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Peyronie’s disease treatment depends on whether the condition is still changing or has stabilized, how much pain or curvature it causes, whether it interferes with sex, and how erectile function and penile length affect your priorities. Not everyone needs active treatment, and no single option is right for every person. A urologist can assess the deformity and discuss whether the goal is pain relief, improved function, or correction of curvature.
Start with an assessment, not a treatment device or procedure
The European Association of Urology (EAU) recommends a medical and sexual history alongside a physical examination. The discussion should cover how long symptoms have been present, pain during erection, the direction and degree of curvature, difficulty with penetration, erectile function, and how the changes affect sexual activity. Examination can include palpable plaques, stretched or erect penile length, and curvature. EAU penile-curvature guideline (2026).
Curvature may be documented with photographs of an erection, a vacuum-assisted erection, or an erection induced with medication in a clinical setting. Routine MRI or CT is not recommended. Ultrasound can help assess plaque presence, location, calcification, or blood flow in selected cases, but plaque-size measurements by ultrasound are inaccurate and operator-dependent. Doppler ultrasound may be useful when evaluating erectile dysfunction, particularly before surgery. These tests are not a substitute for the history and examination.
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Active disease: address pain and changing symptoms
When symptoms are still changing, treatment discussions often focus on pain, progression concerns, and monitoring. The EAU says nonsteroidal anti-inflammatory drugs (NSAIDs) may be considered for penile pain during the active phase, with regular reassessment. A clinician can help decide whether an NSAID is appropriate for your health and other medicines.
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Stable disease: consider correction if function is impaired
The EAU recommends surgery only when disease is stable and the deformity compromises intercourse. It describes stability as generally requiring three to six months of stable symptoms or more than 9–12 months from symptom onset. These are guideline framing points, not a reason to decide on surgery based on a calendar alone; the clinician should assess whether the curvature and deformity have actually stabilized. EAU penile-curvature guideline (2026).
Separate pain relief from attempts to straighten the penis
Some treatments may address one symptom without correcting the bend. The EAU says extracorporeal shockwave therapy may be used for pain in the acute phase, but recommends against using it to improve penile curvature. PDE5 inhibitors are primarily used when erectile dysfunction is also present; observational findings do not establish them as a dependable curvature treatment.
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Evidence for intralesional verapamil or nicardipine is mixed or limited. The EAU also advises counseling patients that evidence for platelet-rich plasma remains limited. Supplements and unproven injections should not be presented as established ways to straighten the penis. EAU penile-curvature guideline (2026).
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Collagenase injections have specific eligibility criteria and risks
Guidelines describe different eligibility criteria, so it matters which recommendation is being summarized. The EAU’s 2026 guideline recommends intralesional collagenase Clostridium histolyticum for people seeking nonsurgical treatment who have dorsal or lateral curvature greater than 30°. The American Urological Association (AUA) 2015 guideline specifies stable disease, curvature greater than 30° and less than 90°, and intact erectile function, with or without medication. These criteria are not interchangeable. EAU guideline; AUA Peyronie’s Disease guideline (2015).
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In the IMPRESS evidence reported by the EAU, the collagenase treatment group had an average curvature improvement of 34%, compared with 18.2% in the placebo group. Those are averages for trial groups, not a prediction or promise for an individual. The cited evidence included three cases of corporal rupture, which were surgically repaired. The AUA advises counseling about bruising, swelling, pain, and corporal rupture before treatment.
Availability is geography-specific. The EAU says collagenase was approved by the European Medicines Agency in 2014 for specified stable-phase disease, but the manufacturer has since officially withdrawn it from the European market. That statement does not establish availability elsewhere; ask a local urologist or regulator about current status where you live. EAU penile-curvature guideline (2026).
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Traction and vacuum devices are options, not guaranteed corrections
The EAU says penile traction devices and vacuum devices may be offered to reduce deformity or as part of multimodal treatment, but this is a weak recommendation because outcome data are limited. Traction studies are small and heterogeneous, with nonstandardized inclusion criteria; the evidence does not establish that one consumer device or protocol reliably works for every patient.
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Surgery is chosen around function, anatomy, and trade-offs
Before surgery, the EAU recommends assessing penile length, curvature, erectile function and response to medication, complex deformities, and expectations. The aim is to choose an approach that makes sexual function possible or easier—not to promise cosmetic perfection. The broad options differ in whom they may suit:
| Approach | When it may be considered | Important trade-off or qualification |
|---|---|---|
| Shortening procedure, such as plication | Some men with adequate penile length and rigidity, less-severe curvature, and no complex deformity. | The approach shortens the longer side to reduce the bend; discuss the potential effect on length. The AUA says plication may be offered when rigidity is adequate. |
| Lengthening procedure, such as plaque incision or excision with 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; discuss risks including erectile dysfunction and sensory changes. |
| Penile prosthesis, with straightening maneuvers if needed | For erectile dysfunction that does not respond to medical treatment; a prosthesis may also be considered when erectile dysfunction or deformity prevents intercourse despite medication or vacuum-device therapy. | The AUA recommends an inflatable prosthesis for prosthetic surgery for Peyronie’s disease. Additional maneuvers may be needed to address curvature. |
Hourglass or hinge deformity can change which procedure is appropriate, so the table is a framework for discussion, not a procedure selector. The EAU advises discussing possible shortening, erectile dysfunction, numbness, delayed orgasm, recurrence, residual curvature, and other procedure-specific risks before proceeding. EAU penile-curvature guideline (2026); AUA Peyronie’s Disease guideline (2015).
Use current guidance as a starting point for shared decisions
The EAU’s current Sexual and Reproductive Health guideline is its 2026 edition; the association describes it as a limited update of the 2025 guideline, with substantial revision to the penile-curvature section, including conservative and surgical treatment. Its figure of 116 updated studies applies across the Sexual and Reproductive Health guidelines, not specifically to Peyronie’s disease. EAU 2026 summary of changes.
The AUA Peyronie’s Disease guideline is dated 2015, not a newly updated guideline. Its guideline listing says a combined Disorders of Penile Erection guideline that includes Peyronie’s disease is due in 2027; that is a scheduled listing, not a guarantee of publication on that date. AUA guideline listing.
Guidelines inform decisions but do not replace a clinician’s assessment of individual circumstances and preferences. At an appointment, it can help to explain what matters most to you—pain control, penetration, erectile function, length, or a particular treatment’s risks—so you and your urologist can weigh options against those priorities.
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