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.

What causes a dent or indentation in the penis when erect?

A dent or indentation in the penis during erection is a recognised presentation of Peyronie’s disease, clinically called the hourglass deformity or hinge effect. It is caused by scar tissue (plaque) forming inside the erectile tissue in a location or distribution that causes the shaft to narrow rather than bend. The mechanism is the same as curvature – restricted expansion – but the shape it produces is different.

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 does Peyronie’s cause a dent rather than a curve?

Inside the shaft, two cylindrical chambers (the corpora cavernosa) fill with blood during an erection, enclosed in a fibrous sheath called the tunica albuginea. When scar tissue forms in this sheath and prevents it from expanding in a localised area, the rest of the tissue puffs up normally while the affected area does not – producing a dent or narrowing. A curve results when plaque is concentrated on one side; an hourglass or dent results when plaque wraps further around or sits in a position that causes narrowing rather than bending.

The mechanism is the same. The location and distribution of the scar tissue just produces a different visual result. In some men there’s a combination – a curve and a dent at the same time. I had a mild version of this the second time around: a slight leftward pull combined with a flattening on the underside that was more noticeable than the curve itself.

What is the hinge effect in Peyronie’s disease?

The hinge effect is when Peyronie’s plaque causes a point of structural weakness along the shaft, making the penis appear to fold or buckle at that point under pressure during sex. It is a recognised Peyronie’s presentation that can make intercourse difficult and feels unstable or alarming. It is not life-threatening, but the tissue at that point is under abnormal stress – anything that adds to that stress during the active phase can worsen it.

If you experience this, avoid any sexual position or activity that puts significant lateral pressure on that point until you have a clearer picture of where you are in the condition’s progression. It’s not a permanent sentence – but it needs to be treated with some care while the tissue is still changing.

Is a penile indentation from Peyronie’s disease permanent?

It depends on which phase of Peyronie’s disease you are in. If the indentation is still changing – becoming more pronounced or shifting – you are likely still in the active phase and the shape is not yet fixed. Once the stable phase is reached and the plaque has set, the indentation is unlikely to worsen further, but it is also unlikely to resolve on its own at that stage. Intervention is most effective during the active phase.

The distinction matters because what can be done about it differs significantly depending on which phase you’re in. 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 information that isn’t presented clearly anywhere.

Can a penile dent or hourglass shape get worse?

During the active phase, yes – the indentation can become more pronounced or change shape. Research puts spontaneous improvement at around 20 per cent of cases without any intervention. For the other 80 per cent, things either stay the same or worsen. This is not a figure that encourages a pure wait-and-see approach, particularly during the active phase when intervention can still influence the outcome.

Once the stable phase is reached and the plaque has set, the indentation is unlikely to worsen further. But it’s also unlikely to resolve on its own. 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.

What will a urologist say about a penile indentation?

A urologist will typically diagnose Peyronie’s disease fairly quickly – the hourglass and hinge presentations are well known to specialists even if they are underrepresented in general health articles. What you may not hear without specifically asking is a detailed explanation of the phases, the timing, or the full range of options. The standard appointment often ends with a tadalafil prescription and a follow-up in a few months.

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.

Go in prepared. Know what phase you think you’re in. Ask specifically about the phases. Ask what the plaque looks like on examination and whether there is calcification. The more specific your questions, the more useful the answers tend to be.

What can actually be done about a penile indentation or hourglass shape?

During the active phase, the priority is managing inflammation and avoiding further tissue damage – this means stopping painful activity, considering medical options designed for this window, and looking at supplements with anti-inflammatory or connective-tissue-supporting evidence. During the stable phase, traction devices have reasonable evidence for reducing deformity over time. For significant cases affecting sexual function, grafting surgery is an option – but most urologists recommend waiting until the condition has been stable for at least six months before considering it seriously.

The key word for traction is timing. Using a traction device during the active phase, while the tissue is still inflamed, is counterproductive and can cause further damage. This is not a minor detail – it’s the whole point. I made exactly this mistake the first time I had Peyronie’s. I found information about traction therapy online, started using it too early, and made things worse before they got better.

The guide I’ve written 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 gives you something to walk into the urologist’s office with: a clearer understanding of your own situation and the right questions to ask.

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Frequently Asked Questions

Is an hourglass shape in the penis the same as Peyronie’s disease?

Yes. The hourglass deformity is a recognised presentation of Peyronie’s disease. It occurs when plaque forms in a distribution that causes narrowing of the shaft rather than a lateral curve. The underlying mechanism – scar tissue restricting expansion of the erectile tissue during erection – is identical to standard Peyronie’s. It is simply a different visual outcome depending on plaque location.

Can the hinge effect cause injury during sex?

In theory, yes. If the hinge point is under significant stress during intercourse – particularly if there is lateral pressure at that spot – there is a risk of further micro-trauma to already damaged tissue. During the active phase especially, this is a reason to be cautious about sexual activity that puts pressure on the affected area. This is worth discussing specifically with your urologist.

Why don’t search results describe what I’m seeing?

Because the hourglass and indentation presentations of Peyronie’s disease are significantly underrepresented in general health content. Most articles focus on curvature because that is the most common presentation, and the hourglass variant – while well known to urologists – rarely makes it into patient-facing resources. If you have searched for “dent in penis” or “hourglass shaped penis” and found almost nothing useful, that is why.

Is surgery the only option for an hourglass deformity?

No. Surgery – typically a grafting procedure to restore more even expansion – is one option for significant cases, but it is not the only one and most urologists recommend exhausting non-surgical approaches first. Many men manage the condition without surgery. The severity of the deformity, whether it affects sexual function, and which phase the condition is in all determine what options are appropriate and in what order.

Sources

American Urological Association – Peyronie’s Disease Guideline – Comprehensive clinical guidelines including hourglass and hinge presentations.

Cleveland Clinic – Peyronie’s Disease – Clinical overview of presentations, plaque types and treatment.

NIDDK – Penile Curvature (Peyronie’s Disease) – Overview of the condition including structural causes of deformity.

Journal of Sexual Medicine – Peyronie’s disease presentations – Research on clinical presentations including indentation and hourglass deformity.

Harvard Health Publishing – Peyronie’s Disease – Patient overview including deformity types and management options.