Private peyronie's disease clinic in London, same-day men's health.

The two phases

In the active phase the plaque is forming: there is often pain with erections, and the curvature changes over weeks. Surgery is avoided here because the shape is still moving. In the stable phase pain has gone and the curve has not changed for several months — this is when definitive correction is considered.

What you may notice

• a bend when erect — upward, downward or to one side
• a firm lump or band under the skin of the shaft
• pain with erections, particularly early on
• shortening, narrowing, or an hourglass or hinge deformity
• difficulty with penetration, and erectile difficulty in a substantial proportion of men

Causes and associations

Usually repeated minor injury during intercourse that heals with scar rather than normal tissue — often with no memorable single incident. It is more common with diabetes, high blood pressure, high cholesterol, smoking, and after prostate surgery. It is associated with Dupuytren's contracture of the hand, which shares the same underlying tendency. It is not caused by anything you did wrong, and it is not sexually transmitted.

Treatment

• In the active phase — pain control, and treatment aimed at limiting progression. Around one in eight men improve without any treatment; most stabilise rather than resolve.
• Traction and vacuum devices, used consistently over months, have reasonable evidence for maintaining or improving length and reducing curvature.
• Shockwave therapy is used principally for pain relief in the active phase; it does not reliably straighten the curve.
• Injectable treatments into the plaque are available in specialist practice.
• Surgery in the stable phase — several techniques, chosen according to the degree of curve and erectile function. Highly effective for correcting the bend.
• Treating erectile dysfunction alongside, which is present in a large proportion of men and affects satisfaction more than the curve itself in some cases.