What’s Normal?

An absolutely straight penis is unusual – most have a slight curve when erect. But this should not be more than about 25° from straight, like a banana. If your penis bends more than this, you might have Peyronie’s disease.

It is also quite normal and harmless for the penis to have a slight twist (usually anticlockwise).

Peyronie’s Disease

A condition called Peyronie’s disease, in which the penis becomes crooked when it is erect, occasionally develops in men. This can make sexual intercourse difficult, if not impossible. The condition is named after Dr François Gigot de la Peyronie (physician to King Louis XV of France) who wrote about it in 1743, but it has probably been around for much longer; sculptures dating from the 6th century BC depict angulated erect penises. It is estimated that 3–9 in every 100 men has Peyronie’s disease.

Men with Peyronie’s disease often worry about starting a new relationship, because of embarrassment. It is important to realize that while you will be very aware of a slight physical change, your partner will be much less aware. Talk to your new partner about it and explain that it is not an infectious or cancerous condition.

Peyronie’s disease most commonly occurs in men aged 50–60, but it can occur in young men and in old age. The cause is thickening of the fibrous tissue in the penis on one side. This means that, during an erection, one side of the penis cannot lengthen, and the penis will bend. The direction of the bend depends on the position of the thickening (which can often be felt as a lump or lumps when the penis is limp).

  • If the thickening is on the top of the penis, the erection tends to curve upwards; this is the most common type.
  • If the thickening is on either side, the penis will bend towards the side that is thickened.
  • If there is thickening on both sides, the penis may develop an hour-glass shape, but this is unusual.

You may be able to feel the thickened area; it feels like a hard piece of toffee.

Will it get better? For the first 9–18 months after Peyronie’s disease starts, it is often quite painful, especially when the penis is erect. During this period, the thickened area increases in size. After this ‘active period’, it is unlikely to become worse, and the pain becomes less. In 20% of cases, the penis will go back to normal without any treatment. Those who have had the condition for a long time feel no pain but sometimes have difficulty achieving an erection (perhaps because the lumpiness is obstructing blood flow in the penis).

What causes Peyronie’s disease? No one knows why the thickening occurs, but it is not a cancerous condition, nor is it the result of sexually transmitted disease or of any odd previous sexual practices. It is more common in smokers. There seems to be a link with some other conditions. For example, men with Peyronie’s disease are quite likely to have Dupuytren’s contracture, a thickening of fibrous tissue in the palm of the hand. They are also quite likely to have raised blood pressure; some doctors think that the blood pressure itself might be responsible for the penis problem, while others blame the drugs used to treat blood pressure (particularly beta-blockers).

Treatments. There is no need to feel embarrassed about discussing the problem with your family doctor, because doctors are very familiar with the condition. It may be difficult for your doctor to assess how severe the problem is, because the curvature shows only when the penis is erect, so take a photograph of your erect penis and show it to your doctor. If the Peyronie’s is only mild and does not cause any inconvenience, no treatment is necessary.

Some treatments used to be popular, but are not used much now, either because they cause too many side effects and/or because they are not effective. These include tamoxifen (a medication also used for breast cancer, but Peryonie’s disease is not a cancerous condition), L-carnitine, steroid injections into the thickening, and X-ray treatment.

There has been a lot of research into treatments for Peyronie’s disease. ‘Collagenase’ is a new treatment that seems very promising. Treatments that do not involve surgery are recommended during the first 12 months, while the scarring is developing. After that, when the scarring has finished forming, surgery is often the best option; more research is needed to see how effective collagenase might be at this stage.

Cocoa butter cream. Some men with mild Peyronie’s disease say that massaging cocoa butter cream (available from pharmacies) into the curved area is helpful.

Vitamin E tablets are sometimes recommended, but scientific evidence to show that they help is scanty, although they may help other treatments to work better. Do not take more than 250 mg of vitamin E a day, because higher doses may damage your health.

Potassium aminobenzoate (sometimes called ‘potaba’) is another nutritional substance that has been used for a long time. Recent research shows it can reduce pain and the amount of thickening in the early stage, and that it can help to prevent the problem getting worse. However, potaba may have severe gut side effects, so many people cannot tolerate it (World Journal of Mens Health 2016;34:65–72).

Collagenase. The fibrous tissue in the thickened area of the penis contains a substance called collagen. Collagenase is a natural substance (‘enzyme’) that can destroy collagen. Intralesional collagenase injection therapy during the acute phase of PD can be both safe and effective and clinically significant improvements in penile curvature may be achieved (World Journal of Urology 2020;38,299304). Side effects seem to be mostly minor – some pain and bruising. At present, it is used for men whose penis curves more than 30 degrees when erect. More research is needed to see what the long-term results are.

Certain medications that are cousins of Viagra (but not Viagra itself), such as pentoxifylline and tadalafil may help to reduce the size of the plaque. They may be useful in combination with other medications, and especially in men who have erection problems as well as Peyronie’s disease. More research is needed.

Verapamil is a medication that is used to treat blood pressure. Verapamil gel, massaged into the skin over the thickened area, may help by dilating blood vessels and so improving oxygen supply. More research is needed.

Colchicine is a medication that may reduce tissue thickening and reduce Peyronie symptoms, but it has side effects – nausea and bowel problems.

Interferon-alpha 2A is a drug that may be able to reduce the amount of thickening when injected into the area, but more research is needed.

Penis extension (penile traction therapy) using a special device may improve Peyronie’s very slightly. The drawback is that it needs to be used for a long time (several hours a day for several months). The device may be available from some hospital clinics that deal with Peyronie’s and seems to work better when used with other treatments and after surgery.

Sound wave treatment is called ESWT (extracorporeal shock wave treatment). It may reduce pain somewhat, but in any case pain reduces over time. It does not straighten the penis.

Surgery to correct the deformity is the most effective treatment, especially if the curve is severe (more than 60 degrees). Before deciding on surgery, the surgeon will carry out some tests. These might include an injection into the penis to make it erect so that the problem can be seen properly. The surgeon will probably suggest waiting several months before having the operation to ensure the condition is stable, i.e. not in the ‘active’ phase. Ultrasound or MRI scans might also be performed. In the usual operation, the surgeon cuts out some tissue from the opposite side to balance out the thickened area. After the operation the erect penis will be straighter (but not always restored to normal) and 1–3 cm shorter than before when erect, but many men do not notice any difference. Studies have shown that only 58–88% of men are satisfied with the result of the operation, partly because although it straightens the penis it leaves the thickened area in place, so it may still be painful. Also, a few men have difficulty achieving an erection after the operation.

In another type of operation, the surgeon cuts a slit in the thickened area and inserts a piece of tissue (usually a piece of vein from the groin or ankle, or an artificial substance). This makes the area more flexible, and there is no shortening of the penis. However, about 30% of men have difficulty in obtaining an erection after this operation.


First published on: embarrassingproblems.com
Reviewed and edited by: Matt Brewer
Last updated: May 2021

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