Peyronie's disease treatment: options with and without surgery

The short version: Peyronie’s disease is benign scar tissue, called plaque, inside the penis that can cause a curve, pain and erection problems (NIDDK, Peyronie’s Disease). Treatment is not one thing. It runs from watching and waiting, through pain relief, injections into the plaque and traction devices, to straightening surgery and penile implants. Which of these fits depends on whether the disease is still changing or has settled, how much the curve gets in the way, and how firm erections are. This page walks through each option with what national guidance and the drug label say about it. If you want the basics of the condition first, start with our guide to Peyronie’s disease and ED.

Sources for the table: AUA Peyronie’s Disease Guideline, NIDDK and the XIAFLEX prescribing information.

What treatments are there for Peyronie’s disease?

There are four broad groups: watchful waiting, medicines (mostly injections into the plaque), devices such as traction, and surgery, including penile implants. NIDDK says the goals of treatment are to reduce pain, get the penis straight or close to straight, and restore and keep the ability to have intercourse (NIDDK). The American Urological Association (AUA) guideline tells clinicians to go through the available options with their known benefits and risks, and frames the plan as a shared decision once realistic goals are agreed (AUA Guideline, Statement 4).

The phase of the disease shapes the menu. The AUA describes active disease as a period of changing symptoms, with pain as its defining feature, and stable disease as symptoms that have not changed for at least three months with a deformity that is no longer progressing (AUA Guideline). Surgery and collagenase injections are aimed at stable disease, while pain relief is aimed at the active phase.

Does every man with Peyronie’s disease need treatment?

No. NIDDK says treatment may not be needed with small plaques, little or no curve, no pain, and no problems with intercourse or urination (NIDDK). The AUA guideline points out that Peyronie’s disease does not appear to affect survival, so each treatment’s benefit has to be weighed against how likely, how severe and how reversible its side effects are. For some men, it says, a clear explanation of the condition and its usual course is enough, and they choose not to pursue treatment (AUA Guideline).

Can Peyronie’s disease go away on its own?

Occasionally, but it is uncommon for the curve to go away completely. NIDDK says that in a very few cases Peyronie’s disease goes away without treatment (NIDDK). In the untreated-men studies the AUA summarizes, pain usually improved, while the curve was much less likely to.

In the Mulhall study, every man who had pain at the start reported improvement and 89% said the pain resolved completely. The AUA’s reading is that for many or most men pain resolves over time without intervention, while the curve is much less likely to improve and may need treatment if it gets in the way of sex or causes distress (AUA Guideline). These are group results, not a forecast for any one man.

That same pattern is why personal success stories are hard to read. The AUA notes that some symptoms change or resolve with time alone and that pain is highly sensitive to placebo effects, so studies without a comparison group cannot show whether a treatment did the work (AUA Guideline).

What are the options without surgery?

Nonsurgical treatment includes pain relievers, injections into the plaque, and device-based therapies such as traction. NIDDK says nonsurgical treatments may be used in the acute phase, and lists injections, oral medicines and other medical therapies (NIDDK). The honest answer to “how do I cure Peyronie’s without surgery” is that nonsurgical options can reduce the curve or ease pain for some men, but none of them is a guaranteed cure. The sections below cover each one.

Pain relief

For pain in active disease, the AUA says clinicians may offer oral non-steroidal anti-inflammatory drugs (NSAIDs), which is an Expert Opinion statement rather than one built on trials (AUA Guideline, Statement 5). NIDDK also mentions NSAIDs for pain (NIDDK). Pain relief treats the pain; it is not described as straightening the curve.

How does Xiaflex work, and what are the risks?

Status: FDA-approved for another condition, not for ED (approved for Peyronie’s disease and Dupuytren’s contracture). Source: XIAFLEX prescribing information, DailyMed, checked 2026-10-17.

Xiaflex is collagenase clostridium histolyticum, an enzyme injected directly into the plaque in a doctor’s office. NIDDK says collagenase helps break down the substances that make up the plaque, and calls these injections the only FDA-approved treatment for Peyronie’s disease (NIDDK). The label limits it to adult men with a palpable plaque and a curve of at least 30 degrees at the start of therapy, and says it must not be used when the plaque involves the urethra (XIAFLEX prescribing information). The AUA says clinicians may use it, together with penile modeling (a straightening procedure done by the clinician and then by the patient at home), in men with stable disease, a curve between 30 and 90 degrees, and erections that still work, with or without medicine (AUA Guideline, Statement 8, Grade B).

What the trials showed. In the two placebo-controlled trials behind the approval, 832 men with stable disease and a curve of at least 30 degrees took part. Men with a curve that pointed downward, an isolated hourglass shape, or a calcified plaque were excluded. At one year, the curve improved by an average of 35.0% and 33.2% with Xiaflex, compared with 17.8% and 21.8% with placebo injections and modeling. Scores for how bothered men felt by Peyronie’s also improved more with Xiaflex (XIAFLEX prescribing information). In plain terms, the average man’s curve got smaller, not gone, and the placebo group improved too.

The risks. The label carries a boxed warning for corporal rupture (penile fracture) and other serious penile injury, and for Peyronie’s disease Xiaflex is available only through a restricted safety program, the XIAFLEX REMS Program. In the trials, corporal rupture was reported in 5 of 1,044 treated men (0.5%), and severe penile hematoma (a collection of blood under the skin) in 3.7%. The most common side effects were penile hematoma, swelling and pain (XIAFLEX prescribing information). The label also says it was not associated with shortening of the penis in the trials.

The label lists aftercare instructions that the treating urologist goes through, covering sexual activity, at-home modeling, avoiding a vacuum erection device during treatment, and avoiding straining. It tells men to contact their doctor promptly for severe pain or swelling, heavy bruising, trouble urinating or blood in the urine, or a sudden loss of erection, which may come with a popping or cracking sound (XIAFLEX prescribing information). The amounts and timing of injections are set by the label and the treating urologist.

Do verapamil or interferon injections work?

They may help some men, but the evidence is weaker than for collagenase, and neither is FDA-approved for Peyronie’s disease. The AUA says clinicians may offer interferon alpha-2b injections (Moderate Recommendation, Grade C evidence) and may offer verapamil injections (Conditional Recommendation, Grade C evidence) (AUA Guideline, Statements 10 and 12). The guideline itself notes that it may discuss uses that are not FDA-approved. NIDDK says interferon has been shown in studies to reduce pain, curving and plaque size, and that verapamil, a blood pressure medicine, may reduce pain and curving when injected into the plaque (NIDDK).

The side effects to discuss first, per the AUA, are sinusitis, flu-like symptoms and minor penile swelling for interferon, and penile bruising, dizziness, nausea and pain at the injection site for verapamil (AUA Guideline, Statements 11 and 13).

Does penile traction therapy work?

It shows promise, but it is still being studied. NIDDK lists mechanical traction and vacuum devices among therapies still under study (NIDDK). The 2015 AUA guideline put traction in its group of possibly promising but unproven treatments, because the studies it had were small and observational and needed randomized trials (AUA Guideline).

One randomized trial has been published since. It assigned 110 men with a curve of 30 degrees or more to a traction device or to no therapy for three months. The traction group’s curve improved by an average of 11.7 degrees, while the control group’s curve worsened slightly (by 1.3 degrees), with only mild, temporary side effects reported (Ziegelmann et al., Journal of Urology, 2019). The follow-up phases reported curve improvement in 61% of men treated for six months (Joseph et al., Journal of Sexual Medicine, 2020). It is one trial of one device, which was developed in cooperation with the institution that ran the study, and the control group received no treatment rather than a sham, so it is worth weighing with a urologist rather than buying a device off the internet.

On vacuum devices, the AUA’s evidence for curve correction was one small observational study (AUA Guideline). Their more established role is for erections; our guide to vacuum erection devices covers that.

Does shockwave therapy help Peyronie’s disease?

For pain, possibly; for the curve, no. The AUA says clinicians may offer extracorporeal shock wave therapy to improve penile pain (Conditional Recommendation, Grade B), but should not use it to reduce curvature or plaque size (Moderate Recommendation, Grade B) (AUA Guideline, Statements 14 and 15). Shockwave for ED itself is a separate question, covered in our page on experimental ED therapies.

Do vitamin E, supplements or home remedies help?

Vitamin E and several other oral treatments did not show benefit in the studies the AUA reviewed, and it tells clinicians not to offer them. Its list of oral treatments not to offer is vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, and vitamin E combined with L-carnitine. It also says not to use electromotive verapamil (verapamil pushed through the skin with an electric current) or radiotherapy (AUA Guideline, Statements 6, 7 and 16). NIDDK says no oral medicine effectively treats penile curvature at this time, and that diet and nutrition have not been found to play a role in preventing the disease (NIDDK).

Other oral and topical options, including colchicine, pentoxifylline, potassium aminobenzoate, coenzyme Q10 and topical verapamil, sit in the AUA’s unproven group: a few small studies, often without controls for natural change over time (AUA Guideline). That is the problem with “how I cured my Peyronie’s” stories online. Pain often fades on its own and the curve sometimes improves without treatment, so a remedy taken during that window can look like it worked when time did the work. Supplements bought online also carry their own risks; our page on FDA warnings about tainted supplements explains why.

What are the surgical options?

There are three: plication, plaque incision or excision with grafting, and penile implants. The AUA says clinicians should assess men as candidates for surgery based on the disease being stable (AUA Guideline, Statement 17). NIDDK says surgery may be recommended when symptoms have not improved, when erections or intercourse are painful, or when the curve prevents intercourse, that some men develop complications after surgery, and that surgery sometimes does not correct effects such as shortening of the penis (NIDDK).

(AUA Guideline, Statements 18 to 22; NIDDK)

For implants in Peyronie’s disease, the AUA says clinicians should use an inflatable implant, and may add modeling, plication or grafting during the operation if a significant curve remains after the implant is placed (AUA Guideline, Statements 21 and 22). Before any invasive treatment, it says the urologist should do an in-office injection test to produce an erection, with or without an ultrasound (AUA Guideline, Statement 2). Our guides to the penile implant and penile implant surgery and recovery go further into that option.

How do I choose between options?

The choice comes down to a few questions a urologist will work through with you: is the disease still active or stable, how big is the curve and which way does it point, are erections firm enough for intercourse, and how much is it bothering you or your partner. The AUA statements map onto those questions: pain relief in active disease, collagenase or surgery in stable disease depending on the curve and erections, and an implant when ED or deformity still gets in the way of intercourse (AUA Guideline). The AUA also says clinicians should take on Peyronie’s disease only when they have the experience and tools to evaluate, counsel and treat it, so it is reasonable to ask a urologist how often they treat it (AUA Guideline, Statement 3).

Distress counts as part of the picture. The AUA cites studies in which up to 81% of men with Peyronie’s reported emotional distress and 54% reported relationship difficulties, and tells clinicians to ask about distress before and during treatment (AUA Guideline). Saying how much it bothers you is useful information for the plan, not a side issue.

When to talk to a clinician

See a urologist if you notice a new curve, a hard lump in the penis, pain with erections, or a change in erections, so the cause can be confirmed and the phase worked out before choosing anything. NIDDK says men with Peyronie’s disease are usually referred to a urologist, who diagnoses it from a history and exam (NIDDK). During Xiaflex treatment, the label says to contact the doctor promptly for severe pain or swelling, heavy bruising, or a sudden loss of erection, which may come with a popping or cracking sound (XIAFLEX prescribing information). Our page on when to see a doctor about ED covers what to raise at the visit.

The bottom line

Peyronie’s disease treatment ranges from watching and waiting, through pain relief, injections and traction, to plication, grafting and implants. Not every man needs treatment, pain often eases on its own, and the curve is less likely to. Xiaflex is the only FDA-approved medicine for it, and it carries a boxed warning and a restricted program. Vitamin E and several other oral treatments are on the AUA’s list of treatments not to offer. A urologist who treats Peyronie’s regularly is the right person to match the option to the curve, the pain and your erections.

Sources

Every clinical statement on this page traces to a primary or guideline source:

• NIH NIDDK, Penile Curvature (Peyronie’s Disease) (last reviewed August 2019): treatment goals, who may not need treatment, rare resolution without treatment, nonsurgical treatments (collagenase as the only FDA-approved treatment, verapamil, interferon, NSAIDs, no effective oral medicine for curvature, traction and vacuum devices still being studied), surgery indications, grafting, plication and implants with their trade-offs, referral to a urologist, and prevention.
• American Urological Association, Peyronie’s Disease Guideline (Nehra et al., 2015): active versus stable disease, natural history studies of untreated men, psychosocial impact, limits of the evidence, Guideline Statements 2 to 22 on diagnosis before invasive treatment and on each treatment, and the “Other Treatments” section on unproven therapies including traction.
• XIAFLEX (collagenase clostridium histolyticum) prescribing information, DailyMed (revised September 2026): Peyronie’s disease indication and contraindications, boxed warning for corporal rupture and serious penile injury, XIAFLEX REMS Program, adverse reaction rates, the two placebo-controlled trials and their curvature and bother results, and patient counseling information.
• Ziegelmann M, et al. Outcomes of a Novel Penile Traction Device in Men with Peyronie’s Disease: A Randomized, Single-Blind, Controlled Trial. Journal of Urology, 2019: three-month randomized results for penile traction versus no therapy.
• Joseph J, et al. Outcomes of RestoreX Penile Traction Therapy in Men With Peyronie’s Disease: Results From Open Label and Follow-up Phases. Journal of Sexual Medicine, 2020: six- and nine-month follow-up of the same trial.