Peyronie's disease is one of the most distressing conditions a man can face — and one of the most isolating. The penile curvature, pain, and associated erectile dysfunction that characterise the condition are rarely discussed openly, and many men spend months managing symptoms alone before seeking specialist help.
It is also one of the most misunderstood conditions in men's health. Many men are told there is nothing that can be done in the early stages, or that surgery is the only option once the condition is established. Neither is accurate. Peyronie's disease has a defined clinical course with specific treatment windows — and intervention at the right stage produces significantly better outcomes than waiting.
This guide explains what Peyronie's disease is, how it progresses, what the treatment options are at Shockwave ReVibe Clinic in London, and what the evidence shows for focal shockwave therapy in this condition. See also our Peyronie's Disease service page.
"Intervention at the right stage produces significantly better outcomes than waiting."
What Is Peyronie's Disease?
Peyronie's disease is a connective tissue disorder of the penis characterised by the formation of fibrous scar tissue (plaques) within the tunica albuginea — the tough fibrous sheath that surrounds the erectile tissue. These plaques are inelastic and do not expand with erection, causing the penis to bend toward the affected side, shorten, develop an hourglass deformity, or — in some men — a combination of all three.
The condition is more common than most men realise. Prevalence estimates range from 3-9% of adult men, with most studies suggesting the true prevalence is higher due to significant underreporting. (Stuntz M et al., PLOS ONE, 2016) It can affect men of any age but is most common between 40 and 70 years.
The psychological impact of Peyronie's disease is substantial. Studies consistently report high rates of depression, anxiety, and relationship difficulty in affected men — not as secondary concerns, but as clinically significant outcomes that warrant attention alongside the physical management. (Nelson CJ et al., Journal of Urology, 2008) Where psychological distress is significant, a psychosexual consultation alongside physical treatment is often appropriate.
The Two Phases of Peyronie's Disease
Understanding the clinical course of Peyronie's disease is essential — because the appropriate treatment depends entirely on which phase the condition is in.
The Active Phase (Acute Phase)
The active phase typically lasts 6-18 months from onset. During this phase:
- The plaques are forming and evolving
- Pain during erection is common — often the presenting complaint
- The degree of curvature may be changing
- The plaques are not yet calcified and are more amenable to treatment
This is the critical treatment window. Focal shockwave therapy is most effective during the active phase — when the plaques are still remodelling and the tissue is responsive to biological stimulation. Intervention during this phase has the best evidence for halting progression and reducing plaque burden.
The Stable Phase (Chronic Phase)
The stable phase begins when pain during erection has resolved or significantly reduced, the curvature has not changed for at least 3 months, and the plaques may have calcified.
Treatment in the stable phase is more challenging. Shockwave therapy has a role in reducing pain and improving erectile function even in the stable phase — but the potential for plaque reduction and curvature improvement is less pronounced than in the active phase.
Causes and Risk Factors
The precise aetiology of Peyronie's disease is not fully understood, but it is thought to involve an abnormal wound healing response following minor trauma to the erect penis — often during sexual activity, without the man being aware of any specific injury.
In genetically predisposed individuals, this trauma triggers a cascade of aberrant fibrous tissue deposition rather than normal healing — leading to plaque formation.
Risk factors include:
- Increasing age — the aberrant healing response is more common with age
- Genetic predisposition — Dupuytren's contracture (a fibrotic condition of the hand) is strongly associated
- Diabetes mellitus — associated with abnormal collagen metabolism (see our guide to ED and diabetes)
- Hypertension — associated with endothelial dysfunction
- Erectile dysfunction — both a risk factor and a consequence
- History of prostate surgery — post-prostatectomy trauma
How Peyronie's Disease Causes Erectile Dysfunction
ED is present in an estimated 30-80% of men with Peyronie's disease — making it one of the most significant associated conditions. (Hatzimouratidis K et al., European Urology, 2012)
The mechanisms are multiple:
- Vascular — the plaques disrupt the normal venous occlusion mechanism of erection, causing venous leakage that prevents adequate penile rigidity
- Mechanical — severe curvature makes penetration difficult or impossible regardless of erectile function
- Psychological — the distress, embarrassment, and performance anxiety associated with Peyronie's disease directly compound any physical erectile dysfunction through the psychogenic inhibition of the erectile reflex
- Neurological — plaque compression of local nerve structures can contribute to erectile impairment
This is why management of Peyronie's disease cannot focus exclusively on the plaques. The associated ED must be assessed and managed simultaneously — which requires specialist urological input, not just a referral for penile surgery. See our Erectile Dysfunction Treatment London service and our guide to every cause of ED.
Treatment Options for Peyronie's Disease in London
Focal Shockwave Therapy
Focal shockwave therapy is the most widely used non-invasive treatment for Peyronie's disease — and the treatment with the most evidence for use in the active phase. See our guide to how focal shockwave therapy works for the underlying mechanism.
The acoustic waves delivered by focal shockwave therapy act on the Peyronie's plaques in several ways:
- Mechanical disruption of the fibrous plaque structure
- Stimulation of collagenase activity — promoting the breakdown of abnormal collagen
- Anti-inflammatory effects — reducing the inflammatory mediators that drive plaque formation in the active phase
- Pain modulation — providing analgesic benefit for the painful erections characteristic of the active phase
A systematic review of shockwave therapy for Peyronie's disease confirmed significant reduction in pain in the majority of patients, with modest but clinically meaningful improvement in penile curvature in some patients — particularly those treated in the active phase. (Palmieri A et al., European Urology, 2009)
At Shockwave ReVibe Clinic, the protocol for active-phase Peyronie's disease is 6 sessions, delivered bi-weekly. See our guide to how many sessions other conditions require.
Intralesional Injection Therapy
Collagenase clostridium histolyticum (Xiapex/Xiaflex) — an enzyme that breaks down collagen — is injected directly into the Peyronie's plaque. It is the only pharmacological treatment licensed specifically for Peyronie's disease in the UK.
Evidence shows meaningful improvement in curvature (average reduction of approximately 17 degrees) and plaque consistency in stable-phase Peyronie's disease. (Gelbard M et al., Journal of Urology, 2013) It requires specialist administration and is not widely available in all private settings.
Shockwave therapy and intralesional injection therapy are sometimes used in combination — the shockwave sessions preceding injections to soften the plaque and potentially enhance the penetration and efficacy of the enzyme.
Vacuum Erection Device
Vacuum erection devices — when used as part of a structured penile traction programme — have evidence for modest reduction in curvature in stable Peyronie's disease and are useful for maintaining penile length during the acute phase. They are safe, non-invasive, and available without prescription.
PRP Therapy (Platelet-Rich Plasma)
PRP — concentrated growth factors derived from the patient's own blood — injected into or around the Peyronie's plaque aims to promote normal healing and reduce aberrant fibrosis. Evidence is emerging but less established than for shockwave therapy or collagenase injections. See our PRP Shot service.
Surgical Treatment
Surgery is the most effective treatment for curvature correction in stable Peyronie's disease — but is reserved for men with stable disease (no change in curvature for at least 3 months), curvature severe enough to prevent intercourse, failure of non-surgical treatment, and adequate erectile function (or concurrent penile implant where function is severely impaired).
Surgical options include plication (shortening the unaffected side), incision/excision with grafting (lengthening the affected side), and penile prosthesis implantation where ED is also severe. All carry risks including further shortening, numbness, and worsening of ED.
Treatment by Phase: What to Do and When
| Phase | Characteristics | Recommended Treatment |
|---|---|---|
| Active phase (0-18 months) | Pain on erection, changing curvature, soft plaques | Focal shockwave therapy, pain management, VED |
| Transitional | Pain resolving, curvature stabilising | Shockwave + consider intralesional injection |
| Stable phase (18+ months) | No pain, static curvature, possible calcification | Intralesional injection, VED, surgery if indicated |
What to Expect at Shockwave ReVibe Clinic
The consultation. Dr Bahl takes a comprehensive history — onset and duration of symptoms, presence and severity of pain, degree and direction of curvature, impact on sexual function and relationships, and relevant medical history including cardiovascular risk factors and diabetes. Where available, photographic documentation of curvature or previous imaging is reviewed.
The IIEF-EF questionnaire is completed at baseline to assess associated erectile dysfunction. The phase of disease — active or stable — is established clinically, as this determines the treatment pathway.
The treatment course. For active-phase Peyronie's disease: 6 sessions of focal shockwave therapy, delivered bi-weekly. Each session lasts approximately 20 minutes. The EMS Dolorclast Focal Shockwave system delivers precisely targeted acoustic energy to the plaque site. No anaesthesia is required. No downtime.
Managing associated ED. Where significant ED is present alongside Peyronie's disease, Dr Bahl addresses both conditions as part of an integrated management plan. PDE5 inhibitors, focal shockwave therapy for the ED component, and vacuum devices are all considered based on the clinical picture.
Initial consultation: £59. No referral needed.
Dr Kishore Bahl
Every Peyronie's assessment at Shockwave ReVibe Clinic addresses both the plaque and any associated ED as one integrated plan. Read our complete guide to ED treatment →
Frequently Asked Questions
What is Peyronie's disease?
Peyronie's disease is a condition where fibrous scar tissue (plaques) form inside the penis, causing penile curvature, pain during erection, and often erectile dysfunction. It affects an estimated 3-9% of adult men and is significantly underreported.
Is Peyronie's disease permanent?
In approximately 13% of men, Peyronie's disease resolves spontaneously without treatment. In the majority, the condition stabilises — curvature stops changing, pain resolves — but the plaque and resulting curvature persist without treatment. Early intervention in the active phase produces the best outcomes.
Does shockwave therapy work for Peyronie's disease?
Focal shockwave therapy has the strongest evidence for pain reduction and slowing progression in active-phase Peyronie's disease. Evidence for curvature improvement is more modest — meaningful in some patients, particularly in the active phase. It is most appropriately used in the active phase as a conservative first-line treatment before considering injections or surgery.
When is the best time to treat Peyronie's disease?
The active phase — typically the first 6-18 months from onset, characterised by pain on erection and changing curvature — is the critical treatment window. Intervention during this phase has the best evidence for halting progression. Do not wait for the condition to stabilise before seeking assessment.
Can Peyronie's disease cause erectile dysfunction?
Yes — in 30-80% of men with Peyronie's disease. The mechanisms are both physical (plaque disrupting normal erectile mechanics) and psychological (distress and anxiety inhibiting the erectile reflex). Both the Peyronie's and the associated ED need to be addressed in a comprehensive management plan.
Do I need a GP referral?
No. You can book directly with Dr Bahl without a GP referral. Initial consultation: £59.
Is surgery the only option?
No. Surgery is reserved for stable-phase Peyronie's disease with curvature severe enough to prevent intercourse, after non-surgical treatment has been tried. In the active phase, focal shockwave therapy and intralesional injection therapy are first-line non-surgical options that frequently prevent the condition from progressing to the severity that surgery would require.
Is everything confidential?
Completely. Your consultation and any treatment at Shockwave ReVibe Clinic are entirely private. Your records are never shared without your explicit consent.
Clinical References
- Stuntz M et al. (2016). The prevalence of Peyronie's disease in the United States: a population-based study. PLOS ONE, 11(2): e0150157.
- Nelson CJ et al. (2008). Psychological impact of Peyronie's disease: a review. Journal of Urology, 180(4): 1407-1411.
- Hatzimouratidis K et al. (2012). EAU guidelines on penile curvature. European Urology, 62(3): 543-552.
- Palmieri A et al. (2009). A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie's disease. European Urology, 56(2): 363-370.
- Gelbard M et al. (2013). Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of Peyronie disease in 2 large double-blind, randomized, placebo-controlled phase 3 studies. Journal of Urology, 190(1): 199-207.
- European Association of Urology (2024). EAU Guidelines on Sexual and Reproductive Health. EAU Guidelines Office, Arnhem, The Netherlands.
Dr Kishore Bahl is a Specialist Grade Doctor in Urology (GMC Registration: 6070860) and founder of Shockwave ReVibe Clinic, 22 Notting Hill Gate, London W11 3JE. To book a consultation, call 020 3004 0564 or visit shockwave-revibe.co.uk.
Last reviewed: September 2026