A man notices it in a moment he did not plan to analyze.

An erection that used to be straight now bends. There is a new ache. Sex feels different, less reliable, more tense. He tells himself it is temporary. He avoids looking too closely. He stops initiating intimacy. And most of the time, he does not say a word.

That quiet delay is one of the most overlooked parts of Peyronie’s disease.

Peyronie’s disease is not just a “bend.” It is a condition that can bring pain, deformity, sexual difficulty, and a surprising amount of shame. Historically described centuries ago and most commonly seen in middle-aged and older men, it remains a diagnosis many men carry privately, sometimes for months or years, before they seek help. In severe cases, the curvature and deformity can make penetration difficult or impossible, but the emotional burden often starts long before that.

A U.S. survey estimated that definite Peyronie’s disease affects about 0.7 percent of men, while “probable” cases may be as high as 11 percent, a gap that strongly suggests PD is frequently under-recognized and under-diagnosed.

Why the silence is so common

Men do not delay because they do not care. They delay because the problem feels loaded, medically and psychologically.

• Embarrassment: Many men are taught to treat sexual problems as personal failures, not medical conditions.
• Fear of what it means: “Is this permanent?” “Will I need surgery?” “Will I lose function?” These questions can be so frightening that avoidance feels safer than clarity.
• Minimizing symptoms: In many cases, men have no pain when the penis is flaccid, so they convince themselves the issue is not “real enough” to bring up.
• Relationship pressure: Some men worry their partner will judge them, lose attraction, or view them differently. So they withdraw, often without explaining why.
• Internet misinformation: Online searches can swing between worst-case images and miracle-cure marketing. Both can keep men stuck.

And then the condition becomes more than physical. It becomes a private narrative: Something is wrong with me. I am the only one. I should be able to handle this.

What Peyronie’s disease actually is

Peyronie’s disease involves a plaque (scar-like area) in the tissue layer that helps the penis expand evenly during an erection. When that tissue loses elasticity in one region, erections can curve toward the tighter side. The tunica’s normal role is to provide structure, rigidity, length, and flexibility, so when part of it becomes scarred, the mechanics of erection can change in ways that feel alarming and unfamiliar.

The symptoms men report are remarkably consistent:

• Painful erections
• Penile curvature
• A sense that the erection is weaker “beyond” the involved area (distal to the plaque)

Many men also notice a firm area on palpation, a painless plaque that can vary in size and location. Often it is located on the dorsal (top) side near the midline. Over time, calcification can occur and may be visible on imaging.

The key point is this: These are recognized clinical features. This is not “in your head,” and it is not something you should have to interpret alone.

The dangerous comfort of “maybe it will go away”

One of the reasons men wait is hope. Hope can be helpful, but it can also delay appropriate evaluation.

Some sources describe spontaneous improvement in a portion of patients. But the problem is uncertainty: You cannot reliably predict who will improve, who will stabilize, and who will progress. Meanwhile, the months spent waiting often come with mounting anxiety, avoidance of intimacy, and sometimes secondary erectile dysfunction driven by fear and performance pressure.

A better approach than silent waiting is structured waiting:

• Document changes.
• Measure and monitor.
• Manage pain and sexual function.
• Make decisions with a plan instead of panic.

What a Peyronie’s evaluation looks like

Many men picture humiliation. The reality is usually straightforward.

A typical evaluation includes:

• A timeline of symptoms (onset, pain, progression).
• Assessment of sexual function and distress.
• A focused genital exam to feel for plaque.
• When needed, objective assessment such as ultrasound and measurement of curvature (often using a goniometer).

Objective measurement matters. Anxiety distorts perception; some men overestimate curvature because they are terrified; others underestimate because they are trying not to see it. A clinician’s job is to replace guesswork with clarity.

Why early care matters even if you do not want “treatment”

Not every man needs immediate intervention. But early evaluation helps in three big ways:

1. It reduces fear. Understanding what is happening is often the first therapeutic step.
2. It protects relationships. Silence can create distance; a plan creates teamwork.
3. It preserves options. Even when definitive procedures are not needed, early strategies can support function and reduce distress.

Men often believe the only outcomes are “do nothing” or “have surgery.” In reality, management is individualized, and often stepwise.

Treatment: Not one-size-fits-all, and not always surgery

If there is one message I try to land early, it is this: Peyronie’s treatment depends on the phase and on the person. Is the curve still changing? Is there pain? Are erections reliable? And what matters most to the patient: penetrative function, preserving length, minimizing risk to erectile quality, or simply feeling “normal” again?

In the active phase (when pain is present and/or the curvature is evolving), the goal is often to calm things down and protect sexual function, not to “fix it overnight.” That can mean simple measures like anti-inflammatories for pain, plus addressing erectile function when needed (because good rigidity can make everything, physically and emotionally, more manageable). Many oral supplements have been tried over the years with mixed or disappointing results, and a lot of the “popular” options online do not match what evidence-based urology actually supports.

One conservative tool that deserves more attention is mechanical therapy, especially penile traction therapy. Traction is not magic, but in selected patients, and particularly when used consistently, it may help limit length loss and modestly improve curvature. Some clinicians also use traction as part of a combined approach alongside other treatments.

Once the deformity is stable (typically stable for months) and the curve meaningfully affects sex, we can talk about more targeted options. The main non-surgical category here is injection therapy into the plaque. In the U.S., collagenase (CCH) is a well-studied option for appropriately selected men and is often paired with careful “modeling” and/or traction. Availability varies internationally, and in some regions it is not marketed. Other injectable options used in certain settings include interferon or verapamil, though results can be variable and patient selection matters.

Surgery is usually reserved for men with significant, stable deformity and clear functional impairment, or for men whose erectile function is already compromised. Surgical choices are not “better or worse,” just different trade-offs:

• Tunical plication (Nesbit-type/plication techniques): Reliable straightening, generally best when erections are strong, but may come with some length loss.
• Plaque incision/excision with grafting: Considered for more severe curves or complex deformities (like hinge/hourglass), with a greater focus on length/shape restoration, but typically with a higher risk of post-op erectile issues than plication in some men.
• Penile implant (prosthesis): The most effective solution when ED is significant and medical therapy is not working, often correcting rigidity and allowing additional straightening maneuvers if needed.

The goal in modern practice is not simply “straightening.” It is matching treatment to what the patient values most—function, length, rigidity, and confidence—and being honest about what each option can (and cannot) deliver.

The sentence that changes everything

Men often tell me, “I did not know how to start the conversation.”

Try any of these:

• “I have noticed a new curve during erections, and it worries me.”
• “I have pain with erections and sex has changed.”
• “I think I might have Peyronie’s disease.”
• “I am avoiding intimacy because I am scared something is wrong.”

That is enough. The rest is a clinical discussion, one you deserve to have without shame.

A message to partners, too

If you are a partner reading this: Withdrawal is often fear, not rejection. Many men stay silent because they do not want to disappoint you or appear vulnerable. The most helpful words are simple:

• “We will deal with this together.”
• “I care about you more than performance.”
• “Let us get you seen so you do not carry this alone.”

The takeaway

Peyronie’s disease combines pain, curvature, and silence in a way that makes men delay, sometimes long past the point where reassurance and a plan could have eased suffering.

If something has changed, you do not need to wait until it becomes unbearable to deserve help. Quiet symptoms can still be clinically important. Quiet care can still be excellent care. And speaking up early is not weakness; it is how men protect their health, relationships, and peace of mind.

Martina Ambardjieva is a dedicated urologist and medical educator with extensive experience in both clinical practice and academic instruction. She earned her MD from the University “Sv. Kiril i Metódij” in Skopje and is a PhD candidate in urological oncology, with a focus on bladder carcinoma. Her scholarly work includes numerous publications in oncologic urology, urinary calculosis, and men’s health.

Dr. Ambardjieva currently serves as a urologist at the PHI University Surgical Clinic “Naum Ohridski” and completed her residency training at the University Urology Clinic in Skopje. Earlier in her career, she practiced as a general medical doctor at Sante Plus General Hospital and completed a medical internship at the University of Ljubljana.

In addition to her clinical responsibilities, Dr. Ambardjieva is a teaching assistant at the Medical Faculty in Skopje. She works additionally as a collaborator for Dr. Telx. She has held leadership positions in the European Medical Students’ Association and actively participates in international medical education and policy. She has attended numerous congresses and workshops in France, Italy, Canada, and Turkey, and serves as a delegate for the European Association of Urology (EAU), contributing to cross-border initiatives in urology. Certified in laparoscopic surgery, she continues to integrate patient care, research, and education in her professional work.