Introduction: Who Should Seek Diagnostic Evaluation

If you notice changes in your penis such as a new curve during erections, hard lumps you can feel under the skin, or pain during erections or sexual activity, it’s time to see a healthcare provider. Many men feel embarrassed or hesitant to discuss these symptoms, but Peyronie’s disease is a common condition that doctors are experienced in diagnosing and managing. Medical experts estimate that about 6% to 10% of men between the ages of 40 and 70 have this condition, though it may be even more widespread since many people avoid seeking help due to embarrassment.^[1]

You should seek medical attention especially if the curve in your penis is severe enough to make intercourse painful or impossible, if you’re experiencing persistent pain during erections, or if the shape changes are causing distress or affecting your relationship with your partner. Some men first notice pain during sex, while others observe changes in the appearance of their penis.^[2] It’s important not to wait too long, as early treatment during what doctors call the “acute phase” may work better than waiting until the condition has fully stabilized.^[3]

Talking to your primary care doctor is a good starting point. If your doctor suspects Peyronie’s disease, they will likely refer you to a urologist, which is a specialist who focuses on conditions affecting the urinary system and male reproductive organs. The urologist has specific expertise in diagnosing and treating this condition.^[4]

Classic Diagnostic Methods Used to Identify Peyronie’s Disease

Physical Examination

The most common and often sufficient method to diagnose Peyronie’s disease is a physical examination performed by your healthcare provider. During this exam, the doctor will carefully feel your penis while it’s not erect to locate areas of scar tissue, also called plaque. This plaque feels like flat lumps or a band of hard tissue under the skin of the penis.^[1] The area over the scar tissue may feel tender when touched, which can help the doctor identify where the problem is located.

Your doctor will also measure the length of your penis during this initial examination. This measurement is important because it creates a baseline that can be used later to determine if the penis has gotten shorter as the condition progresses or improves with treatment.^[8] Peyronie’s disease can cause the penis to shorten, and tracking this change helps doctors understand how the condition is evolving.

In many cases, your healthcare provider may ask you to bring photographs of your erect penis taken at home. While this might feel uncomfortable, these photos are extremely helpful for diagnosis. They allow the doctor to see the degree of curving, understand where the scar tissue is located, and gather other details that guide treatment decisions.^[8] This approach is practical because it’s not always possible or appropriate to induce an erection in the doctor’s office for every patient.

Ultrasound Examination

When more detailed information is needed, your doctor may order an ultrasound examination of your penis. Ultrasound is the most commonly used imaging test for penis conditions because it uses sound waves to create images of soft tissues inside the body without any radiation exposure.^[8] This test is safe and provides valuable information that can’t be obtained through physical examination alone.

For the ultrasound to be most useful, it’s typically performed when your penis is erect. To make this possible, you’ll likely receive a shot (injection) directly into the penis that causes it to become erect. While this might sound uncomfortable, the injection is generally well-tolerated and allows the doctor to see exactly how the scar tissue affects your erection.^[8] The ultrasound can show the presence and location of scar tissue, measure blood flow to the penis, and reveal any other irregular signs or problems with the blood vessels that might be contributing to erectile difficulties.

The ultrasound is particularly valuable because it can detect calcium deposits within the scar tissue. When scar tissue calcifies or hardens with calcium, it becomes more rigid and may be more challenging to treat with certain methods. Understanding the characteristics of your plaque helps your doctor recommend the most appropriate treatment approach.^[17]

Assessment of Curvature and Symptoms

During your diagnostic visit, your healthcare provider will ask detailed questions about your symptoms. They’ll want to know when you first noticed changes, whether you experience pain, how the symptoms have progressed over time, and how they affect your ability to have sexual intercourse. Understanding whether you’re in the acute (active) phase or the chronic (stable) phase of the disease is crucial because it influences treatment decisions.^[2]

The acute phase typically lasts between six and 12 months. During this period, the scar tissue is actively forming, and you may notice that the curve is changing or getting worse. Pain during erections is common in this phase. The chronic phase begins when the scar tissue has stopped growing and the curvature has stabilized for at least three to six months. Pain usually decreases or disappears in the chronic phase, though some men continue to experience it.^[2]

Your doctor will also assess the severity of the bend. If the curvature is greater than 30 degrees—which looks similar to when the hands of an analog clock show 1:00—it can make sexual intercourse painful or even impossible.^[2] The direction of the curve (upward, downward, or sideways) 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, but it can occur in any location.

Distinguishing Peyronie’s Disease from Other Conditions

Part of the diagnostic process involves ruling out other conditions that can cause similar symptoms. For example, younger men or infants might have a condition called congenital curvature or chordee, where the penis is curved from birth due to uneven development of the erectile tissues. This is different from Peyronie’s disease, which develops later in life and involves scar tissue formation.^[20]

Your doctor will also check for signs of other scarring conditions that sometimes occur alongside Peyronie’s disease. For instance, some men with Peyronie’s also have Dupuytren’s contracture, a condition where thickened tissue forms in the palm of the hand, causing fingers to bend inward. Similarly, thickening can occur in the feet (plantar fasciitis) or other areas. The presence of these conditions can provide additional clues about the diagnosis.^[5]

Diagnostics for Clinical Trial Qualification

If you’re considering participation in a clinical trial for Peyronie’s disease, you’ll likely need to undergo additional diagnostic procedures to determine if you qualify. Clinical trials often have specific enrollment criteria to ensure that the study results are reliable and that participants are appropriate candidates for the experimental treatment being tested.

One common requirement is a confirmed diagnosis of Peyronie’s disease with a measurable plaque that can be felt during physical examination. For some trials, particularly those testing injectable medications, the curvature must fall within a specific range—often between 30 and 90 degrees when the penis is erect.^[14] This ensures that participants have a significant enough curvature to potentially benefit from treatment, but not so severe that other complications make the experimental therapy unsuitable.

Clinical trials may require documentation of the phase of your disease. Many studies focus on patients in the chronic or stable phase, meaning the curvature hasn’t changed for at least three to six months and the scar tissue has stopped actively growing. This is because treatments are often evaluated based on their ability to improve an established condition, and testing during the acute phase could confuse results since some improvement might occur naturally.^[10]

Additional tests may be required to assess your erectile function. Some trials only accept participants who have adequate erectile function, while others specifically study men who have both Peyronie’s disease and erectile dysfunction. These assessments might include questionnaires about your sexual health, blood tests to measure hormone levels or other markers, and ultrasound examinations to evaluate blood flow to the penis.^[11]

Safety screening is another important component of clinical trial diagnostics. Before enrolling, you may need blood tests to check your liver and kidney function, ensure your blood clots normally, and rule out conditions that could make participation risky. Your medical history will be reviewed carefully, and you’ll need to disclose all medications and supplements you’re taking, as some might interact with the experimental treatment.^[6]

Imaging studies are frequently repeated at various points during a clinical trial to measure changes objectively. Baseline ultrasound measurements of plaque size and location, along with photographic documentation of penile curvature, allow researchers to compare your condition before and after treatment. These standardized measurements help determine whether the experimental therapy is working and to what degree.^[10]