Size matters. No man wants to think he’s got a small dick. But for some guys—about one in ten, in fact—their most immediate worry is caused by the changing shape of their cock. Now, most men’s dicks will stand slightly to the left or right when they’re erect—and that’s nothing to worry about. What we’re talking about here is a severe bend or curve caused by Peyronie's disease (also known as penile curvature, penile fibrosis or induratio penis plastica).
Peyronie's disease is caused by a buildup of plaque or scar tissue at either at the tip or the base your penis. There’s a lot of misinformation surrounding the condition so before we look at it in more detail, let’s set the record straight and debunk three of the most common myths:
- It’s not an STD: Peyronie’s is not an STD, so you can’t catch it and you can’t pass it along. That said, if you’ve noticed a sudden change in the shape of your penis or a lump developing on it, you might want to see a doctor or visit a sexual health clinic—it may not be Peyronie's but it's worth getting a clean bill of health and eliminating all the possibilities.
- It’s not like plaque in your arteries: The plaque or scar tissue that causes the penis to bend is not the same plaque that builds up in your arteries, so it’s not indicative of poor coronary health.
- It’s not cancer: The plaque or scar tissue is not is a tumor or cancer. However, research is emerging that suggests there may be a link between the genes that lead to some instances of Peyronie's and those that are active in the development of some cancers, including stomach and testicular cancer.
Common Causes of Peyronie's Disease
It’s estimated around one in ten men suffer from Peyronie's at some point in their life. It can impact men of any age, but it’s more likely to affect you over the age of 35, with most guys developing the condition around 49.
Today is #NationalImpotenceDay and I would like to share some tips for early detection as early detection and prevention can make a huge difference.— Daniel Garrett (@danielfgarrett) February 14, 2022
No-one really knows what leads to the onset of Peyronie’s. Some doctors think it occurs after an injury to an erect penis—perhaps getting bent or ‘broken’ during sex. Remember guys, you can't technically break your penis as there are no bones in it, but you can suffer a penile fracture—and in some cases the healing process can cause the plaque to build up. It’s also worth noting that the damage doesn’t have to be sexually-related at all—sports injuries or car accidents can lead to penile fractures as well. Other healthcare professionals believe that it might be an autoimmune response, while a growing number think it could be hereditary.
Development and prognosis of Peyronie's Disease
Peyronie’s disease develops in two phases. The acute phase starts from the onset and lasts about a year. At first, the buildup may look like inflammation, but as the plaque continues to develop you’ll be able to see it under the penis skin in flat lumps or as a ring of hard tissue.
The plaque is deposited within a layer of connective membrane called the tunica albuginea which surrounds the erectile tissue. The tunica albuginea plays a significant role in getting and maintaining an erection as it traps your blood in place and keeps you hard. This is why, in some instances, there appears to be a physical link between Peyronie's disease and Erectile Dysfunction (ED).
The curve or bend can become more pronounced as the plaque continues to build over time. In some cases, it becomes painful to get an erection and can make sex difficult or impossible. This is because the scar tissue doesn't stretch when the penis is erect and forces it to bend. Some guys have reported penile pain even without an erection and say that taking a leak can be difficult.
During the acute phase, Peyronie's can also lead to loss of length and girth, or give your cock an hourglass shape. For this reason, it can lead to psychologically-linked ED as guys try to cope with increasing levels of anxiety, worry, and self-consciousness. It’s no surprise, then, that about half of the men suffering from Peyronie's report severe psychological distress and, in some cases, depression. This is really tragic because, although there is no cure, the condition can be treated in nearly all cases.
After about 12 months, Peyronie’s will stabilize and the plaque and symptoms shouldn’t get any worse. At this stage, most guys will stop experiencing any penile pain, but the penis will not return to the way it was before the illness. For just over 10% of men with the disease, the symptoms may lessen during the acute phase and the plaque might even dissolve by itself. At the moment, doctors do not know why it recedes for some men and not others.
If you decide to see a doctor (and we recommend that you do), they’ll probably carry out a physical examination of your penis—holding it and feeling it to search for scar tissue. Although this is a very intimate part of your body, you should try not to be worried. Doctors are professionals, they will be respectful and will treat you with dignity. You might also be asked to bring in some pictures of your erect penis—this is probably the only time where it will be OK to show a stranger a picture of your dick. In some instances, your doctor might also decide to run an ultrasound test. If that's the case they’ll give you an injection that brings on an erection just before the test is carried out. Again, do not be worried or embarrassed.
The treatment that you decide on with your doctor will really depend on how advanced the disease is and which phase it is in. During the acute phase, treatment is really geared to improving the symptoms and attempting to halt further physical penile changes. Once the acute phase has passed more options including surgery are available.
It’s worth knowing a little about the different treatments before you visit your doctor so you can have a more engaged discussion and decide how you want to proceed. Here are a few of the most common options:
- Oral Medicines: There are a variety of oral medicines on the market but at the moment there’s no one single drug that works for everyone. Collagenase clostridium histolyticum (Xiaflex), however, is the only FDA-approved medication. Studies suggest that it seems to work better in conjunction with penile traction.
- Creams: Several creams have been tested but the research data is limited. In the tests we looked at verapamil gel applied directly to the affected areas of the penis helped eliminate pain during an erection and improved the quality of erections. It also reduced plaque and curvature. Initial results were seen within three months and significant improvements were noted after nine months. Verapamil gel is only available to doctors and healthcare professionals. Don’t buy it online as it won’t be the official, approved version.
- Penile traction: Penile traction devices (or penis extenders) can be used to ‘unbend’ your cock. The device is worn for an agreed period of time each day (sometimes up to eight hours—your doctor will advise you on optimum daily usage) over several months. They can also help add an inch or so and help you regain any lost length—if you haven’t lost any length, then you’ll get an extra bonus from the treatment. Penile traction devices have been shown to work as a single treatment method but prove most effective when used in combination injectable and oral medications. It’s worth remembering too that the reshaping and enlarging results are permanent.
- Vitamin E: A couple of studies have reported improvements for guys when they take vitamin E. It’s usually used as part of a combination approach with some of the other options listed here. It’s not believed to work on its own so don't rush out and buy it from a shop thinking that it is the complete solution.
- Penis pump: Penis pumps will improve and sometimes stabilize the curvature caused by Peyronie’s disease. It’s through the tension on the penis created by the vacuum may trigger the plaque to break down which, in turn, could reduce the curve or bend. Talk to your doctor before starting on this treatment as some healthcare professionals think that pumps should only be used once the condition has stabilized, while others believe they can be used at any stage of the disease .
Invasive therapies and surgery
- Penile injections: Injections of drugs including Xiaflex and Verapamil can be given by doctors and medical staff. It is highly specialized and requires extremely precise delivery. It’s not for all patients, but it does deliver results. Guys opting for this treatment will have to be prepared to have injections over many months and follow a complimentary home-based treatment of gently stretching their penis and, while erect, lightly bending it in the opposite direction of the curve.
- Iontophoresis: Iontophoresis (or Electromotive Drug Administration—EMDA) involves delivering a very weak electrical current to a patch placed over the area of plaque. The patch delivers drugs, including verapamil, while the electrical current is believed to help the drugs penetrate the skin more effectively than a cream.
- Extracorporeal shock wave treatment: Perhaps the most controversial treatment we’ve looked at. With this approach, audible, low-energy sound waves (rather than an electric current) are administered to the area with the plaque buildup. The sound waves are thought to increase blood flow to the area and speed up the natural healing process. Studies suggest that it may be an effective and safe treatment for reducing plaque buildup and pain relief, but not for improving of penile curvature and sexual function.
- Surgery: Surgery is highly risky and the results are not guaranteed. For that reason it's only considered in the most severe of cases—where the pain is extremely difficult to endure or when it becomes completely impossible to get an erection or enjoy sexual encounters. Surgery options include suturing, grafting and penile implants.
Conclusion: a few words on coping and support
A lot of guys find it very difficult to cope with the onset and the acute phase of Peyronie’s disease. If you’re in a relationship, it could help to explain to your partner what it is and how it could impact lovemaking. And, although most of us guys aren’t so good at talking about stuff like this—it could help to discuss how feel about the changed appearance of your dick and your performance in the bedroom. Some guys really genuinely benefit from seeking emotional counseling too, but we know that’s not for everyone.
If you are suffering from Peyronie’s disease or know someone that is, you might be interested in joining one of many online support groups. There's also a website with the results from the latest Peyronie’s disease-related clinical trials if you want to read more on the latest thinking on the condition. There are sources of further information and suggestions for additional reading in the footnotes of this article too.
 Using penile traction for Peyronie's disease treatment
 Can a penis pump treat Peyronie’s disease?