Peyronie’s disease usually has two phases:

• Acute (Active) Phase: This is the early stage, lasting usually several months, and sometimes over a year. In this phase, the scar tissue (plaque) is forming. Men often notice the penile curvature getting worse over time, and there may be penile pain with erections. Changes in penis shape or length tend to progress during this period. The acute phase is when inflammation is active, and the condition is not yet stable.

• Chronic (Stable) Phase: In the later stage, the plaque stops growing and the disease stabilizes. The penile curvature stops worsening (it plateaus), and pain usually subsides or goes away. In the chronic phase, there are typically no further changes in the curve or length of the penis. This is essentially the “scarred over” stage; the damage has been done, and things have settled.

In many men, Peyronie’s does not resolve on its own. Pain often improves over time (studies found the vast majority of patients had pain resolution after a year), but the curvature usually does not fully straighten without treatment.

Treatment for Peyronie’s disease depends on how severe the curvature is, how much it interferes with sexual activity, and whether the disease is in the active or stable phase. Mild curvatures that do not affect sexual function may not require active treatment – sometimes reassurance and observation are enough. However, if the curvature is significant (making intercourse difficult or causing distress), or if it’s worsening, then treatment is considered.

Broadly, treatments fall into non-surgical (conservative) therapies and surgical interventions. Below, we break down the options in simple terms:

Oral Medications

There is no pill cure for Peyronie’s disease, and research on oral treatments has shown mixed results. Oral treatments alone have limited effect on Peyronie’s disease. There is no reliable oral medication to straighten the penis, and guidelines emphasize that therapies like vitamin E or various supplements have not shown significant benefit. If used, oral medications are typically part of a broader treatment plan or used to manage symptoms (like pain), rather than as stand-alone cures.

Intralesional Injections (Injecting Medication into the Plaque)

Another non-surgical approach is to inject medication directly into the penile plaque. The goal of intralesional injection therapy is to break down or remodel the scar tissue to reduce curvature, or to reduce inflammation. There are a few different drugs that can be used this way:

• Verapamil: Verapamil is a medication that has been used as an injection into Peyronie’s plaques. The idea is that verapamil may disrupt collagen production and stimulate enzymes that break down scar tissue. It may also increase blood flow and reduce plaque size or hardness. Some studies and clinical reports have shown that verapamil injections can lead to improvements in curvature and pain for a subset of men. Verapamil shots might help and are generally safe (possible side effects include temporary penile bruising, pain at the injection site, dizziness and nausea), but patients should have realistic expectations. It requires a series of 6 - 12 injections.

Penile Traction Therapy

Penile traction therapy (PTT) is a nonsurgical treatment where a man uses a mechanical stretching device to gently pull or stretch the penis over time. Consistent traction may gradually remodel scar tissue and encourage tissue expansion. In Peyronie’s, the goal of traction is to reduce curvature and prevent length loss (or even regain some length) by stretching the scar tissue and the penis daily.

Penile traction involves wearing a device on the penis (while flaccid) that applies a steady, gentle force. Over months of regular use, this can lead to measurable improvements in curvature and penile length. Traction is typically done for a set amount of time each day. Modern devices such as the RestoreX® and other next-generation adjustable systems have clinical evidence supporting shorter daily use (as little as 30–90 minutes) while maintaining effectiveness.

Many urologists suggest traction therapy, either alone (for mild cases or during the acute phase to preserve length) or in combination with other treatments.

Traction devices are generally safe; the main downsides are the time commitment and some discomfort from stretching. Men have to be motivated to use them daily as directed. Minor side effects can include soreness or slight bruising, but serious injuries are rare when devices are used correctly.

Surgery is the most effective way to straighten the penis in Peyronie’s disease. However, it is usually considered a last resort or indicated for cases where the curvature is severe (for example, intercourse is impossible) or other treatments haven’t helped.

Here are a few surgical techniques for Peyronie’s disease:

• Plication Surgery: This is the simplest surgical fix. Think of it as “tautening” the longer side of the penis. In a curvature, one side of the penile tissue is shorter (the side with the scar) and the opposite side is longer. Plication involves placing stitches in the longer side of the penis (opposite the plaque) to shorten it, thereby straightening the penis. It does not remove the plaque; it just evens out the lengths. Plication is often chosen for curvatures that are not extremely severe and in men who have good erectile function. The procedure is relatively fast and has a high success rate in terms of straightening the curvature. The downside is that because the longer side is shortened, there is a loss of penile length. Also, the stitches (suture knots) can sometimes be felt under the skin, and in a small number of cases the curvature can recur over time. The rigidity of erections can also decrease after a plication surgery.

• Penile Prosthesis (Implant) Surgery: This is typically reserved for men who have Peyronie’s disease with coexistent erectile dysfunction – in other words, they not only have curvature, but also cannot achieve a satisfactory erection suitable for intercourse.

Surgery for Peyronie’s can improve quality of life. However, it’s not a complete cure or a way to restore the penis exactly to how it was prior to the curvature. Realistic expectations are important: even after surgery, the penis may be shorter than it used to be and erections might be less rigid than before. Most importantly, Peyronie’s surgery does not increase penis size – it mainly straightens the curvature.

Living with Peyronie’s can be challenging, but support is available. With proper treatment – whether medical, mechanical, or surgical – many men with Peyronie’s disease can regain a functional erection and significantly improve their sexual confidence and quality of life.

Email: Dr.Gavin.Langille.Office@horizonnb.ca

Call: 1-506-636-8818