Peyronie's disease: causes, symptoms and treatment

Peyronie's disease (Induratio Penis Plastica) is an inflammatory condition of the tunica albuginea, the sheath surrounding the corpora cavernosa of the penis, which undergoes fibrosis and thickening. The result is the formation of true plaques or scars, which may also calcify, and which cause pain and curvature of the penis on erection. It mainly affects middle-aged men, with an estimated prevalence of around 7–10% of the male population.

It is named after François de La Peyronie, the French surgeon to King Louis XV who first described it in 1743.

Causes: why the plaques form

The precise cause is unknown. Inflammatory, immunological and infective hypotheses have been proposed over the years. The currently most accepted hypothesis is this: on a genetically predisposed background, micro- or macro-trauma to the penis — even ordinary sexual activity — produces small lesions of the tunica albuginea, from which an inflammatory process begins that progressively leads to plaque formation.

Several important co-factors in the onset of the disease are recognised:

• Smoking
• Lipid metabolic disorders (abnormal blood fats)
• Glucose metabolic disorders (abnormal blood sugar, diabetes)

Symptoms: a progressive disease

The onset is often insidious and non-specific: a vague discomfort within the penis, mild soreness during intercourse. Underlying it is an inflammatory process, first acute and then chronic, with one crucial feature: progression. The symptoms tend to worsen over time, which is why early diagnosis is decisive.

When the disease is fully established, the classic symptom triad appears:

• Pain in the penis on erection
• Curvature of the penis on erection
• Progressive erectile dysfunction

Diagnosis

Diagnosis should be made as early as possible, precisely because the disease progresses. It rests on two elements:

• Self-photography of the erect penis: taken by the patient with the penis erect, it allows the exact angle of curvature to be calculated
• Dynamic penile colour Doppler ultrasound: performed with the penis flaccid and after a painless intracavernous microinjection of Alprostadil (Prostaglandin E1) at the base of the penis, which induces a pharmacological erection. It allows assessment not only of the blood supply, but also of the internal structure of the organ and the extent of the disease within it

Treatment

Treatment follows the course of the disease: medical and physical therapy first, in the active phase, then surgery where appropriate, once the disease has stabilised.

Medical and physical therapy (active phase)

In the active inflammatory phase the aim is to block or reduce the inflammatory process, control the pain and limit the size of the plaques. The following are combined:

• Systemic medical therapy, with anti-inflammatory drugs
• Local physical treatments: laser therapy, ultrasound, ionophoresis and iontophoresis with anti-inflammatory drugs, shockwave therapy

Hyaluronic acid: the most recent treatment

Since May 2025 a medical treatment based on hyaluronic acid (HA) has been available — a molecule naturally present in the body. Chemically it is a polysaccharide, like starch and cellulose, and it has shown a potent anti-inflammatory action, helping to reduce the concentration of free radicals at the site where the disease begins. For this reason it is particularly useful in the early phases.

Very recent studies have also shown that hyaluronic acid, thanks to its ability to draw in water, can once injected into the lesion help soften the fibrosis of a stabilised plaque, reducing the curvature of the penis.

Surgical treatment (stabilised phase)

Surgery is undertaken only once the disease has stopped and stabilised, is no longer in the active phase, and in a proportion of cases. The approach depends on whether a valid erection is present:

• If the erection is valid: a penile plastic surgery procedure is performed — straightening of the penis — when the curvature is such as to mechanically prevent penetration
• If the erection is not valid: a penile prosthesis is implanted, resolving both the erectile problem and the curvature at the same time

Frequently asked questions about Peyronie's disease

Is Peyronie's disease a cancer?

No. It is a benign inflammatory condition of the tunica albuginea, the sheath of the corpora cavernosa. It is not a tumour and not a sexually transmitted disease: the process that leads to the plaque is scar-like fibrosis, not a neoplasm.

Can the penile curvature be straightened?

Yes, in a proportion of cases. In the early phases medical and physical treatments, including hyaluronic acid, can reduce the curvature. Once the disease has stabilised and the curvature prevents penetration, penile plastic surgery straightens the penis if the erection is valid; if it is not, a penile prosthesis resolves both problems.

Why is it important to see a specialist early?

Because the disease is progressive: if untreated, the inflammatory process tends to worsen the pain, the curvature and erectile function. Early diagnosis allows treatment in the phase when medical and physical therapies are most effective, before the plaque stabilises and calcifies.

Does Peyronie's disease cause erectile dysfunction?

Progressive erectile dysfunction is part of the classic symptom triad of established disease, along with pain and curvature. It is not always present, but it should always be assessed, because it affects the choice of treatment: if the erection is no longer valid, the surgical strategy changes.

What is the difference from congenital penile curvature?

Congenital penile curvature is present from development, without a plaque and without inflammation. Peyronie's disease is acquired, with a fibrous plaque that forms as a result of an inflammatory process. They are two distinct conditions, treated differently. The professor devotes a separate page to congenital penile curvature.

Do you notice pain, curvature or a thickening in the penis on erection? Ask Prof. Natali for a consultation or book an appointment at his practices in Florence and Empoli, Italy.

The information on this page is provided for general educational purposes and does not replace a medical examination, which remains the only diagnostic tool for correct and effective treatment.