Peyronie’s disease treatment depends on how long the condition has been present, how much the curvature or other deformity interferes with sex, whether erections are reliable, and what trade-offs matter most to you. Not everyone needs active treatment. The first step is a urologic assessment; pain relief, nonsurgical options and surgery each have different goals and limits.
How does a urologist assess Peyronie’s disease?
The 2026 European Association of Urology (EAU) guideline recommends starting with a medical and sexual history and a physical examination. The goal is to understand both the shape of the penis and how the condition affects function—not simply to record an angle.
- History: how long symptoms have been present; pain during erection; changes in curvature or other deformity; difficulty with penetration; and erectile dysfunction.
- Examination: palpable plaques, penile length when stretched or erect, and the degree and direction of curvature.
- Documenting curvature: a clinician may use photographs of an erection, a vacuum-assisted erection, or an erection induced with medication.
Ultrasound can help assess a plaque’s presence, location or calcification in selected cases, but plaque-size measurements are inaccurate and depend on the operator. Doppler ultrasound may be useful when evaluating erectile dysfunction, particularly before surgery. Routine MRI or CT is not recommended. See the EAU’s 2026 penile-curvature guideline.
Why does the phase of the disease matter?
Active and stable disease lead to different treatment discussions. During the active phase, pain or changes in the deformity may be concerns, so care may focus on pain relief and monitoring. Surgery is reserved for stable disease when the deformity compromises intercourse. For surgical planning, the EAU describes stability as generally requiring three to six months or more than 9–12 months from symptom onset; a urologist should assess whether an individual case is stable.
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What can conservative care and medicines do?
NSAIDs for pain
During the active phase, nonsteroidal anti-inflammatory drugs (NSAIDs) may be considered for penile pain, with regular reassessment. Their role here is pain relief; they should not be presented as a way to reliably straighten the penis.
PDE5 inhibitors for erectile dysfunction
Phosphodiesterase type 5 (PDE5) inhibitors are used to treat erectile dysfunction that occurs alongside Peyronie’s disease. Observational findings do not establish these medicines as a dependable treatment for curvature.
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Shockwave treatment for pain, not curvature
The EAU allows extracorporeal shockwave treatment to be considered for pain in the acute phase, but advises against using it to improve penile curvature. Relief of pain and correction of a bend are different treatment goals.
Other injections and supplements
Evidence for injections such as verapamil or nicardipine is mixed or limited. The EAU also advises full counseling about platelet-rich plasma (PRP), for which evidence remains limited. Supplements and unproven injections should not be treated as established therapies.
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When might collagenase injections be an option?
Guidelines describe different eligibility criteria, so it matters which recommendation is being discussed. The EAU’s 2026 guideline recommends intralesional collagenase Clostridium histolyticum for people with dorsal or lateral curvature greater than 30° who want nonsurgical treatment. The American Urological Association (AUA) guideline, published in 2015, specifies stable disease, curvature greater than 30° and less than 90°, and intact erectile function—with or without medication.
In the IMPRESS evidence cited by the EAU, the collagenase group had an average curvature improvement of 34%, compared with 18.2% in the placebo group. These are trial-group averages, not a prediction of an individual result. In the cited evidence, three cases of corporal rupture were surgically repaired. The AUA says patients should be counseled about bruising, swelling, pain and corporal rupture before treatment. Read the AUA’s 2015 Peyronie’s disease guideline.
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Availability is country-specific. The EAU says collagenase was approved by the European Medicines Agency in 2014 for specified stable-phase disease, but was later officially withdrawn from the European market by its manufacturer. That European status does not establish whether the treatment is currently approved or commercially available elsewhere; ask a local urologist about your country’s current status.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Do traction or vacuum devices work?
The EAU says penile traction devices and vacuum devices may be offered to reduce deformity or as part of multimodal therapy, but its recommendation is weak because outcome data are limited. Traction studies are small and varied, with different designs and nonstandardized inclusion criteria; the evidence does not show that one consumer device or usage protocol works reliably for everyone. A vacuum erection device should not be assumed to straighten curvature. Ask a urologist whether either type of device is suitable for your case.
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When is surgery considered?
The EAU recommends surgery only when disease is stable and the deformity compromises intercourse. Before choosing a procedure, the urologist should assess penile length, curvature, erectile function and response to medication, any complex deformity, and the patient’s expectations. Hourglass or hinge deformities can affect which operation is appropriate.
| Procedure approach | When it may be considered | Important trade-off or context |
|---|---|---|
| Shortening procedure, such as plication | Some men with adequate penile length and rigidity, less-severe curvature, and no complex deformity. The AUA says plication may be offered when rigidity is adequate. | Penile shortening is a potential trade-off to discuss. |
| Lengthening procedure, involving plaque incision or excision and grafting | May be considered for severe curvature, inadequate length, or complex deformity. The AUA permits plaque incision or excision with grafting in selected patients with adequate rigidity. | Suitability depends on anatomy and erectile function; no one technique fits every deformity. |
| Penile prosthesis | For erectile dysfunction that does not respond to medical treatment. The AUA also describes prosthesis for erectile dysfunction and/or deformity that prevents intercourse despite medication or vacuum-device therapy. | Additional straightening maneuvers may be needed. The AUA recommends an inflatable prosthesis for prosthetic surgery for Peyronie’s disease. |
Discuss the possible effects of surgery on length, erections, sensation and orgasm, as well as recurrence, residual curvature and recovery. The goal is a procedure suited to function, anatomy and personal priorities—not a guarantee of perfect cosmetic straightness.
How should you make the treatment decision?
Guidelines help structure a discussion, but they do not replace clinical judgment or individual preferences. The EAU’s 2026 summary of changes says the guideline is a limited update of the 2025 edition, with substantial revision to the penile-curvature section, including conservative and surgical treatment. The AUA document remains its 2015 Peyronie’s disease guideline; its listing says a combined Disorders of Penile Erection guideline that includes Peyronie’s disease is due in 2027, which is a scheduled date rather than a guarantee of publication.
Bring questions about pain, curvature, penetration, erections and length to a urologist, along with any erection photographs the clinician requests. Ask what each option is intended to improve, what it is unlikely to change, what risks apply to you, and how your goals affect the choice. The EAU describes its guidelines as aids to decisions rather than mandates or a legal standard of care.
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