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Finding It and Treating It Are Not the Same Thing
A reader recently wrote with a question I hear often.
“I’ve developed a plaque and an indentation, but my penis is still straight. What should I do?”
It’s a great question.
Because finding Peyronie’s disease and treating Peyronie’s disease are not the same thing.
One of the biggest misconceptions about Peyronie’s is that every plaque needs treatment.
It doesn’t.
What Peyronie’s Actually Is
Peyronie’s disease is scar tissue that forms within the erectile tissue of the penis.
That scar can cause curvature.
It can cause shortening.
Sometimes it causes an hourglass narrowing or an indentation.
Sometimes it causes pain during erections, particularly early on.
And sometimes the only thing a man notices is a lump.
Those are all part of the same condition.
But they don’t all require the same response.
I Treat the Man, Not the Ultrasound
When someone comes to see me, I’m not treating the plaque.
I’m not even treating the ultrasound.
I’m treating the man sitting in front of me.
Can you still have intercourse?
Are your erections good enough?
Is the deformity getting worse?
Are erections painful?
Is this affecting your confidence or your relationship?
Those answers matter far more than the diagnosis alone.
When the Right Answer Is Observation
If a man has a small plaque, a mild indentation, good erections, and no meaningful curvature, my recommendation is often surprisingly simple.
Observation.
Sometimes a vacuum erection device to help maintain penile health.
Sometimes nothing at all except follow-up.
That can be frustrating to hear.
We’re conditioned to think that every diagnosis deserves a treatment.
Medicine doesn’t always work that way.
When Treatment Makes Sense
If the disease progresses, the conversation changes.
If curvature develops and begins interfering with intercourse, we have treatments that can help.
Penile traction has the best evidence among the non-surgical options for preserving length and improving curvature in appropriately selected men.
Collagenase injections (Xiaflex®) can be very effective for the right patient with stable disease and a significant bend.
And for men with severe deformity or significant erectile dysfunction, surgery may eventually become the best option.
The important point is that we match the treatment to the problem – not simply to the diagnosis.
What About the Treatments You’ve Read About Online?
I also get asked every week about treatments people read about online.
Vitamin E?
I wish it worked.
It has been studied repeatedly, and the evidence simply hasn’t shown meaningful improvement in curvature or long-term outcomes.
PRP?
It’s biologically interesting.
Right now, the clinical evidence isn’t there.
I don’t think we’re ready to recommend it outside of research.
Shockwave therapy?
This one surprises a lot of men.
There is evidence that shockwave can shorten the painful phase of active Peyronie’s disease.
There is not convincing evidence that it reliably straightens the penis or improves curvature.
Pain and curvature are different problems.
The treatment that helps one doesn’t necessarily help the other.
A Crisis, Not an Emergency
One of the hardest parts of Peyronie’s disease is that men often feel they have to act immediately.
We’ve written before that Peyronie’s is a crisis, not an emergency.
That’s still true.
There is time to understand what’s happening, determine whether the disease is still changing, and choose the treatment that fits your situation.
Not every plaque progresses.
Not every curve needs an injection.
Not every man needs surgery.
The Goal Is Function, Not a Straight Line
The goal isn’t to create a perfectly straight penis.
The goal is to preserve function.
If you can have satisfying intercourse, your erections are good, and the condition is stable, sometimes the best treatment is careful observation.
Not because we don’t have options.
Because we do.
And choosing not to treat is sometimes just as thoughtful as choosing to intervene.
That’s not doing nothing.
That’s practicing good medicine.
