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There is no single best treatment for Peyronie’s disease. The choice depends on whether the condition is still changing, how much the curvature or other deformity interferes with sex, erectile function, and what trade-offs a patient is willing to accept. Collagenase injections and traction are nonsurgical options for selected patients; surgery is generally considered for stable disease that compromises intercourse. Each has different evidence, eligibility limits, burdens, and risks.
How do the treatment options compare?
This overview compares treatments by their usual role, not as interchangeable ways to straighten the penis. The European Association of Urology (EAU) guideline chapter and the American Urological Association (AUA) guideline, published in 2015 emphasize assessment by a clinician experienced in Peyronie’s disease. The AUA advises discussing the known benefits, risks, and burdens of available treatments.
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| Option | Usual role | Main trade-off |
|---|---|---|
| Collagenase injections | Curvature reduction for a selected group with stable disease and suitable curvature | Requires clinician-administered treatment; bruising, swelling, pain, and rare serious injury are important risks |
| Penile traction | Nonsurgical mechanical stretching; may help curvature and length | Requires substantial daily device time; evidence is limited and varies across studies and devices |
| Surgery | Correction of stable deformity that interferes with intercourse | Procedure choice depends on anatomy and erectile function; surgery has procedure-specific risks and recovery |
These categories do not predict an individual result. The right comparison for a patient depends on the examination, disease history, erection quality, and personal goals.
Why disease phase and assessment matter
Peyronie’s disease can involve a period when symptoms or curvature are changing and a later period when the deformity is stable. Surgery is generally reserved for stable disease; the AUA guideline notes that stability often occurs 12–18 months after symptoms begin. Studies of surgery commonly required at least 12 months of symptoms and 3–6 months of stable curvature, but those study criteria are not rigid rules for every patient.
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Assessment may include the plaque, stretched or erect penile length, curvature, erectile function, and whether the deformity prevents intercourse. Erection photographs or an induced-erection assessment may help document curvature when appropriate. The EAU guideline describes these assessment considerations; the AUA recommends that evaluation and treatment be handled by clinicians with suitable experience and diagnostic tools.
Collagenase injections: who may be eligible, benefits, and risks
Collagenase clostridium histolyticum (CCH) is injected into the plaque with the aim of reducing curvature. It is a curvature treatment, not a treatment for penile pain or erectile dysfunction, according to the AUA guideline.
Eligibility and expected effect
The EAU recommends considering CCH for men with stable disease, dorsal or lateral curvature greater than 30 degrees, who seek nonsurgical treatment. The AUA guideline describes candidates as having stable disease, curvature greater than 30 and less than 90 degrees, and intact erectile function, with or without medication. A urologist must determine whether a particular patient meets appropriate criteria.
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The EAU’s current online guideline chapter, accessed in 2026, reports average curvature improvement of 34% with CCH compared with 18.2% with placebo. Improvement in the placebo group matters: the reported change is not all attributable to the injection, and it is not a prediction for an individual patient.
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In its 2015 summary of the IMPRESS trials, the AUA reports mean curvature reductions at one year of 17 degrees with collagenase and 9.3 degrees with placebo, a 7.7-degree difference between groups. These are trial averages, not guaranteed outcomes, and should not be treated as the same analysis as the EAU’s percentage figures.
Burden, precautions, and availability
Treatment involves clinician visits and injections. In its 2015 trial summary, the AUA reports that 84.2% of collagenase-group patients and 36.3% of placebo-group patients had at least one adverse event after up to four cycles. Most events were described as mild or moderate and resolved without intervention.
The EAU chapter reports penile hematoma in 50.2%, pain in 33.5%, swelling in 28.9%, and injection-site pain in 24.1%. Most local events resolved spontaneously within 14 days. It also reports serious treatment-emergent adverse events, including hematoma and corporal rupture requiring surgery, at 0.9%. Patients should be counselled about bruising, swelling, pain, and corporal rupture. The EAU advises avoiding intercourse for four weeks after injection to reduce serious adverse events; follow the treating clinician’s specific instructions.
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Penile traction: a device-based option with daily demands
Penile traction therapy uses a device to apply sustained mechanical stretch. The EAU describes potential goals as reducing curvature and recovering length, either with traction alone or as part of a multimodal approach. A meta-analysis cited in its current online chapter found approximately 15 degrees of curvature improvement across five randomized and nonrandomized controlled studies. This is a pooled association from heterogeneous studies, not a guaranteed response or a direct comparison with surgery.
The evidence has important limitations: studies are small, use different devices and protocols, and do not apply standardized criteria. The EAU describes use in the cited literature as requiring two to eight hours daily. No serious adverse events were reported in those studies, but the time commitment may be inconvenient or uncomfortable. Effects for calcified plaques, hourglass deformity, and hinge deformity have not been systematically studied.
A result reported for a study device or protocol cannot automatically be applied to an ordinary retail traction product. The EAU evidence does not establish that all devices perform alike or that a particular retail model matches a clinically studied device. Discuss device selection and use with a urologist.
Surgery: matching the procedure to deformity and erectile function
Guidelines generally place surgery in stable disease when deformity causes functional impairment or compromises intercourse. Procedure choice depends on curvature and complexity, penile length, erectile function and response to medication, and the patient’s priorities. The EAU recommends surgery only when disease is stable and intercourse is compromised.
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Tunical plication
Plication corrects curvature by shortening the longer side of the penis. The AUA says it may be offered when rigidity is adequate for intercourse, including when medication or a vacuum erection device helps. It is a curvature-correction procedure, not a treatment for erectile dysfunction.
Plaque incision or excision with grafting
This lengthening approach may be offered for deformity when rigidity is adequate for intercourse, according to the AUA. Erection quality and the risks of the procedure require careful consideration; the AUA identifies possible effects on erectile function as an important issue to discuss.
Penile prosthesis
The AUA says a penile prosthesis may be offered when erectile dysfunction, deformity, or both prevent intercourse despite pharmacotherapy or a vacuum device. If significant curvature remains after placement, the surgeon may use additional modeling, plication, or incision with grafting.
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Other treatments: what they do and do not establish
Shockwave therapy
Shockwave therapy should not be presented as a proven way to straighten the penis or shrink plaque. The AUA advises against using it for curvature or plaque-size reduction, while allowing it as an option for pain. The EAU likewise reports pain relief but no effect on curvature or plaque size.
Verapamil injections
Evidence for intralesional verapamil is weak or conflicting. The AUA advises careful consideration because evidence is weak; the EAU says contradictory evidence does not support meaningful curvature improvement compared with placebo.
Interferon and oral supplements
The EAU reports that interferon alfa-2b was withdrawn from European and US markets in 2021 and does not recommend it. This market-status statement should not be generalized to every jurisdiction or to compounded treatments. The AUA advises against vitamin E and several other oral therapies it reviewed because convincing evidence of efficacy is lacking; the EAU also advises against several oral agents. Supplements should not be represented as established curvature treatments.
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Quick Recap
Questions to take to a urologist
- Is the curvature still changing, or has it been stable long enough to consider a particular treatment?
- Which part of the problem is the priority: curvature, pain, erectile function, length, or ability to have intercourse?
- How do my curvature pattern, plaque location, erection quality, and any complex deformity affect eligibility?
- What benefit is realistic for this option, and what uncertainty or risk matters most in my case?
- What visits, daily device use, recovery, and follow-up would treatment require?
- Is the treatment available where I live, and what local experience does the clinician have with it?
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