Peyronie's disease

Peyronie’s disease is a localised connective-tissue disorder of the tunica albuginea — the fibrous envelope of the corpora cavernosa — characterised by plaque formation that causes penile curvature, pain and, in some cases, erectile dysfunction (El-Sakka et al., Arab J Urol 2013; PMID 26558092). The condition typically follows a biphasic course. The acute phase (roughly the first 12 to 18 months) involves inflammation, pain on erection and progressive deformity. The chronic phase follows, in which the plaque stabilises or calcifies but the curvature persists. Severe Peyronie’s usually needs an in-person urology assessment, so the online consultation is not the right fit for every case.

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Diagnostic evaluation

The European Association of Urology recommends an objective assessment of penile curvature using pharmacologically induced erection (intracavernous injection of a vasoactive agent such as alprostadil), supplemented by self-photography of a natural erection where injection is not feasible. Intracavernous injection is considered the reference standard because home photography and vacuum-assisted measurements tend to underestimate the degree of curvature, especially in men with concurrent ED (Ohebshalom et al., J Sex Med 2007; PMID 17362277). The American Urological Association further advises duplex Doppler ultrasound before any invasive intervention to evaluate plaque calcification, penile haemodynamics and the quality of erection after injection. The most common plaque location is the dorsal mid-shaft; curvature exceeding roughly 48 degrees (the median across published studies) is often considered for intervention. A focused history should also assess for Dupuytren’s contracture, which shares a genetic predisposition with Peyronie’s and is present in a subset of patients (EAU Guidelines on Penile Curvature 2024).

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Pathophysiology

The prevailing model implicates repetitive microvascular trauma to the tunica albuginea during intercourse, which triggers a dysregulated wound-healing response. Key mediators include transforming growth factor beta 1 (TGF-β1), a cytokine that promotes fibroblast proliferation, myofibroblast differentiation and excessive type I collagen deposition. This fibrotic process is thought to be self-limiting because the inflammatory reaction is trapped within the multilayered tunical structure, preventing normal cytokine dispersal and resolution (El-Sakka et al., Arab J Urol 2013; PMID 26558092). Genetic predisposition is supported by the association of Peyronie’s with Dupuytren’s contracture and with certain HLA haplotypes. The disease follows a biphasic course. The acute (active) phase, lasting roughly the first 12 to 18 months, is characterised by inflammation, pain on erection and progressive deformity. The European Association of Urology defines disease stability as resolution of pain and no change in curvature for at least three consecutive months. A 2024 evidence-based PTNM classification further distinguishes four Peyronie’s subtypes — classical, calcifying, progressive and relapsing-remitting — each with distinct criteria for active versus stable disease (Trost et al., J Sex Med 2024; PMID 39115123). In the chronic (stable) phase, the plaque may calcify but the curvature persists.

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Can Hi-Doctor help?

A licensed doctor reviews your questionnaire and assesses whether your case can be handled through an online consultation. If your case needs an in-person urology assessment, the doctor tells you and does not charge for a service that would not be appropriate.

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Your path to treatment

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How Hi-Doctor handles it

See how the consultation works, how we handle safety and eligibility, and pricing.

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Related reading

• Erectile dysfunction — a related concern reviewed in the same consultation
• Sexual health consultation — the pathway this review sits in

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