Dr. Nathan Starke Addresses Peyronie’s Disease: An Under-Recognized Condition

Most men have never heard of Peyronie's disease. Many who have it don't know there's a name for what they're experiencing. And a significant number who do know suffer quietly for years before seeing a doctor, convinced either that nothing can be done or that it's too embarrassing to bring up.

Dr. Nathan Starke, a urologist who specializes in reconstructive surgery, has seen this pattern throughout his career. Peyronie's disease has been one of his clinical focuses and one of the conditions he's most emphatic about destigmatizing.

"Men don't realize it's fixable," Dr. Starke says. "It's very embarrassing, and it just harms their intimate relationships and causes psychological damage on top of the physical. Awareness that it's treatable, if not fully fixable, is what I want men to have."

Here's what you need to know.

What Is Peyronie's Disease?

Peyronie's disease is a condition in which scar tissue, called plaque, forms beneath the skin of the penis, inside the tough fibrous layer that surrounds the erectile tissue. As that plaque builds up, it creates an area that can't stretch normally during an erection. The result is a bend, curve, or deformity that ranges from mild to severe. Dr. Starke states that he asks men at every new visit if they “have noticed a new lump, bump, or curve” as a simple, memorable screener for Peyronie’s.

The condition affects somewhere between 1% and 13% of men, depending on the study, with most estimates landing around 3–9% of the adult male population. It's most common in men between 40 and 70, though younger men get it too. Due to the stigma surrounding it, the true prevalence of Peyronie’s disease is effectively unknown. 

Peyronie's disease is not the same as having a natural curve to an erection, which many men have without issue. The key distinction is whether the curvature causes pain, prevents or limits sexual intercourse, or is causing psychological distress. If any of those apply, it warrants a conversation with a urologist.

What Are the Symptoms of Peyronie’s Disease?

The symptoms of Peyronie's disease vary depending on severity and stage. Common signs include:

• Penile curvature: the penis bends upward, downward, or to either side during an erection; in severe cases, the angle can reach 90 degrees or more

• Pain: with or without an erection, particularly in the early stages when inflammation is active

• Palpable plaque: a hard or rubbery lump under the skin of the penis, which can often be felt even without an erection

• Deformity: narrowing, indentation, or an hourglass shape to the erection

• Shortened length: the plaque restricts stretching, which can reduce the functional length of the penis

• Erectile dysfunction: difficulty getting or maintaining an erection, which frequently accompanies Peyronie's disease

The combination of these symptoms, particularly the visual change to the erection and the impact on sexual function, can cause significant emotional distress. Relationship strain, anxiety, and depression are common secondary effects that Dr. Starke says are just as real as the physical ones.

What Causes Peyronie’s Disease?

The exact cause of Peyronie's disease isn't fully understood, but the leading explanation often involves microtrauma from repeated bending or pressure during sexual activity, especially if erections aren't fully firm. In some cases, a more acute injury, like a penile fracture, triggers the process. In others, no clear incident can be identified.

What happens at a biological level is that the body's normal wound-healing response goes wrong. Instead of resolving cleanly, the inflammation leaves behind a buildup of collagen that forms rigid plaque rather than normal elastic tissue. Because scar tissue doesn't stretch, one side of the penis becomes anchored during an erection, pulling the whole structure toward it.

Several factors increase a man's risk:

• Age: the condition becomes more common after 40, likely because tissue elasticity decreases with age

• Genetics: men with a family history of Peyronie's disease or related connective tissue disorders (such as Dupuytren's contracture, which causes similar scarring in the palms of the hands) are at higher risk

• Erectile dysfunction: men who have difficulty maintaining full erections may be at greater risk because soft-tissue bending during sex is more likely

• Prostate surgery: trauma from procedures such as radical prostatectomy can trigger scar formation

• Connective tissue disorders: conditions like Dupuytren's contracture and plantar fasciitis are associated with increased risk

The Two Phases: Active and Stable

Understanding treatment for Peyronie's disease starts with understanding that the condition has two distinct phases. The right treatment depends on which phase a patient is in.

The active phase is when symptoms are still changing: the curvature is progressing, pain may be present, and new plaque formation may be occurring. This phase can last anywhere from six months toa year. During this time, the priority is managing symptoms and potentially slowing or limiting the scarring process. More aggressive surgical intervention is generally not recommended while things are still changing.

The stable phase is when the condition has plateaued—curvature has been consistent for at least three to six months and pain has typically resolved. This is when more definitive treatment becomes appropriate, including surgical correction.

Treatment Options for Peyronie's Disease

The good news is that Peyronie's disease is treatable at nearly every severity level. Treatment is matched to how much the condition is affecting the patient's life and what phase they're in.

Nonsurgical Treatments

For men in the active phase, or those with milder stable disease, nonsurgical approaches are typically tried first.

Collagenase injections (Xiaflex) are the only FDA-approved treatment specifically for Peyronie's disease. Collagenase is an enzyme that breaks down the collagen building up in the plaque. It's administered as a series of injections directly into the plaque in the doctor's office and is approved for men with curvature of 30 degrees or more. Studies have shown meaningful reduction in both curvature and penile pain. It won't always eliminate the plaque entirely, but it can significantly reduce the scar tissue burden and the angle of deformity.

Other injectable treatments, including verapamil and interferon, have been used for years, particularly as lower-cost alternatives or for men who don't meet Xiaflex criteria. Evidence varies, but these options can reduce pain and, in some cases, reduce curvature and/or limit curvature progression.

Penile traction therapy uses an external device to gently stretch the penis in the opposite direction of the curve for several hours per day. Studies suggest it can improve both curvature and penile length over several months of consistent use. It's non-invasive and often recommended alongside other treatments.

Oral medications are sometimes used for pain management during the active phase, though no oral drug has strong evidence for reversing the plaque or curvature itself.

Surgical Treatments

Reconstructive surgery is reserved for men in the stable phase with significant curvature or deformity that makes sexual intercourse difficult or impossible. Waiting until the disease is stable—typically, at least nine to twelve months without worsening—is important since operating during the active phase risks the condition continuing to progress after surgery.

Plication is the simplest surgical approach. It shortens the unaffected side of the penis to counterbalance the curvature. It straightens the erection effectively but may reduce penile length slightly.

Plaque incision or excision with grafting involves cutting into or removing the plaque and filling the gap with graft tissue (either from elsewhere in the patient's body or a synthetic material). It preserves more length than plication but is a more complex procedure.

Penile prosthesis implantation is the preferred surgical option when Peyronie's disease is accompanied by significant erectile dysfunction that doesn't respond to medication. An inflatable implant both treats the ED and, in many cases, allows the surgeon to manually straighten the penis during placement. For men dealing with both problems, it can be the most comprehensive single solution.

Do You Have Peyronie’s Symptoms? Don’t Suffer in Silence

Peyronie's disease is one of those conditions where the barrier to care is rarely medical — it's psychological. Men feel embarrassed. They can scarcely believe what they are seeing, not even realizing it was possible. They don't want to describe what's happening to a doctor. They worry about what it means. They assume it's permanent.

Dr. Starke sees the same hesitation with most men's health issues, but especially this one. "Men don't talk about it, don't want to deal with it, feel like less of a man," he says. 

The longer Peyronie's disease goes unaddressed, the more impact it has on relationships, self-confidence, and sometimes on the effectiveness of treatment options. Catching it during the active phase, when injectable therapies and traction can do the most good, requires actually making the appointment.

If you've noticed a new curve to your erection, pain during sex or at rest, a lump under the skin of your penis, or changes in your erectile function, now is the time to see a urologist.