You’ve searched for this and found almost nothing. Or you’ve found articles about curved penises and Peyronie’s disease that don’t quite describe what you’re looking at. Because what you have isn’t really a curve. It’s more like… a dent. A narrowing somewhere in the middle. A place where the shaft seems to collapse inward slightly when you’re erect, while the rest of it looks normal.
Maybe it looks a bit like an hourglass. Maybe it’s more of a hinge, where the penis seems to fold at one point. Maybe there’s a flat spot, or a groove running along one side.
Whatever the exact shape, you’ve probably had a hard time finding a name for it. And that’s frustrating, because when you can’t name something you can’t research it, and when you can’t research it you just sit there wondering what’s wrong with you.
Here’s what’s going on.
It has a name – it’s just not well publicised
What you’re describing is a recognised presentation of Peyronie’s disease. The hourglass deformity, as it’s called clinically, or the hinge effect. It happens to a subset of men with Peyronie’s – not the majority, which is probably why most of the articles you find focus on curvature and leave this variant almost entirely unaddressed.
Peyronie’s disease is usually described as a condition that causes the penis to curve. And it does – that’s the most common presentation. But the curve is just one possible outcome depending on where the scar tissue forms and how it’s distributed. The indentation, the hourglass, the hinge – these are what happens when the plaque sits differently.
So if you’ve been reading about Peyronie’s and thinking “that’s not quite what I have” – you might be right that it doesn’t match the pictures. But you’re probably still looking at the same underlying condition.
Why a dent and not a curve?
To understand this, it helps to know a little about the structure of the penis.
Inside the shaft, there are two cylindrical chambers – the corpora cavernosa – that run side by side the length of the penis. These are the chambers that fill with blood during an erection. They’re enclosed in a tough, fibrous sheath called the tunica albuginea. When that sheath can’t stretch properly in a localised area – because scar tissue has formed there – the erection can’t expand fully at that point. The surrounding tissue puffs up normally. The affected area doesn’t. And what you get is an indentation, a narrowing, a dent.
A curve happens when the plaque is concentrated on one side – the penis bends toward it because that side can’t expand. An hourglass or indentation happens when the plaque wraps further around the shaft, or sits in a location that causes it to narrow rather than bend. In some men there’s a combination – a curve and a dent at the same time.
The mechanism is the same. The location and distribution of the scar tissue just produces a different visual result.
The hinge effect – when it folds
Some men describe something slightly different again: not so much a dent as a point where the penis seems unstable. Where it bends, or “hinges,” under pressure during sex in a way that feels wrong. Like there’s a weak spot.
This is also a recognised Peyronie’s presentation. When plaque forms in a location that affects the structural integrity of the shaft at that point, the surrounding tissue can become what’s sometimes called a pseudo-joint – a spot where the penis flexes when it shouldn’t. It’s uncomfortable, it can make intercourse difficult, and it can also feel alarming if you don’t know what you’re dealing with.
It’s not dangerous in the sense of being life-threatening. But it does mean the tissue there is under abnormal stress, and anything that adds to that stress – vigorous sex during an active phase, for example – can worsen things.
Is the indentation permanent?
That depends on where you are in the condition’s timeline.
Peyronie’s disease moves through an active phase, where the scar tissue is still forming and changes are still happening, and a passive phase, where the plaque has stabilised and the shape has largely settled. If you’ve recently noticed the indentation and it seems to be changing – getting more pronounced, shifting slightly – you’re probably in the active phase. If it’s been the same for six months or more, you’re likely in the passive phase.
The distinction matters because what can be done about it differs significantly depending on which phase you’re in. There are approaches that work best while the tissue is still active – while the body is still in the middle of the inflammatory process that’s creating the problem. Try those same approaches in the passive phase and they’re largely ineffective. And conversely, there are things that are appropriate to try in the passive phase that would be actively harmful during the active phase.
Getting this wrong is one of the most common mistakes men make when they try to manage Peyronie’s on their own. Not through any fault of their own – it’s just genuinely confusing information that isn’t presented clearly anywhere.
Can it get worse?
During the active phase, yes. The indentation can become more pronounced. It can change shape. In some men what starts as a mild narrowing becomes a more significant hourglass over the months that the condition is developing. That’s not inevitable – but it’s possible, and it’s one of the reasons that sitting on this and hoping it resolves tends to be a gamble.
The research on spontaneous improvement – meaning the condition getting better without any intervention – puts the figure at around 20 per cent of cases. For the other 80 per cent, things either stay the same or get worse without some kind of management. That’s not a figure that encourages a pure wait-and-see approach.
Once the passive phase is reached and the plaque has stabilised, the indentation is unlikely to worsen further. But it’s also unlikely to resolve on its own at that stage. The passive phase is when men start thinking more seriously about longer-term options – including, for some, surgery. Though surgery is far from the only path, and for many men it’s not the right one.
What you’ll probably hear from a urologist
If you go to a urologist with an indentation or hourglass deformity, they’ll likely diagnose Peyronie’s disease fairly quickly. This particular presentation is well known to specialists even if it’s underrepresented in general health articles.
What you may not hear – unless you specifically ask – is a detailed explanation of the phases, of timing, or of the range of options available. A standard appointment often covers the diagnosis and possibly a prescription for tadalafil, with a follow-up in a few months. That’s a reasonable starting point but it leaves a lot on the table.
In my experience – and I’ve sat in front of seven different urologists across two separate episodes of this condition – nobody spontaneously mentioned supplements, lifestyle, or anything beyond the standard medical options. The connection between what you eat, how you live, and how your body manages inflammation and tissue repair simply isn’t part of the typical Peyronie’s conversation. And yet it probably should be.
What can actually be done?
The answer to this depends, again, on the phase.
During the active phase, the priority is managing the inflammation and protecting the tissue from further damage. That means stopping anything that’s causing pain or mechanical stress, looking at medical options that work in this window, and considering whether supplements with anti-inflammatory or connective-tissue-supporting properties might help. The evidence base for some of these is more modest than for prescription options, but it exists.
In the passive phase, traction devices – which apply a gentle, sustained stretch to the tissue over time – have reasonable evidence behind them for reducing curvature and, in some cases, improving indentation. The key word is “passive.” Using traction during the active phase, while the tissue is still inflamed, is counterproductive and can cause more damage. The timing is not a minor detail. It’s the whole point.
For men whose indentation or hourglass is significant enough to affect sexual function, surgery is an option – specifically grafting procedures that aim to restore more even expansion across the shaft. But surgery comes with trade-offs, it’s not without risk, and most urologists recommend waiting until the condition has been stable for at least six months before considering it seriously.
The part that’s hardest to find online
Most men with the hourglass or indentation presentation spend a lot of time searching and come up mostly empty. The articles that exist focus on curvature. The pictures show curved penises. The forums have a mix of reassurance and panic, and very little that’s practically useful.
What’s missing is a clear explanation of what this specific presentation is, why it happens, how it fits into the broader Peyronie’s picture, and what the options actually are – laid out in a way that makes sense to someone who isn’t a urologist.
That’s the gap the guide I’ve written tries to fill. It covers the full range of presentations – including the hourglass and hinge effect – and goes through the phases, the timing, the treatments with real evidence behind them, and the ones that are mostly wishful thinking. It’s not a substitute for seeing a doctor. But it gives you something to walk in with: a clearer understanding of your own situation and the right questions to ask.
Because right now, the most useful thing you can have is not a diagnosis – you can probably get that from a urologist in ten minutes. It’s context. It’s understanding what the diagnosis actually means, what happens next, and what you can do about it at each stage.
That’s what this is all about.
–
Sources: American Urological Association guidelines on Peyronie’s disease, Cleveland Clinic, Journal of Sexual Medicine, NIDDK, Harvard Health Publishing.