What is Peyronie's disease?
Erection of the penis occurs when sexual stimulation causes blood to flow into the spongy, so-called cavernous bodies that run along the length of the penis. The cavernous bodies expand, pressure increases, and the penis becomes firmer. In Peyronie's disease a nodule appears in the connective tissue layer covering the cavernous body: the number of elastic fibers decreases, fibrin and collagen increase, and calcium may be deposited among them. As a result, the nodule becomes cartilage- or bone-hard—this is called a "plaque".
The curvature is mainly visible in the erect state (in severe cases even at rest), because the plaque prevents the tunica of the cavernous bodies from following the size increase that occurs during erection. The side toward the plaque therefore does not expand, its shape distorts and it bends. This can cause pain, erectile dysfunction and even impotence.
As the curvature worsens, the problem also intensifies (the degree values are indicative):
- with a smaller curvature of 5–20° intercourse is typically still possible,
- with curvature of 20–45° it may become difficult,
- with curvature over 45° it is often impossible.
What causes Peyronie's disease?
The exact cause of Peyronie's disease is not yet completely known. Current concepts suggest an abnormal wound-healing process after repeated, small (microscopic) injuries to the penis: the protein fibrin plays a role in plaque formation; fibrin normally participates in blood clotting and scar tissue formation. If fibrin is deposited at the site of injury and does not break down properly, a connective tissue plaque can develop.
Predisposing factors
Factors that may contribute to plaque formation include diabetes and smoking (which increase fibrin levels), chronic prostatitis, chronic changes of the glands around the urethra, and repeated microtrauma to the penis during sexual activity.
When should you see a doctor?
As a general rule: the earlier treatment begins, the greater the chance of success. If you postpone it for months, you may "run out" of the period when the process is still well modifiable. In a minority of cases the problem may resolve on its own, but more often it does not go away without treatment.
If the shape of your penis has changed recently, has become curved, or you can feel a nodule in it, see a urology or andrology (men's health) clinic as soon as possible. Early-stage Peyronie's disease is more amenable to certain methods; as time passes—especially after the plaque calcifies—the chances for non-surgical treatment decrease.
How can Peyronie's disease be treated?
Treating Peyronie's disease (PD) remains challenging: there is no single "gold standard", meaning no method guarantees success in every case. Systematic reviews show that the evidence for non-surgical options is of variable strength—the mechanical (traction/vacuum) devices and some intralesional (into-plaque) treatments have shown the most promising results for curvature.2 Some treatments can only be performed in a medical office, but there are also home methods that you can use under your doctor's guidance.
The aim of oral medications is to reduce plaque size, penile pain and curvature. Their drawback is that much of the active substance is broken down in the digestive tract, and only a small portion reaches the penis—therefore the effectiveness of oral agents is limited.
A drug is injected directly around the plaque. This can only be performed by a knowledgeable physician under sterile conditions. According to systematic reviews, intralesional treatments are among the better-documented non-surgical methods, although the evidence is still variable.2
The goal of this treatment is rehabilitation rather than sexual pleasure: mechanical "training" of the cavernous bodies that give the penis its elasticity using a vacuum penis pump. Systematic reviews indicate that mechanical (traction/vacuum) devices contributed to curvature improvement, and Raheem and colleagues (2010) also documented a penis-straightening effect.2,3
Procedure (under medical supervision): the vacuum created in the tube placed over the penis induces an erection within 60–90 seconds, which should be maintained for 2–3 minutes; after releasing the vacuum the erection subsides. This should be repeated 4–5 times daily. The method does not require a constriction ring, because the goal is not to maintain an erection but to mobilize the tissue.
Regular training may improve arterial blood supply to the penis and surrounding tissues, supporting the body's natural restorative processes; some hypotheses suggest this may activate macrophages to break down excess fibrinous material and loosen the plaque.
The device most suited for this is the Rehabi PVT, which was specifically designed for "training". Other devices in the product group can also be used for this, although their primary purpose is erectile dysfunction support. Click here to find vacuum penis pumps →
In phonophoresis, the vibrations of ultrasound are used to drive a topical active substance into deeper tissues. The medication in cream or gel form is applied to the skin over the plaque, then the ultrasound head is moved slowly in circular motions over the plaque at low intensity for 2–3 minutes.
Ultrasound phonophoresis is typically performed in a physiotherapy clinic, but with appropriate instruction and a home therapeutic ultrasound device the simple technique can also be performed at home. It is important to know that the evidence for topical/combined methods in Peyronie’s is limited, so use should always be considered in consultation with your treating physician and only with the agent recommended by the doctor.2
An appropriate device for this may be the SonicRelief therapeutic ultrasound.
Iontophoresis uses a weak and generally safe electric current. Ionic active substances (charged molecules) move between the two poles of the current, allowing the active ingredient to be delivered directly to the treated area without needle puncture. Iontophoresis can be done in a physiotherapy clinic, but with proper instruction it can also be performed at home using an iontophoresis device—for example, the Genesy SII may be suitable.
The selection and prescription of drugs for iontophoresis is the responsibility of the treating physician; iontophoresis requires water-soluble agents (e.g., verapamil, lidocaine, dexamethasone or a combination). Studies suggest starting verapamil treatment in the early stage, when the curvature is still under 30° and the plaque has not calcified; in a randomized trial (Di Stasi et al., 2004) verapamil–dexamethasone iontophoresis led to reduction of curvature and plaque.4 However, systematic reviews have found the overall effect of iontophoresis to be mixed and limited2—therefore decide on its use together with your physician.
Soft laser therapy is used in some cases as an adjunctive home physiotherapy option. However, it is important to know that the scientific evidence for soft laser in Peyronie's disease is limited, so it should not be considered a standalone primary treatment—its use should always be discussed with your treating physician and considered as an adjunct. If you and your doctor opt for this, consistent, persistent use is essential.
You can read more about soft laser treatment and devices in the soft laser category; one possible device is the Personal Laser L400.
Surgery should only be considered after at least 3 months of stable condition. At that time either the plaque is removed or the connective tissue on the opposite side is shortened. Surgery can have residual symptoms (e.g., incontinence, erectile dysfunction), so it is generally considered a last resort if non-surgical methods have failed.
Frequently asked questions
In a minority of cases the process may resolve spontaneously, but more often it does not disappear without treatment. That is why it is worth having the symptom examined as soon as possible—early-stage disease is more modifiable.
According to systematic reviews, mechanical (traction/vacuum) devices have shown the most promising results for curvature among non-surgical options.2,3 The evidence for iontophoresis and topical methods is mixed, and for soft laser it is limited. Begin any home treatment only after consulting with your treating physician.
No. The goal of the training is to mobilize the tissue and support blood supply, not to maintain an erection, so a constriction ring is not used. The Rehabi PVT was designed for this purpose.
Certain methods (cavernous body training, ultrasound, iontophoresis) can be performed at home after proper instruction—but only under medical supervision and only with the agents recommended by your doctor. Always seek the opinion of a urologist or andrologist before starting treatment.
Summary
Peyronie's disease is a curvature caused by plaque formation in the penis, which can be associated with pain and erectile dysfunction. No method guarantees success in every case, but early treatment offers the best chance. Among non-surgical options, mechanical (vacuum/traction) devices have the most promising evidence for improving curvature; several home methods (ultrasound, iontophoresis) may also be considered, but always under medical supervision and with physician-recommended agents. If symptoms are persistent or worsening, consult a urologist or andrologist.
Sources
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health (Peyronie's Disease). uroweb.org
- Randhawa K, Shukla CJ. (2023). A systematic review of non-surgical management in Peyronie's disease. Int J Impot Res. PMC10499596
- Raheem AA, Garaffa G, Raheem TA, et al. (2010). The role of vacuum pump therapy to mechanically straighten the penis in Peyronie's disease. BJU Int. 106(8):1178–1180. PubMed: 20438558
- Di Stasi SM, Giannantoni A, Stephen RL, et al. (2004). A prospective, randomized study using transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease. J Urol. 171(4):1605–1608. J Urol / ScienceDirect
