An injury to the penis isn’t something most men want to think about, but it can happen, potentially causing curvature and shortening of the penis. This condition is called Peyronie’s disease, and it can make intercourse difficult or impossible, says Stanton Honig, MD, a urologic surgeon who heads Yale Medicine’s Male Sexual Medicine and Male Reproductive Health programs.

Although Peyronie’s disease isn’t a widely known condition, it is more common than you might guess, affecting about 1 in 11 men.

Until recently, surgery was the only effective treatment for Peyronie’s disease. Dr. Honig participated in clinical trials for the first drug approved by the Food and Drug Administration (FDA) for treatment of Peyrone’s disease, collaganese (brand name: Xiaflex). “I think the fact that we have an FDA-approved drug is really a breakthrough in this disease,” he says.

When the penis is injured, micro-bleeding and inflammation result. This may lead to the development of scar tissue (called plaque) in the shaft of the penis. Scar tissue may cause the penis to begin to curve or bend, potentially interfering a man’s ability to have sexual intercourse.

The disease has a major impact on a man’s wellbeing, including not only sexual function and physical appearance, but also psychological health. “About 50% of people with this disease have some level of depression,” says Dr. Honig. 

It usually happens as a result of an injury, for instance if you accidentally bump into your partner’s pubic bone during sex or if you have an injury to the groin while engaged in sports, such as surfing.

The “injury” itself isn’t necessarily dramatic; often it is just a bump. “Most of the time, men don’t even remember when they got the injury,” says Dr. Honig. 

A couple of weeks later, however, they may notice aching during an erection. This is caused by the buildup of scar tissue, which may cause the penis to bend. Sex can become difficult or even impossible. The condition can also shorten the penis, and it can result in some erectile dysfunction as well.

If it happens during sex, you might hear a “pop” and experience some inflammation directly afterward. You may feel an ache during erections; for some men this is mild, but for others the discomfort is intense enough to prevent intercourse.

It’s mostly caused by injury, but there can be a genetic predisposition to developing curvature of the penis. 

A mild, achy pain during an erection could be the first sign of Peyronie’s disease. The pain usually isn’t intense, and most men don’t even recall being injured. The pain may subside, but scar tissue in the penis may cause it to curve and shorten. Many men with this condition suffer from depressive symptoms as well.

Peyronie’s disease can be treated with a medication called Xiaflex, which was first approved by the FDA in 2010 for treatment of Dupuytren’s contracture, a disease that affects a person’s ability to straighten and use the fingers. In Peyronie’s disease, the drug is thought to work by breaking down the scar tissue that causes the curvature. Treatment consists of a series of Xiaflex injections, followed by massage to break down the scar tissue.

This treatment is ideal for a man with mild to moderate curvature of the penis who has significant difficulty with intercourse, says Dr. Honig. For more severe cases, he recommends surgery by a skilled microsurgeon. Surgical treatment is highly successful, but poses a small risk of post-operative problems that include slight shortening of the penis and changes in sensation, though this is rare.

Dr. Honig is recognized nationally for his expertise in treating Peyronie’s disease and often cares for patients who are referred to him by other physicians. He has years of experience in performing the delicate microsurgery that’s sometimes necessary to properly correct Peyronie’s disease and restore sexual function. Dr. Honig presents his work around the country and conducts ongoing research evaluating care for patients with Peyronie’s disease.