What is Peyronie’s disease?
Peyronie’s disease is the formation of a benign, hardened area of scar tissue (plaque) in the tough, elastic sheath (tunica albuginea) that surrounds the erectile tissue inside the penis. During erection, the plaque prevents the sheath from stretching where it is located; as a result, the penis curves towards the side of the plaque, may shorten, or may develop deformities such as an hourglass appearance.
The exact cause of the disease is not known. The most widely accepted view is that small, unnoticed strains and injuries during intercourse heal in an abnormal way in some people and turn into a plaque. Diabetes, smoking, high blood pressure, previous prostate surgery and Dupuytren’s contracture of the hands are among the conditions in which the disease is more common. Peyronie’s disease mostly affects men over 40, but it can also occur at a younger age. It is not contagious and does not turn into cancer.
Phases of the disease
Peyronie’s disease has two phases, and the treatment plan depends largely on which phase the patient is in.
Active (acute) phase
This is the initial phase of the disease. There may be pain during erection, a hard area that can be felt on the penis, and a new or increasing curvature. During this phase the plaque is still forming and the curvature may change. The active phase usually lasts between a few months and a year.
Stable (chronic) phase
This is the phase in which the pain has gone and the curvature has remained unchanged for at least 3 months. The plaque has matured; sometimes calcification may also develop. Surgical treatment is usually planned during this phase.
Symptoms
- Upward, downward or sideways curvature of the penis during erection
- A hard area or lump that can be felt on the penis
- Pain during erection, especially in the active phase
- Shortening of the penis, an indentation or an hourglass appearance
- Difficulty with intercourse because of the curvature
- Accompanying erectile dysfunction
The disease can also cause anxiety and loss of self-confidence. Talking openly about these feelings during the consultation is an important part of the treatment process.
How it differs from congenital penile curvature
Not every penile curvature is Peyronie’s disease. In congenital penile curvature, there is no plaque and no pain, and the curvature has usually been noticed since puberty; it is mostly downward or sideways. Peyronie’s disease, by contrast, develops later in a penis that was previously straight. The distinction is made from the history and physical examination. Medication or injections have no role in congenital curvature; if the curvature affects sex life, it can be corrected surgically.
How is it diagnosed?
At the consultation, the doctor asks when the symptoms began, whether there is pain, whether the curvature has changed and about the quality of erections. The penis is examined by hand to assess the location and size of the plaque.
- Assessment during erection: To measure the degree of curvature, photographs taken by the patient at home can be used, or an erection can be induced during the consultation with a medication injection into the penis so that measurements can be taken.
- Penile ultrasound: Shows the location and size of the plaque and whether it is calcified; where needed, colour Doppler is used to assess the blood vessels and the cause of any erectile dysfunction.
- Additional tests: Blood tests may be requested for diabetes and other risk factors.
Treatment options
Treatment is decided individually after examination, taking into account the phase of the disease, the degree and direction of curvature, penile length, the quality of erections and the patient’s expectations. Patients with mild curvature who can have intercourse without difficulty may not need treatment.
Conservative (non-surgical) methods
- Observation and pain relief: The pain of the active phase usually settles over time; painkillers can be used during this period.
- Traction device: Worn on the penis for a few hours a day, these devices may help reduce curvature and preserve length in some patients when used regularly.
- Injections into the plaque: In selected patients, medication is injected into the plaque at set intervals with the aim of reducing curvature. Which medication is suitable and the expected benefit are discussed during the consultation.
- Treatment of erectile dysfunction: Accompanying erectile dysfunction can be supported with oral medication.
There is no strong scientific evidence that oral vitamins or certain supplements correct the curvature.
Surgical treatment
Surgery is considered in the stable phase for patients whose curvature makes intercourse difficult or impossible.
- Plication: The penis is straightened by slightly shortening the sheath on the side opposite the curvature with stitches. It is often chosen for patients with good erections and moderate curvature. There may be some loss of penile length.
- Plaque incision and grafting: The plaque is cut or partly removed and the resulting gap is closed with a patch (graft). It may be considered for patients with severe curvature or an hourglass deformity and good erections. Length is better preserved, but the likelihood of erectile dysfunction after surgery is higher.
- Penile prosthesis: If Peyronie’s disease is accompanied by severe erectile dysfunction, a penile prosthesis is placed; if necessary, additional straightening procedures are carried out in the same operation.
How is the surgical method chosen?
Three key questions guide the choice of surgical method: Are erections sufficient before surgery? How severe is the curvature, and is there an additional deformity such as an hourglass shape? How important is penile length to the patient? For patients with good erections and moderate curvature, plication is a simpler and more predictable option, whereas grafting may be considered for severe curvature. In patients who also have erectile dysfunction, a penile prosthesis both provides rigidity and helps to correct the curvature. The choice is made by discussing the advantages and disadvantages together with the patient.
Peyronie’s disease and erectile dysfunction
Erectile dysfunction is common in men with Peyronie’s disease. This is because the same risk factors (diabetes, vascular health, smoking) also affect erections, the plaque can impair the trapping of blood in the erectile tissue, and the disease itself causes anxiety. Assessing the quality of erections directly influences the choice of treatment. See the erectile dysfunction page for details.
Psychological effects and communication with your partner
Penile curvature can have a negative effect on how a man sees himself and on his sex life; anxiety, embarrassment and avoidance of intimacy are common. Knowing that this is a medical condition and communicating openly with your partner make the treatment process easier. Where needed, sex therapy or psychological support can also be part of treatment.
Recovery and risks
Operations are usually performed under general or spinal anaesthesia and the hospital stay is short. Swelling and bruising are expected in the first days. Sexual intercourse can usually be resumed after a few weeks with the doctor’s approval. Possible risks include loss of penile length, altered sensation in the head of the penis, incomplete correction or recurrence of the curvature and, especially after grafting, erectile dysfunction. These possibilities are discussed in detail before surgery.
Follow-up
Patients in the active phase are invited for check-ups at regular intervals to monitor the course of the curvature. Check-ups after surgery are planned to assess healing and the result; in some patients, a traction device may be recommended after surgery.
Peyronie’s disease treatment in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He has scientific studies in the field of andrology published in international peer-reviewed journals. In Bursa (Nilüfer), he sees patients with penile curvature at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00), with particular care for privacy.
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book your consultation in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). For questions before you travel, you can send a message via WhatsApp (+90 541 622 54 82). More information is available on the international patients page and the contact page.
