Understanding How Common Peyronie’s Disease Really Is

Peyronie’s disease affects more men than many people realize, though the exact numbers vary depending on how studies are conducted. Medical experts estimate that approximately 6% to 10% of men between the ages of 40 and 70 have Peyronie’s disease.^[1] Some research suggests the prevalence could be even higher, ranging from 0.3% to 13.1% of men worldwide.^[2] In one study that screened men for prostate cancer, researchers found that nearly 9% had a penile nodule characteristic of Peyronie’s disease, meaning almost 1 out of 10 men examined showed signs of the condition.^[3]

However, these numbers may not tell the complete story. Many healthcare professionals believe Peyronie’s disease is actually more widespread than statistics suggest because many men feel too embarrassed to talk about it with their healthcare providers.^[4] This hesitation to seek medical attention means that numerous cases likely go undiagnosed and unreported. The condition most commonly affects men over the age of 40, though it can occur in younger individuals as well.^[5] The average age of men diagnosed with Peyronie’s disease tends to be in their 60s, with those having risk factors like hypertension or diabetes being more likely to develop the condition.^[6]

What Causes Peyronie’s Disease to Develop

The exact cause of Peyronie’s disease remains somewhat mysterious, though researchers have developed several theories about how it develops. The most widely accepted explanation relates to physical injury or trauma to the penis.^[7] This injury can happen during sexual intercourse, particularly if the intercourse is vigorous or if penetration occurs when the erection is not fully firm. Research has found that men who engage in more frequent or vigorous intercourse appear more likely to develop Peyronie’s disease.^[8]

The injury doesn’t have to be a single dramatic event. In many cases, the trauma is silent and occurs more than once over time.^[9] Some men may even injure their penis if they roll over during a nighttime erection without realizing it.^[10] When the penis experiences this type of trauma, the body’s natural healing process begins. However, in men who develop Peyronie’s disease, this healing process goes awry. Instead of normal tissue repair, the body forms excessive fibrous scar tissue, which is tough, inflexible tissue that doesn’t stretch like normal penile tissue.^[11]

This scar tissue, also called plaque (though it’s different from the plaque that builds up in blood vessels or on teeth), forms in the tunica albuginea, which is the elastic sheath of fibers that surrounds the erectile chambers of the penis.^[12] The tunica albuginea is made primarily of type 1 collagen fibers and needs to expand properly during erections. When scar tissue forms in this delicate structure, it prevents normal expansion, causing the penis to bend or curve toward the side where the scarring has occurred.^[13]

The reason why some men develop this abnormal scarring pattern while others don’t is rarely clear and likely involves multiple factors. Some people wonder if they did something wrong that caused the condition, but this is very unlikely.^[14] The condition appears to affect how the tissue in the penis heals after being wounded, suggesting that individual differences in wound healing play an important role.

Risk Factors That Increase Your Chances

Several factors can increase a man’s likelihood of developing Peyronie’s disease. Understanding these risk factors helps explain why some men are more susceptible to the condition than others. Age is one of the most significant risk factors, with the condition primarily affecting men over 40 years old.^[15] As men get older, their risk increases, which may relate to changes in tissue elasticity and healing capacity that occur with aging.

Medical conditions that affect blood flow and tissue health significantly increase risk. Men with diabetes are at higher risk, and importantly, the better their diabetes is controlled, the less chance they have of developing Peyronie’s disease.^[16] However, in most men with diabetes, control is not optimal, making them more prone to developing the condition earlier in life than men without diabetes. High blood pressure, high cholesterol, and coronary heart disease also increase risk, as does having thickened blood vessels in the heart, a condition known as arteriosclerosis.^[17]

Certain medications may also play a role. Men taking beta blockers or antidepressants appear to have an increased risk of developing Peyronie’s disease.^[18] Additionally, there may be a genetic component, as the condition sometimes runs in families.^[19] Men with Peyronie’s disease are also more likely to have scarring disorders in other parts of their body. For example, some men with Peyronie’s also have a condition called Dupuytren’s contracture, which causes thickening and scarring in the hands, or similar conditions affecting the feet.^[20]

An important and often overlooked risk factor relates to erectile function. Some experts believe that erectile insufficiency, which refers to erections that are not as firm as they should be, may actually contribute to causing Peyronie’s disease rather than being just a result of it.^[21] When men have penetrative sex with an erection that is not strong enough to resist too much bending, the penis becomes more vulnerable to injury. This repeated minor trauma during sexual activity with insufficient erectile rigidity may set the stage for the development of scar tissue and curvature.

Recognizing the Symptoms of Peyronie’s Disease

The symptoms of Peyronie’s disease can develop suddenly or appear gradually over time. The most noticeable symptom is a curve or bend in the penis during erection.^[22] The direction of the curve depends on where the scar tissue has formed. In most cases, the scar forms on the top of the penis, causing it to curve upward when erect. If the scar is on the bottom, the penis will bend downward, and if the scar is on the side, it will curve sideways.^[23]

Before the curve becomes apparent, many men first notice hard lumps or a band of firm tissue under the skin of the penis.^[24] These can be felt as flat lumps or a hard band when touching the penis, even when it’s not erect. The area over the scar tissue may feel tender to the touch. In some cases, the scar develops on both the top and bottom of the penis shaft, which can create an indentation that gives the penis an “hourglass” appearance rather than a simple curve.^[25]

Pain is another common symptom, particularly in the early stages of the disease. About half of men with Peyronie’s first notice pain during intercourse.^[26] The penis may be painful when erect, and sometimes even when soft or flaccid. The severity of pain varies considerably from person to person. For some, it’s a mild discomfort, while for others, it can be quite significant. Fortunately, pain tends to decrease over time as the condition stabilizes, though it can sometimes persist, especially during erections.^[27]

Other symptoms include changes in penis size and shape. Many men experience a loss of length in their penis, and some notice loss of girth or thickness in the shaft.^[28] The penis may also develop changes in the quality of erections, becoming softer or less rigid than before. If the bend in the penis is greater than 30 degrees (which looks similar to when the hands of an analog clock read 1:00), it can make sexual intercourse painful or even impossible for the man or his partner.^[29] These physical changes often lead to difficulty having sex, which can cause significant emotional distress and anxiety.

Ways to Prevent Peyronie’s Disease

While it’s very difficult to prevent Peyronie’s disease specifically, there are several approaches that may help reduce your risk. Since the risk factors for Peyronie’s disease are essentially the same as those for cardiovascular disease and erectile dysfunction, maintaining good overall vascular health is beneficial.^[30] Engaging in regular cardiovascular exercise such as walking, running, biking, or weightlifting helps maintain healthy blood flow throughout the body, including to the penis.

Maintaining a healthy overall body weight is also important. A healthy weight supports better blood flow and reduces the risk of conditions like diabetes, high blood pressure, and high cholesterol, all of which are risk factors for Peyronie’s disease. Avoiding or quitting smoking is crucial, as smoking damages blood vessels and impairs circulation. Similarly, limiting alcohol consumption can help maintain better vascular health and erectile function.

For men with diabetes, keeping blood sugar levels well controlled is particularly important. The better diabetes control is, the lower the risk of developing both erectile dysfunction and Peyronie’s disease.^[31] Men with high blood pressure or high cholesterol should work with their healthcare providers to manage these conditions effectively through medication, diet, and lifestyle changes.

Some experts have proposed what could be considered a new definition of “safe sex” that includes guidance for prevention of injury to the penis during sexual activity. This involves ensuring that erections are firm enough before attempting penetration and being careful to avoid forceful bending of the penis during intercourse.^[32] Men who notice that their erections are not as firm as they used to be should consider discussing this with a healthcare provider, as treating erectile insufficiency early might help prevent penile trauma that could lead to Peyronie’s disease. Using medications that enhance erectile function, such as phosphodiesterase type 5 (PDE5) inhibitors, which are medications that help increase blood flow to the penis, may help some men maintain firmer erections and reduce the risk of penile injury during sex.

How Peyronie’s Disease Changes Normal Body Function

To understand how Peyronie’s disease affects the body, it helps to know some basic anatomy of the penis. The penis contains two erectile bodies called the corpora cavernosa, which run along the length of the penis.^[33] During an erection, these chambers fill with blood, which increases the size and rigidity of the penis. Each corpus cavernosum is surrounded by a sheath of elastic fibers called the tunica albuginea, which is made up predominantly of type 1 collagen fibers. In the middle, where the two corpora cavernosa meet, their sheaths merge to form a septum that separates them.

Under normal circumstances, when sexual arousal occurs, the nervous system signals increased blood flow to the penis. The smooth muscles in the walls of the blood vessels relax, allowing blood to rush into the corpora cavernosa. As these chambers fill with blood, they expand, and the tunica albuginea must stretch to accommodate this expansion. The elastic nature of healthy tunica albuginea allows it to stretch evenly in all directions, resulting in a straight or nearly straight erection.

In Peyronie’s disease, this normal process is disrupted by the formation of scar tissue within or adjacent to the tunica albuginea. When injury occurs to the penis, whether from trauma during sex or other causes, the body initiates a wound-healing response. In susceptible individuals, this healing process becomes abnormal. The inflammation from trauma causes localized fibrosis, which is the formation of excessive fibrous connective tissue, in the tunica albuginea.^[34] Over time, this plaque builds up and prevents the tunica albuginea from expanding normally in the affected area.

During an erection, when blood fills the corpora cavernosa, the normal tissue stretches as it should, but the scarred area cannot stretch. This creates an imbalance. The side with healthy, elastic tissue expands fully, while the side with scar tissue remains relatively fixed. This uneven expansion forces the penis to curve or bend toward the side with the scarring, much like how a balloon bends toward a spot where you’ve placed a piece of tape that prevents expansion in that area.

The scar tissue also affects the length and girth of the penis. Since the scarred area cannot expand properly, it effectively shortens that portion of the penis. Many men notice that their penis becomes shorter overall when erect. In some cases, when scar tissue forms around the circumference of the penis, it can create a narrowing or indentation that gives an hourglass appearance.

Peyronie’s disease progresses through two distinct phases that reflect different stages in the body’s wound-healing process. The acute phase lasts between six and twelve months.^[35] During this period, the scar tissue is actively forming and may continue to grow or change. The inflammation and ongoing tissue changes during this phase often cause pain, particularly during erections. The curvature may worsen during this time as more scar tissue develops. The acute phase represents the active wound-healing stage, where the body is still laying down new scar tissue.

Eventually, the condition transitions to the chronic phase, also called the stable phase. During this phase, the scar tissue has finished forming and is no longer growing.^[36] The curvature stabilizes and won’t get any worse on its own. Pain usually goes away during the chronic phase, though it can sometimes continue, especially during erections. However, the chronic phase brings its own challenges. Many men develop erectile dysfunction during this phase, as the structural changes to the penis and the presence of scar tissue can interfere with the normal process of achieving and maintaining erections. The transition from acute to chronic phase typically occurs between 12 and 18 months after symptoms first appear, though the exact timing varies among individuals.