Peyronie’s Disease (Penile Curvature) Treatment: An End to Pain and Deformity

What causes penile curvature and pain? Expert guide on Peyronie’s disease symptoms, non-surgical treatment methods (ESWT, Injection) and curvature correction surgeries.

Introduction: Curvature Is Not Your Destiny

Do you experience pain during sexual intercourse? Or have you noticed a hard lump under the skin of your penis, similar to a grain of rice or an olive pit, when touching it? Perhaps your erect penis has developed a noticeable bend (curvature) downwards, upwards, or to the side.

These symptoms may be indicative of a condition known in medical literature as Peyronie’s disease, commonly referred to as ‘penile calcification’. Peyronie’s disease is a distortion of the shape of the penis due to ‘scar tissue’ (scarring) forming in the flexible sheath of the penis.

This condition not only makes sexual intercourse difficult, but can also lead to loss of self-confidence, depression and serious crises in relationships. However, do not worry; Peyronie’s disease caught in its early stages can be stopped with medication and injections, while advanced curvatures can be completely corrected with surgical methods.

In this guide, you will find the treatment plan that varies according to the stages of the disease and the most suitable solution for you.

What is Peyronie’s Disease?

What is Peyronie’s Disease? Peyronie’s disease is the formation of a hard, fibrous tissue called a plaque on the ‘Tunica Albuginea’, the flexible sheath surrounding the tubes (corpora cavernosa) that enable the penis to become erect.

Normally, this sheath is elastic and expands evenly in all directions during erection. However, the area where the plaque forms loses its elasticity and cannot expand. When the penis becomes erect, this inelastic side remains fixed while the other side continues to stretch. Result: A penis that bends, curves, or shortens in the direction of the plaque.

What Causes Peyronie’s Disease? (Who is to Blame?)

Although the exact cause is not fully understood, the strongest theory is **‘Microtraumas’**.

Sexual Trauma: Bending or straining the penis during rough sexual intercourse causes microbleeds in the sheath tissue. As the body heals this bleeding, individuals with a genetic predisposition form hard ‘scar tissue’ (scarring) instead of normal tissue.
Genetic Factors: The risk is higher in those with a family history of Peyronie’s disease. Additionally, the incidence of Peyronie’s disease increases in patients with Dupuytren’s contracture (hardening of the palm).
Diabetes and Hypertension: Diseases that damage blood vessels negatively affect the healing process, increasing the risk.
Age: It is commonly seen in men between the ages of 40 and 70.

The Difference Between Congenital Curvature and Peyronie’s Disease

This is the issue that patients confuse the most. Their treatments are completely different.

Congenital Penile Curvature: Present from birth. Noticed during the first erections. There is NO palpable hardness or plaque. There is NO pain. It is usually corrected surgically.
Peyronie’s Disease: Appears later in life. There is a palpable hard PLAQUE. There is PAIN at the onset.

Symptoms and Stages: How Does the Disease Progress?

Peyronie’s disease progresses in two distinct stages. The treatment plan changes completely depending on which stage the patient is in.

1. Period: Acute (Active) Phase

The first 6-12 months after the onset of the disease.

Pain: Pain is present in the penis during erection or in its normal state.
Variable Curvature: The degree of curvature continues to increase.
Plaque: The palpable lump is still soft or newly formed.
Treatment Approach: SURGERY IS ABSOLUTELY NOT PERFORMED during this period. The aim is to relieve pain and stop the plaque from growing.

Phase 2: Chronic (Stable) Phase

It is usually the period at the end of the year.

Painlessness: Pain has completely disappeared.
Permanent Curvature: The curvature has reached its final state; it will neither increase nor decrease.
Hard Plaque: The tissue beneath the skin may have hardened (calcified) like bone.
Erectile Dysfunction: Erectile problems may accompany the condition.
Treatment Approach: If the curvature interferes with sexual intercourse, SURGERY is the only solution.

5. Diagnostic Methods

Physical Examination: The doctor determines the location and size of the plaque by feeling it with their hand.
Self-Photography: The patient is asked to take photographs of their penis from above and from the side while erect at home. This is the most practical way to measure the degree of curvature (30 degrees, 60 degrees, 90 degrees, etc.).
Penile Doppler Ultrasound: This shows whether the plaque is calcified, the condition of the blood vessels, and the quality of the erection.

Non-Surgical Treatment Methods (For the Acute Phase)

The aim during the initial painful period of the disease is to halt the progression of the curvature.

A. Medication Treatment

Oral medications such as vitamin E, colchicine, and tamoxifen have been used frequently in the past. However, current scientific studies (EAU Guidelines) show that the effect of these drugs is very limited. Nevertheless, they may be administered for supportive purposes.

B. Injection Therapies (Needle Therapy)The aim is to soften the plaque by injecting medication directly into it.

Collagenase (Xiaflex): A special enzyme that dissolves plaque. It is FDA-approved but its use is limited due to its high cost and side effects.

Verapamil / Interferon: Other agents used to halt plaque growth.

PRP (P-Shot): Used experimentally to accelerate tissue regeneration.

C. Shockwave Therapy (ESWT)Shock waves are sent to the penis from outside the body.

Effect: ESWT does not correct curvature. However, it is very effective in relieving PAIN during the acute phase. It also supports erection quality by increasing blood flow.

D. Vacuum and Traction Devices

It attempts to prevent the plate from shortening and the curvature from increasing by mechanically stretching the penis. It requires regular use for several hours a day.

Surgical Treatment: Definitive Solution (For Chronic Stage)

Once the condition has stabilised (pain has ceased, curvature has stopped), if the curvature is over 30 degrees and makes sexual intercourse difficult or impossible, surgery is essential.

The type of surgery is selected based on the length of the penis, the degree of curvature and whether there is an erection problem.

A. Plication Methods (Nesbit Procedure)This is the most commonly used, simple and safe method.

Rationale: The curved side is shorter. The surgeon shortens the opposite (longer) side by suturing it, thereby equalising the length of the penis.

Who is it suitable for? Patients whose penis is sufficiently long, whose curvature is less than 60 degrees and who do not have erectile dysfunction.

Disadvantage: There may be a 1-2 cm reduction in penis length.

B. Grafting (Patch) MethodsThe hard plaque on the curved side is cut out or opened. A patch (leg vein, collagen patch, etc.) is sutured into the resulting gap.

Rationale: The penis is straightened by lengthening the shorter side.

Who is it suitable for? Patients with a short penis or severe curvature (over 60-90 degrees).

Advantage: Penis length is not reduced and may even increase.

Disadvantage: It is a more complex surgery, and there is a risk of erectile dysfunction (albeit rare).

C. Penile Prosthesis (Penile Implant) CorrectionIf the patient has severe erectile dysfunction (impotence) in addition to Peyronie’s disease, correction alone is not sufficient.

Solution: A penile prosthesis (penile implant) is inserted during the same operation. The prosthesis provides rigidity and also resolves the curvature from within, effectively correcting the problem at its root (modelling manoeuvre).

Post-Treatment Recovery Process

Hospitalisation: One day of hospitalisation is usually sufficient.
Catheter: A urinary catheter may remain in place for one day.
Pain: Pain is mild and can be controlled with painkillers.
Sexual Abstinence: Depending on the type of surgery, sexual intercourse is prohibited for 4 to 6 weeks. This period is critical for the stitches to heal.

Frequently Asked Questions (FAQ)

Question: Does Peyronie’s disease turn into cancer? Answer: No. Peyronie’s disease is a benign tissue disorder. It is not cancer and does not turn into cancer.

Question: Does the curvature resolve on its own? Answer: In Peyronie’s disease, the likelihood of the curvature resolving on its own is very low (around 3-5%). It usually remains the same or worsens if left untreated.

Question: Will my penis shorten after surgery? Answer: In plication (Nesbit) type surgeries, there may be a shortening of 1-1.5 cm depending on the degree of curvature. However, a slightly shorter but straight and functional penis is always preferred over a curved and unusable penis. There is no shortening with graft methods.

Question: Which doctor should I see? Answer: You should consult an experienced Urology (Andrology) specialist. Not every urologist may perform Peyronie’s surgery; specialists in this field achieve more successful outcomes.

Conclusion: Saving Your Relationship is in Your Hands

Peyronie’s disease is a ‘deformity’ that can turn a couple’s sex life into a nightmare. However, waiting in embarrassment or thinking ‘it will go away with time’ causes the plaque to harden further and makes treatment more difficult.

If you notice any hardness, pain or curvature in your penis, do not delay. Simple interventions in the acute phase can resolve the problem without the need for major surgery later on. In the chronic phase, surgery can restore your former sexual performance.

Take steps towards a healthy and happy sex life.