Peyronie's disease: what the scar tissue is, what causes it, and how it connects to ED

The short version: Peyronie’s disease is scar tissue, called plaque, that forms under the skin of the penis and can pull it into a curve or bend, usually during an erection. It does not get talked about much, but the National Institutes of Health lists it among the conditions that can lead to erectile dysfunction. This page covers what the plaque is, what causes it, how common it is, how it relates to ED, why the order of the two is not always what people assume, how a urologist evaluates it, and what national guidance says about care. It is the starting point for our Peyronie’s coverage: our guide to Peyronie’s disease vs normal curvature covers how a urologist tells the two apart, and our guide to Peyronie’s disease treatment goes option by option. It is educational only, and it is not a substitute for an exam.

What is Peyronie’s disease?

Peyronie’s disease is a disorder in which scar tissue, called plaque, forms under the skin of the penis. The plaque builds up in the tunica albuginea, the thick elastic membrane that helps keep the penis firm during an erection, and it can develop anywhere along the shaft. As it develops, it pulls on the surrounding tissue and causes the penis to curve or bend, usually during an erection. Curves can make erections painful and may make intercourse painful, difficult or impossible (NIDDK, Peyronie’s Disease).

Three points about the plaque tend to reassure people. NIDDK says it is benign, meaning it is not cancer and not a tumor. It is not the same plaque that can build up in arteries. And Peyronie’s disease is not contagious or caused by any known transmittable disease (NIDDK). The American Urological Association (AUA) defines it as an acquired condition, meaning it develops during life rather than being present from birth, marked by fibrosis (scarring) of the tunica albuginea that may come with pain, deformity, ED and distress (AUA Peyronie’s Disease Guideline).

Is it Peyronie’s disease or a normal curve?

A curve on its own is not a diagnosis. The AUA guideline says a lifelong curve with no pain and no plaque in a young man suggests congenital curvature, a different condition present from development, rather than Peyronie’s disease (AUA Guideline). What points toward Peyronie’s disease is a change: a new curve, a hard lump, pain with erections, or narrowing or shortening (NIDDK). Our guide to Peyronie’s disease vs normal curvature walks through how a urologist tells the two apart.

What causes Peyronie’s disease?

Experts do not know the exact cause. NIDDK says they believe it may result from acute or repeated injury to the penis, or from autoimmune disease. Hitting or bending the penis may injure the tissue inside, during sex, athletic activity or an accident, and the injury may cause bleeding and swelling inside the tunica albuginea. When it heals, scar tissue may form, and that scar is the plaque (NIDDK). Many men cannot recall a specific incident before their symptoms began. The AUA guideline describes buckling of the penis during sexual activity as the most commonly suspected trigger, while noting that many patients do not recall one (AUA Guideline). It is not contagious and is not caused by any known transmittable disease.

Can Peyronie’s disease cause erectile dysfunction?

Yes, it is one recognized route to ED. The NIH’s list of the most common conditions that can lead to ED includes problems of the male reproductive system, naming enlarged prostate and penile curvature, also called Peyronie’s disease (NIDDK, Symptoms & Causes of ED). NIDDK’s Peyronie’s page lists ED among the complications and says that once the plaque has formed, ED may develop or become worse (NIDDK).

The AUA guideline describes how that can happen. The plaque may restrict the tunica from lengthening on the affected side during an erection, which can lead to curvature, deformity, pain and ED. In the stable phase, erectile function may be compromised by pain or deformity, or it may be reduced by ED that is not related to the deformity or the pain at all (AUA Guideline).

Did Peyronie’s disease cause my ED, or the other way around?

Not necessarily, and the order is often the reverse of what people expect. The AUA guideline reports that ED may be present in up to 33% of men with Peyronie’s disease, and that more than half of those men say their ED was there before their Peyronie’s symptoms began. It also notes that a man may come in with ED as his main concern and have Peyronie’s disease that has not been diagnosed, with the plaque or curve only becoming apparent during drug-induced erection testing or during implant surgery (AUA Guideline).

The overlap shows up in other ways too. NIDDK reports that men with diabetes-associated ED have a 4 to 5 times higher chance of developing Peyronie’s disease than the general population, and that the chance rises after prostate cancer surgery, which experts believe is related to the ED that can follow that surgery (NIDDK). These are associations. They show that the two conditions often appear together, not which one started things for any one man. Sorting that out is part of what a urologist’s history and exam are for.

What are the signs and symptoms of Peyronie’s disease?

NIDDK lists these signs and symptoms (NIDDK):

• hard lumps on one or more sides of the penis
• pain during intercourse or during an erection
• a curve in the penis, with or without an erection
• changes in shape, such as narrowing or shortening
• ED

They can develop slowly or appear quickly, and they range from mild to severe. NIDDK notes that in many cases the pain decreases over time even if the curve remains, and that problems with intercourse or ED can occur in either phase of the condition (NIDDK).

The AUA guideline describes the most common presentation as a man in his mid-50s with a recent curve and mild to moderate pain, who usually cannot recall a specific injury and whose erections are usually still firm enough for intercourse. It adds that a lifelong curve with no pain and no plaque in a young man suggests congenital curvature, a different condition that should not be mistaken for Peyronie’s disease (AUA Guideline).

How common is Peyronie’s disease?

About 1 in 100 US men over 18 have been diagnosed with it, but NIDDK says studies of men who report symptoms suggest the real number is more than 1 in 10 (NIDDK). Estimates vary a lot depending on how the question is asked. The AUA guideline reports prevalence figures from 0.5% to 20.3% across different study populations, and says the numbers depend on the method, the sample, and how Peyronie’s disease is defined. In one population-based U.S. study of men 18 and older cited in the guideline, 0.5% had been formally diagnosed, while 13.1% had been diagnosed, treated, or reported any symptom of it (AUA Guideline).

Rates in the studies the guideline cites were higher among men who already had other conditions: 7.9% in one study of men who came in with ED, and 20.3% in one study of men with diabetes and ED. The guideline’s reading is that prevalence has historically been underestimated (AUA Guideline). NIDDK adds that the chance of developing it increases with age and that it is less common in men in their 20s and 30s (NIDDK).

Who is more likely to get Peyronie’s disease?

NIDDK lists several factors linked to a higher risk (NIDDK):

These are associations: having a risk factor does not mean a man will develop it, and many men with Peyronie’s disease have none of them.

What are the phases of Peyronie’s disease?

Peyronie’s disease usually moves through two phases. In the acute phase, which can last up to 18 months, inflammation may occur, the plaque forms, the penis starts to curve, and there may be pain with or without an erection. The chronic phase usually begins 12 to 18 months after symptoms first appear: the plaque and curve may stabilize, pain may lessen, and ED may develop or become worse (NIDDK).

The AUA guideline uses the terms active and stable disease, and the difference matters because treatment depends on it. Active disease is defined by changing symptoms, with pain as its defining feature. Stable disease means symptoms have been unchanged for at least three months and the deformity is no longer progressing (AUA Guideline).

Does Peyronie’s disease go away on its own?

Rarely completely. Pain often eases, but the curve is much less likely to improve. NIDDK says that in a very few cases Peyronie’s disease goes away without treatment (NIDDK). The AUA guideline summarizes studies of men who had no treatment. In one, 246 newly diagnosed men who had no medical treatment were followed for at least 12 months: everyone who had pain at the start reported improvement, and 89% reported that the pain resolved completely. Among those with curvature, 12% improved, 40% stayed the same and 48% got worse (AUA Guideline).

The guideline’s conclusion is that for many or most men, pain resolves over time without intervention, while curvature is much less likely to improve. It also stresses that the condition does not appear to affect survival, and that for some men, clear counseling about the typical course may be enough to ease their concerns (AUA Guideline). Those are group results from a handful of studies, not a forecast for any one person.

How is Peyronie’s disease diagnosed?

Diagnosis rests on a history and a physical exam, usually by a urologist. NIDDK says men with Peyronie’s disease are usually referred to a urologist, who diagnoses it from the medical and family history and an exam. Expect questions about when symptoms began, pain, erection or intercourse problems, family history, and any medicines you take. A urologist can usually feel the plaque whether or not the penis is erect. If the exam needs an erection, an injected medicine is used to produce one, and some urologists ask for photos taken at home to track the curve over time. Imaging is usually not needed for diagnosis but may add detail about the plaque (NIDDK).

The AUA sets the minimum as a careful history covering deformity, effects on intercourse, pain and distress, plus a genital exam. Before any invasive treatment, it says clinicians should perform an in-office injection test, with or without a Doppler ultrasound (AUA Guideline, Statements 1 and 2).

The overlap with ED shows up here too. When clinicians evaluate ED, the physical exam often checks for injury to or physical problems with the penis, such as Peyronie’s disease (NIDDK, Diagnosis of ED). Our guide on how ED is diagnosed walks through the rest of that evaluation.

What treatments are there for Peyronie’s disease?

Not everyone needs treatment, and the choice depends on symptoms, the degree of curve, and whether the disease is active or stable. NIDDK says treatment may not be needed with small plaques, little or no curve, no pain, and no problems with intercourse or urination. When it is needed, the stated goals are to reduce pain, achieve a straight or close to straight penis, and restore and maintain the ability to have intercourse (NIDDK). The AUA says clinicians should talk through the options with their known benefits and risks, and that a shared decision follows (AUA Guideline). In broad strokes, the options fall into four groups:

Source: AUA Guideline. Our guide to Peyronie’s disease treatment goes through each option, including what the guideline does not recommend, and our guide to penile implants covers the device used when Peyronie’s disease and ED occur together.

One safety point belongs here. Xiaflex, the collagenase injection, carries a boxed warning in its prescribing information for corporal rupture (penile fracture) and other serious penile injury, and for Peyronie’s disease it is available only through a restricted safety program (XIAFLEX prescribing information, DailyMed). Our page on penile fracture explains the warning signs. NIDDK also says a urologist may suggest lifestyle changes to lower the risk of ED linked to Peyronie’s disease (NIDDK). For the full range of ED options, see our guide to ED treatment options.

Can you live a normal life with Peyronie’s disease?

For many men, yes, though it can weigh on sex life and mood. The AUA guideline says Peyronie’s disease may compromise sexual function and quality of life “but does not appear to affect survival,” and that for some men, clear counseling about the condition and its typical course is enough to ease their concerns, so they choose not to pursue treatment (AUA Guideline). It also describes the most common presentation as a man whose erections are usually still firm enough for intercourse. Pain often settles with time, as the section above on whether it goes away on its own shows. When the curve or ED does get in the way, the treatments above aim to restore the ability to have intercourse (NIDDK).

How does Peyronie’s disease affect mood and relationships?

Often more than people say out loud. NIDDK lists emotional distress, depression, anxiety about sexual ability or appearance, and strain in a relationship among the complications (NIDDK). The AUA guideline cites studies in which up to 81% of men with Peyronie’s disease reported emotional distress, 48% in one study had clinically meaningful depressive symptoms, and 54% reported relationship difficulties. It also describes men feeling isolated because it is hard to talk about with partners or clinicians, and it tells clinicians to assess distress before and during treatment (AUA Guideline). If this is weighing on you, saying so at the visit is part of the evaluation, not a detour from it. Our page on ED vs performance anxiety covers how stress and erections interact.

Can Peyronie’s disease be prevented?

Not with anything proven so far. NIDDK says researchers do not know how to prevent Peyronie’s disease, and diet and nutrition have not been found to play a role in preventing it (NIDDK). The practical step is earlier attention: a new curve, a lump, pain with erections, or a change in erections is worth raising with a clinician. Our guide on when to see a doctor about ED covers which changes to raise sooner. One related note from the AUA guideline: a sudden popping sound during sex with swelling and bruising points to a different, acute problem, a penile fracture, which the guideline says usually brings men in within hours or days (AUA Guideline).

What other conditions are linked to ED?

Peyronie’s disease is one of several conditions that sit next to ED, and they are easy to confuse. Premature ejaculation is about timing rather than firmness, and our page on premature ejaculation explains the difference. Low desire is a separate problem from erections, which our page on low libido in men covers, and our guide to ED and low testosterone explains when hormones are part of the picture. NIDDK lists penile curvature among the conditions that can lead to ED, alongside diabetes, heart disease, high blood pressure and others (NIDDK, Symptoms & Causes of ED).

The bottom line

Peyronie’s disease is benign scar tissue in the penis that can cause a curve, pain and ED, and the NIH lists it among the conditions that can lead to ED. The order is not fixed: in the AUA guideline, more than half of men with both conditions reported that ED came first. Diagnosis is usually a history and exam with a urologist, pain often settles with time while the curve is much less likely to improve, and not every man needs treatment. If you notice a new curve, a lump or painful erections, a urologist is the right person to see; our guide to which doctor treats ED explains the referral, and our guide to talking to a doctor about ED helps with what to say.

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; checked 2026-10-18): definition, benign plaque, how common it is (about 1 in 100 diagnosed, more than 1 in 10 estimated), how injury may lead to plaque, acute and chronic phases, ED as a complication, signs and symptoms, risk factors including diabetes-associated ED and prostate cancer surgery, causes, urologist diagnosis, who may not need treatment, treatment goals, surgical effects on erections, and prevention.
• NIH NIDDK, Symptoms & Causes of Erectile Dysfunction (last reviewed October 2024): penile curvature (Peyronie’s disease) among the most common conditions that can lead to ED, alongside other diseases.
• NIH NIDDK, Diagnosis of Erectile Dysfunction (last reviewed October 2024): the ED physical exam often checks for physical problems with the penis, such as Peyronie’s disease.
• American Urological Association, Peyronie’s Disease Guideline (Nehra et al., 2015): definition, prevalence ranges and the studies behind them, natural history of untreated disease, psychosocial impact, presentation, congenital curvature as a different condition, the effect on survival, active versus stable disease, ED in up to 33% with more than half reporting ED first, differential diagnosis, and Guideline Statements 1 to 22 on diagnosis and treatment.
• XIAFLEX (collagenase clostridium histolyticum) prescribing information, DailyMed (revised September 2026): Peyronie’s disease indication, boxed warning for corporal rupture (penile fracture) or other serious penile injury, and the restricted REMS program.