Peyronie's disease causes scar tissue (plaque) to form within the penis — leading to curvature, shortening, narrowing, indentation, pain, and erectile dysfunction. It's common, and many men suffer in silence assuming nothing can be done. The reality: Peyronie's is highly treatable, with options ranging from in-office injections to advanced reconstructive surgery.
What's Actually Happening
Scar tissue develops within the tunica albuginea — the tough fibrous layer surrounding the erectile chambers. Normal penile tissue stretches during an erection; scar tissue doesn't. One side expands normally while the scarred side stays restricted, producing curvature or deformity.
Possible presentations:
- Upward, downward, or side-to-side curvature
- Penile shortening
- Indentation ("hourglass deformity")
- Narrowing or hinging
- Painful erections
- Erectile dysfunction
Severity ranges from mild cosmetic changes to deformities that make intercourse difficult or impossible.
What Causes It
Peyronie's typically results from abnormal wound healing after repetitive microtrauma to the penis. Risk factors:
- Penile injury during intercourse
- Genetic predisposition
- Connective tissue disorders
- Diabetes
- Erectile dysfunction
- Increasing age
- Prior penile surgery
Many men don't recall a specific injury.
Comprehensive Evaluation
Accurate assessment is critical — treatment recommendations depend heavily on the type and severity of deformity.
History
Duration of symptoms, degree of curvature, erectile function, penile shortening, prior treatments, impact on sexual activity.
In-office curvature assessment
Objective measurement of penile deformity rather than relying on estimates. Allows precise documentation and treatment planning.
Pharmacologic erection assessment
An in-office penile injection creates a medically induced erection, allowing direct evaluation of curvature severity and direction, plaque location, hourglass deformities, hinge defects, and erectile rigidity. Often the most important component of evaluation.
Goniometer measurements
A goniometer accurately measures the degree of curvature. Precise measurements drive treatment selection, Xiaflex candidacy, surgical planning, and outcome monitoring.
Penile duplex Doppler ultrasound
Critical information about plaque location, calcification, penile blood flow, arterial insufficiency, venous leak, and erectile function. Determines whether erectile dysfunction is contributing and which treatment is optimal.
Nonsurgical Treatment
Many men can be treated without surgery.
Xiaflex® (collagenase clostridium histolyticum)
The only FDA-approved medication specifically for Peyronie's disease. Injected directly into the plaque to weaken scar tissue and improve curvature. Office-based, no surgery, minimal downtime. Patients typically undergo a series of treatment cycles combined with modeling exercises.
RestoreX® traction therapy
Specialized traction device to improve curvature and help preserve or regain penile length. Often combined with Xiaflex for enhanced outcomes.
When Surgery Is Recommended
Surgery is generally recommended when curvature prevents intercourse, significant deformity is present, curvature is stable, nonsurgical treatment has failed, or ED coexists with Peyronie's.
Penile plication
Straightens the penis by shortening the side opposite the curvature. Best for men with good erectile function, adequate length, and curvature without major narrowing or hourglass deformity. Reliable, short operative time, rapid recovery.
Plaque incision or excision with grafting (PIG)
For complex deformities, grafting often provides superior results. The scar tissue is released, the penis straightened, and the defect reconstructed with a graft. Best for severe curvature, hourglass deformities, significant narrowing, length-loss concerns, and good baseline erectile function.
Penile implant for Peyronie's + ED
Many men with Peyronie's also develop ED. In those cases, an inflatable penile prosthesis is often the most comprehensive solution — restoring erectile function, straightening curvature, correcting instability, and providing dependable erections on demand.
For severe Peyronie's with ED, Dr. Asanad specializes in single-incision inflatable penile prosthesis with plaque incision and grafting — combining implant placement, plaque incision, and penile grafting in one operative setting. Corrects severe curvature, hourglass deformity, penile instability, and ED simultaneously, with a single recovery. Performed by only a handful of fellowship-trained reconstructive surgeons nationwide.
Before & After
Selected case results from Dr. Asanad's reconstructive surgery practice.
Before
After
Before
After
Patient outcomes vary. Images shown with patient consent and posted with discretion.
Recovery
Depends on the procedure performed.
Plication
Rapid recovery. Return to sexual activity in approximately 4–6 weeks.
Grafting procedures
Several weeks of healing. Return to intercourse typically around 6 weeks.
Penile implant reconstruction
Outpatient surgery. Device activation within several weeks. Return to sexual activity often within 4–6 weeks.