Something is wrong. You know it. And if you’re anything like the men I’ve spoken to – or like I was the first time it happened to me – your mind is already racing through the worst-case scenarios.

Pain during an erection is not something most men talk about. So when it starts, you’re often completely alone with it. You don’t know what it is. You don’t know if it’s serious. And you’re probably not sure whether to call your doctor or just wait and hope it goes away.

Let me try to help you with that.

Am I the only one experiencing penile pain?

No – penile pain during erection is more common than most people realise. One of the most frequent causes in men over 40 is Peyronie’s disease, which affects between 3 and 10 per cent of men at some point in their lives. You are not alone with this.

It feels like it, I know. But Peyronie’s disease is not a rare condition. That’s your colleague, your neighbour, your friend.

The problem is that men rarely talk about it, doctors don’t always bring it up, and most of the information online is either written in medical language that’s hard to parse or so vague it doesn’t actually help you understand what’s happening.

In my own case, I stumbled around in the dark for months before I started to understand what was actually going on. So let’s go through it properly.

What causes the pain?

Penile pain during erection in Peyronie’s disease is caused by active inflammation as scar tissue (plaque) forms inside the erectile tissue. The area is irritated and swollen at a microscopic level – when an erection stretches it, you feel that tension against tissue that is essentially in the middle of healing. The pain is the inflammation.

It’s the same reason a fresh bruise hurts more when you press on it than an old one does.

You might also feel a hard spot, a lump, or a tightness somewhere along the shaft. My experience the first time was a firm cord-like feeling under the skin on the underside. Some men notice the penis pulling to one side, or a dent that wasn’t there before. Not all of these happen at once – and in some cases the pain comes before any visible change.

The inflammation is also what makes this phase both the most uncomfortable and – as I’ll explain below – the most important one to handle correctly.

Why does Peyronie’s disease develop?

The leading theory is micro-traumas – small injuries to the erectile tissue during sex that, in some men, trigger abnormal healing. Instead of clean tissue, the body lays down collagen in a disorganised way that hardens into scar tissue. There is also a genetic component: some men are simply more prone to this type of abnormal scarring, and it tends to run in families.

This is the question most men ask, and the honest answer is: we don’t fully know.

Normally, those tiny injuries heal without a trace. But in certain men, the healing process goes wrong. The same mechanism shows up in Dupuytren’s contracture, which affects the hands – if that runs in your family, your risk of Peyronie’s is higher.

One thing I want to be very clear about: this is not caused by anything you did wrong. It’s not the result of too much sex, the wrong kind of sex, or some personal failing. It’s a tissue response that happens in certain men. Full stop.

What are the two phases of Peyronie’s disease – and why does timing matter?

Peyronie’s disease has two phases: the active phase (typically 3-12 months), where scar tissue is still forming, inflammation is ongoing, and changes in shape are still happening; and the stable phase, where the plaque has set, pain usually eases, and the penis more or less stops changing. Knowing which phase you’re in is critical – treatments that work in one phase can cause harm in the other.

During the active phase, the scar tissue is still forming and the inflammation is still going. The pain, any changes in shape, and any curvature that develops – all of that is happening now, while the tissue is still changing.

Once the active phase ends, the plaque stabilises. This is the stable phase. More stable – but by this point, the tissue has largely set in its new form.

Here’s what most men are never told: some treatments are most effective while the tissue is still actively inflamed. Others only become appropriate once things have stabilised. Use the wrong approach at the wrong time and you can genuinely make things worse, not better.

This is why timing isn’t just important. It’s everything.

I learned this the hard way the first time around. I tried things out of sequence. I was doing traction exercises while the tissue was still inflamed because I read online that traction helps with curvature – and nobody told me that doing it too early was exactly the wrong move.

Does Peyronie’s disease go away on its own?

In most cases, Peyronie’s disease does not fully resolve without treatment. Research suggests around 20 per cent of men see some natural improvement, but roughly 40 per cent worsen over time and 40 per cent see no change. Waiting and hoping is a genuine gamble.

I’m not telling you this to make you panic. I’m telling you because I wish someone had told me when it first happened. When I went through this the first time, I waited. I told myself it was probably nothing. I gave it three months of doing nothing. And I regret it.

That waiting didn’t cost me permanent damage – but it cost me time in the phase where intervention actually makes the most difference.

What does treatment for Peyronie’s disease actually look like?

Standard medical treatment typically starts with low-dose tadalafil (the active ingredient in Cialis), which has clinical evidence for the active phase. However, in my experience seeing seven different urologists over two episodes of this condition, that is often where the conversation ends – despite there being significantly more options available.

Most urologists will offer one thing: a prescription for low-dose tadalafil. It’s a reasonable starting point and there’s evidence behind it. Worth asking about.

But in my experience – and I’ve sat in front of seven different urologists across two episodes of this condition – not one of them mentioned supplements, diet, or lifestyle. Not once. The only lifestyle connection any of them raised was diabetes.

And yet the research tells a different story. Inflammation doesn’t exist in a vacuum. What you eat, how you sleep, how you move – these things affect how your tissue heals. There are supplements with actual clinical backing for connective tissue and inflammatory conditions. There are treatment approaches that most urologists simply aren’t aware of, or don’t consider relevant.

I’m not saying doctors are wrong. I’m saying the standard appointment gives you a fraction of the picture. And when you’re dealing with something like this, a fraction isn’t enough.

There’s also the question of traction devices – which some urologists do mention, and which can be genuinely useful. But the timing is critical. Using traction on inflamed tissue is like stretching a wound that hasn’t healed yet. Done at the wrong phase, it doesn’t help. It can make things measurably worse.

The challenge isn’t that treatments don’t exist. The challenge is knowing which ones apply to where you are right now, in what order, and what to avoid in the meantime.

What should you stop doing immediately if you have penile pain?

If sex is painful, stop having painful sex – not reluctantly, not with adjustments, but stop. Pain during an erection is your body signalling active inflammation and ongoing tissue damage. Continuing through it regularly provides the inflammation with more fuel and can cause further harm.

And be careful with anything marketed specifically as a Peyronie’s cure. The products that promise to dissolve your plaque or straighten your penis in weeks are almost always exploiting the fact that men with this condition are desperate and don’t know where else to turn. Scepticism is healthy here.

What is the emotional impact of Peyronie’s disease?

The emotional impact is significant and widely underreported. Studies show that around 81 per cent of men with Peyronie’s disease experience significant emotional distress, and around 48 per cent show signs of depression. Men describe feeling broken, less like themselves, and many stop having sex entirely – not because they physically can’t, but because the psychological weight becomes too heavy.

Relationships suffer. Some men stop having sex altogether – not because they physically can’t, but because the anxiety and shame become too heavy.

If any of that sounds familiar: it makes complete sense. I know that feeling. The first time I went through this, I didn’t tell anyone – not my partner, not a friend, not a doctor for the first few months. I carried it completely alone. And that made everything harder.

This is not a minor inconvenience. It affects something that for most men is closely tied to identity, confidence, and intimacy. The fact that you’re not talking about it with anyone doesn’t mean you’re handling it fine. It usually just means you’re carrying it alone.

You don’t have to.

What should you do next if you think you have Peyronie’s disease?

The first step is to get a proper diagnosis and understand which phase you’re in – this determines everything that comes next. See a urologist, confirm what you’re dealing with, and then make sure you have the full picture before you start any treatment.

If you’ve been reading this and recognising your own situation – the pain, maybe a lump, maybe a change in shape – you’re already doing the right thing by trying to understand what’s happening.

I’ve been through this twice. The first time in my early thirties, the second time in my mid-fifties. Both resolved without surgery. But I made mistakes the first time because I didn’t have the right information early enough.

The guide I’ve written covers the full picture – the biology, the two phases in detail, the treatments that have real evidence behind them including the ones most urologists won’t mention, what to use when, and how to navigate the decisions most men eventually face. It won’t tell you what to decide. But it will make sure you’re deciding with the right information in front of you – and at the right time.

That last part is the one that matters most.

–

Frequently Asked Questions

Is penile pain during erection always Peyronie’s disease?

Not always. Pain during erection can have other causes including infections, skin conditions, or vascular issues. However, if the pain is accompanied by a hard lump, a new curvature, or a change in shape of the penis, Peyronie’s disease is by far the most likely cause. A urologist can confirm this with a physical examination.

How long does the pain from Peyronie’s disease last?

Pain is typically associated with the active phase, which lasts anywhere from 3 to 18 months in most men. Once the condition moves into the stable phase, the pain usually eases significantly or disappears entirely. The curvature or shape change may remain, but the daily discomfort tends to resolve.

Can you still have sex if you have Peyronie’s disease?

Many men can continue to have sex with Peyronie’s disease, but painful sex during the active phase should be avoided – it risks further micro-trauma to inflamed tissue. Once the condition stabilises and pain eases, sexual activity is generally possible, though curvature may require adjustment. This is worth discussing directly with your doctor.

Should I see a doctor or wait to see if it improves on its own?

See a doctor. Around 40 per cent of men with Peyronie’s disease see their condition worsen without treatment, and the active phase – when many treatments are most effective – is time-limited. Waiting can mean missing the window where intervention makes the biggest difference.

Is Peyronie’s disease the same as a “broken penis”?

No. A penile fracture is an acute injury where the tissue surrounding the erectile chambers ruptures – usually during sex, with a distinct pop and immediate loss of erection. Peyronie’s disease develops gradually through repeated micro-traumas or abnormal healing. They are different conditions, though an unresolved penile fracture can sometimes trigger the abnormal scarring that leads to Peyronie’s.

Sources

NIDDK – Penile Curvature (Peyronie’s Disease) – National Institute of Diabetes and Digestive and Kidney Diseases, overview of causes, phases and treatment options.

Cleveland Clinic – Peyronie’s Disease – Clinical overview of symptoms, diagnosis and treatment.

Harvard Health Publishing – What is Peyronie’s Disease? – Overview for patients including treatment options.

NIH/PMC – Psychological impact of Peyronie’s disease – Research on distress and depression prevalence in men with Peyronie’s disease.

Journal of Sexual Medicine – Peyronie’s disease epidemiology – Research on prevalence rates and natural history of the condition.