque excision with grafting, or penile prosthesis implantation.
Vacuum Devices and Exercise Methods: Penile traction devices and vacuum erection devices may be used to preserve penile length and reduce curvature. Clinical studies suggest that these methods may provide partial improvement over time.
Yes. Especially during the acute phase, which lasts approximately 6–18 months, penile curvature and plaque formation may progress. Pain is also common during this period. Once the disease reaches the stable phase, the curvature usually stops changing and becomes fixed.
Peyronie’s disease can significantly affect sexual life both physically and psychologically. One of the most common issues is difficulty or pain during intercourse due to penile curvature, which may make penetration challenging or even impossible in severe cases. This can also cause discomfort for the partner.
In addition, erectile dysfunction that may accompany Peyronie’s disease can negatively affect sexual performance and desire.
Beyond physical symptoms, psychological effects are often profound. Concerns about penile appearance may reduce self-confidence and lead to anxiety, depression, and relationship difficulties. Over time, reduced sexual performance and emotional distress may result in decreased libido and emotional distancing between partners.
Overall, Peyronie’s disease is not only a physical deformity but a complex condition affecting sexual health, relationships, and psychological well-being. Therefore, treatment should address the condition in a holistic and multidisciplinary way.
If left untreated, penile curvature may worsen in some cases, leading to permanent deformity and erectile dysfunction. In severe cases, sexual intercourse may become impossible.
Yes, although it is less common, Peyronie’s disease can occur in younger men. Trauma during sports or vigorous sexual activity is often a contributing factor in these cases.
Clinical studies suggest that spontaneous improvement occurs in only about 10–13% of cases. Therefore, a wait-and-see approach is generally not recommended, especially if the curvature is progressing.
Severe penile curvature can make penetration difficult or impossible. When combined with erectile dysfunction, sexual activity may be significantly impaired, affecting overall sexual quality of life.
Yes. Depending on the degree and direction of curvature, Peyronie’s disease may cause discomfort or pain for the partner during intercourse.
There is no scientific evidence that massage can correct penile curvature or plaque formation. Uncontrolled or excessive manipulation may even worsen the condition.
Peyronie’s disease does not affect sperm production. However, severe curvature or erectile dysfunction may make natural conception difficult. In such cases, assisted reproductive techniques may be considered.
Prof. Dr. Levent PeşkircioğluUrology & Andrology
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