Peyronie's Disease

Peyronie's disease (induratio penis plastica) is a benign but often disabling connective-tissue disorder of the erectile envelope of the penis (the tunica albuginea). First described by François Gigot de La Peyronie in 1743, it is characterised by the formation of a fibrous plaque that impairs the extensibility of the tunica and leads to an acquired penile curvature.

Contemporary epidemiological studies estimate its prevalence between 3 and 9% of the adult male population, with a marked increase after 50 years of age and in men with diabetes. It is therefore far more common than once thought, which justifies better public information and specialised care.

Peyronie's disease is an acquired disorder in which a fibrous plaque forms inside the tunica albuginea of the penis. Because this plaque is stiffer than the surrounding tissue, the penis bends toward it during erection, producing a curvature that may be associated with pain, shortening or erectile dysfunction.

To understand the disease, one first needs the anatomy. The penis contains two corpora cavernosa (responsible for erection) and a corpus spongiosum (around the urethra). The corpora cavernosa are wrapped in a resistant fibrous membrane — the tunica albuginea — primarily made of type I and III collagen. By distending uniformly during erection, this envelope gives the penis its rigidity.

In Peyronie's disease, a fibrous plaque develops within the tunica. Being stiffer than normal tissue, it loses the ability to extend during erection: as the opposite side continues to stretch normally, the penis deforms into a curvature. The plaque may also calcify and become palpable as an induration under the skin.

Peyronie's plaque is a localised form of penile-tissue fibrosis. For a detailed analysis at the level of the tunica and cavernous bodies, see our dedicated dossier on penile fibrosis.

Longitudinal anatomy

Transverse cross-section

The most common symptoms of Peyronie's disease are penile curvature during erection, penile pain (mainly in the active phase), a palpable plaque on the shaft, penile shortening and, in some patients, erectile dysfunction. Severity varies widely from one man to another.

Early signs to recognise

Early signs of Peyronie's disease can be subtle. Recognising them early makes it possible to start care during the active phase, when several treatments are most effective.

Penile pain: what to know

Pain is one of the first signs reported by patients, occurring mainly during the active phase, on erection, and occasionally at rest. Intensity varies from mild discomfort to a level marked enough to cause sexual avoidance. Importantly, pain does not reflect the severity of the curvature: some patients have a pronounced curvature without pain, while others suffer more with a moderate curvature.

In the vast majority of cases, pain regresses spontaneously as the disease enters the stable phase, which can take several months. Persistence of pain beyond 18 months is less common. If pain significantly affects quality of life, a urologist can propose specific management, especially during the active phase.

Peyronie's disease is thought to result from an abnormal wound-healing response after repeated microtrauma of the tunica albuginea, most often during intercourse. Chronic inflammation, oxidative stress, a genetic background and vascular or metabolic comorbidities appear to amplify the fibrotic response. No single cause has been demonstrated to date.

Oxidative stress holds a particular place in the pathophysiological model: increased reactive oxygen species (ROS) production within injured tissue is studied as an amplifying factor of fibrosis, via activation of TGF-β1 and NF-κB pathways. See our dedicated dossier on oxidative stress.

Peyronie's disease is more common in men over 50, in those with diabetes, cardiovascular disease, smoking history, prior penile trauma or a personal or family history of Dupuytren's contracture. These factors do not cause the disease directly but appear to increase susceptibility.

Peyronie's disease classically evolves in two phases: an active (inflammatory) phase of 6 to 18 months, when curvature and pain typically progress, and a stable (chronic) phase, when the plaque and curvature no longer evolve. Identifying the phase is critical because it determines which treatments are appropriate.

Progression usually follows a two-stage pattern. During the active phase, curvature worsens over weeks or months and pain may accompany erections. Once the disease enters the stable phase, the curvature is fixed, pain typically disappears and the plaque may calcify. Total course from first symptoms to stabilisation is estimated at 12 to 24 months in most patients.

During the active phase, medical management aims to limit progression using penile traction, VED and, in selected cases, intralesional injections. During the stable phase, corrective options (surgery, injections) can be discussed if functional impairment justifies them. Some patients experience partial spontaneous improvement, but complete recovery without treatment remains rare.

Regular urological follow-up allows the therapeutic strategy to be tailored to each patient's actual course.

During erection, Peyronie's disease typically appears as a visible bend in the penis — most often upward (dorsal), but also downward or sideways — sometimes with an hourglass narrowing, a focal indentation over the plaque or a shorter erect length. When flaccid, the shaft can look normal but a firm nodule (the plaque) may be felt under the skin.

The gallery below gathers clinical photographs illustrating different real aspects of Peyronie's disease — mild curvature, severe curvature, hourglass deformity, penile shortening — to address frequent searches such as "Peyronie photo", "Peyronie image" or "what does Peyronie's disease look like". Anatomical diagrams of the different curvature types are shown further down.

Notice. This gallery contains clinical photographs of an erect penis, shared strictly for medical and educational purposes. Images are blurred by default: click a thumbnail to reveal it.

Sensitive medical content — clinical photograph of an erect penis. Click to reveal.

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A · Moderate dorsal curvature

Sensitive medical content — clinical photograph of an erect penis. Click to reveal.

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B · Severe dorsal curvature

Sensitive medical content — clinical photograph of an erect penis. Click to reveal.

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C · Severe ventral deformity

Clinical photographs reproduced for medical information purposes. Detailed credits appear under each image; all rights reserved to their respective authors.

Peyronie's disease can produce several forms of penile deformity, alone or in combination: curvature, hourglass narrowing, indentation, shortening and loss of girth. The type of deformity depends on the location, size and shape of the fibrous plaque.

Mild Peyronie's disease generally refers to a curvature of less than 30°, a small non-calcified plaque, minimal or no pain and preserved sexual function. In many mild cases, urologists initially propose active surveillance combined with non-invasive options such as penile traction or vacuum devices rather than invasive treatment.

Even in mild forms, urological follow-up is important because the disease can progress during the active phase. Reassessment every few months helps detect worsening early and adjust the strategy — for example, adding intralesional injections if the curvature increases.

Patients with mild disease should not assume the condition will resolve without care: spontaneous regression is uncommon, and early intervention during the active phase generally offers the widest range of options.

Hourglass Peyronie's disease refers to a circumferential narrowing of the shaft during erection, caused by a plaque affecting the whole circumference of the tunica albuginea. It can compromise rigidity distal to the narrowing and is often associated with a more complex clinical picture requiring specialised urological assessment.

Beyond the visible narrowing, hourglass deformity may cause instability of the erection distal to the plaque (buckling), painful erections and pronounced psychological impact. Diagnosis relies on clinical examination, photographs during erection and Doppler ultrasound.

Treatment options include penile traction, VED, intralesional injections (collagenase, verapamil) and, when appropriate, corrective surgery. Management is often multimodal and requires a urologist experienced in Peyronie's disease.

A mild natural curvature of the penis is common and, when present since adolescence and non-progressive, does not indicate Peyronie's disease. Peyronie's disease, in contrast, is an acquired, often painful and progressive curvature associated with a palpable fibrous plaque of the tunica albuginea.

Spontaneous complete resolution of Peyronie's disease is possible but uncommon. In most patients, the disease enters a stable phase within 6 to 18 months with a persistent plaque and residual curvature. Pain usually resolves spontaneously in the stable phase, even when curvature persists.

Observational data suggest that a minority of men experience partial spontaneous improvement, particularly when the curvature is mild and the plaque is not calcified. However, waiting passively is not equivalent to treatment: urological follow-up during the active phase remains recommended to detect worsening and offer options if needed.

There is currently no universal treatment that guarantees a cure for Peyronie's disease. Management aims to limit progression in the active phase, correct the curvature once the disease is stable and preserve sexual function. Outcomes are often satisfactory when treatment is tailored to the phase and severity, but a definitive cure cannot be promised.

Corrective surgery can produce durable straightening in patients with a stable curvature and preserved erectile function. Intralesional injections (collagenase, verapamil, interferon α-2b) reduce curvature in selected cases but rarely eliminate the plaque completely. Non-invasive approaches (traction, VED) may slow progression and preserve length. Patient expectations should be discussed openly with a urologist.

Diagnosis is above all clinical, complemented by imaging. The urologist takes a detailed history, palpates the penis for a plaque, measures the curvature during erection and orders penile Doppler ultrasound to locate and characterise the plaque and assess vascular function.

You should consult a urologist as soon as you notice a new penile curvature, a palpable nodule on the shaft, penile pain during erection or unexplained erectile difficulties. Early consultation improves diagnostic accuracy and gives access to the widest range of treatment options during the active phase.

There is no single best treatment for Peyronie's disease. Guideline-based care (EAU, AUA) combines observation, pain management, penile traction, vacuum erection devices, intralesional injections and, when appropriate, corrective surgery. The strategy is tailored to the phase (active vs stable), curvature angle, erectile function and patient preferences.

Guidelines may evolve as new scientific data become available. Therapeutic decisions are always individualised by a urologist based on the phase of the disease, the extent of curvature, erectile function and the patient's expectations.

Dietary supplements are not a validated treatment for Peyronie's disease. Some molecules — antioxidants, polyphenols — are studied for their potential role in oxidative stress, inflammation and fibrosis pathways, but clinical evidence remains limited and heterogeneous. They cannot, on their own, prevent, halt or cure the disease.

For a detailed cross-cutting analysis of nutritional approaches studied in fibroproliferative diseases and their levels of evidence, see our dossier on natural approaches and fibroproliferative diseases.

Current clinical evidence for these compounds as a treatment of Peyronie's disease is still under investigation. The potential place of antioxidants should be discussed on a case-by-case basis with a healthcare professional, within an overall health approach. Dietary supplements do not replace medical care.

Research on Peyronie's disease is active on several fronts: better characterisation of the fibrotic response, evaluation of low-intensity shockwave therapy (Li-ESWT), development of new intralesional agents, regenerative approaches (PRP, stem cells) and refinement of surgical techniques. Evidence quality varies markedly across these avenues.

• Li-ESWT. Meta-analyses (Fojecki et al., 2017) support an effect on pain during the active phase; evidence on curvature reduction remains limited.
• Collagenase Clostridium histolyticum. The IMPRESS trials (Gelbard et al., 2013) demonstrated a modest but statistically significant reduction in curvature versus placebo in the stable phase.
• Regenerative therapies. PRP and stem-cell injections are actively studied but currently lack the level of evidence required to be recommended in routine care.
• Antioxidant and antifibrotic pathways. Preclinical work on ROS, TGF-β1 and NF-κB continues to inform hypotheses on how nutritional or pharmacological modulation might influence fibrosis (Loreto et al., 2022).

Clinical trials registered on ClinicalTrials.gov and EU-CTR continue to evaluate combinations of penile traction, VED, intralesional injections and surgery in an effort to refine individualised care.

Oxidative stress is one of the most studied mechanisms in the pathophysiology of Peyronie's disease. Excessive local production of reactive oxygen species (ROS) within the injured tunica is thought to promote fibrosis, sustain low-grade inflammation and impair cavernous microcirculation.

• Activation of fibroblasts and differentiation into collagen-producing myofibroblasts (fibrosis).
• Maintenance of low-grade local inflammation via NF-κB and NLRP3.
• Impairment of the cavernous microcirculation and endothelial function, contributing to associated erectile dysfunction.

Inflammatory cascade

Collagen remodelling

Microvascularisation · healthy vs dysfunctional arteriole

Consequences

• ↓ NO bioavailability
• ↑ Local oxidative stress
• ↓ Vasodilation
• ↓ Tissue oxygenation
• ↑ Fibrosis risk

To go further, see our dedicated dossiers:

• Oxidative stress
• Dupuytren's disease

A selection of reference publications and international guidelines used to write this dossier. The list is not exhaustive and will be enriched as the dossier is updated.

Peyronie's disease is a common condition, long under-diagnosed, whose management has advanced considerably over the past two decades. Current guidelines (EAU, AUA) rely on a rigorous assessment of the phase, the curvature and erectile function, with a therapeutic range from observation to corrective surgery via intralesional injections, penile traction and vacuum devices.

AARO LAB focuses on the biological mechanisms involved in oxidative stress, microvascularisation and tissue integrity. Dietary supplements do not replace medical care but can be part of an overall health approach, when their use is appropriate and discussed with a healthcare professional.