Can Peyronie’s disease or scarring cause apparent shrinkage and what are non-surgical recovery options?

1. How scarring produces “shrinkage” — the pathology behind the perception

Peyronie’s disease replaces normal elastic tunica tissue and sometimes corporal smooth muscle with dense fibrotic tissue and myofibroblasts; that fibrosis contracts and alters the sinusoidal architecture, producing curvature and objective shortening or the perception of shrinkage ^{[1] [8]}. Clinical reviews and narrative papers explicitly link dye‑able plaque/scar formation to length loss and penile deformity — scar contraction and loss of normal stretchability are the mechanistic explanations offered in multiple sources ^{[1] [2] [8]}.

2. What patients commonly report versus what imaging/clinics measure

Patients may report a smaller or “retracted” penis because curvature and shortening on the affected side reduce functional erect length; ultrasound or exam can demonstrate plaques and quantify deformity, and providers sometimes use induced erection or duplex ultrasound to assess true shortening versus concealment by overlying tissue ^{[9] [10]}. Available sources note that shortening can be a consequence of both the disease process and some corrective surgeries, so perceived size change may be multifactorial ^{[10] [11]}.

3. Proven non‑surgical treatments and what they actually achieve

Guidelines and contemporary reviews list several non‑surgical options: penile traction therapy (PTT) and vacuum erection devices (VED) to preserve or recover length and stretch scarred tissue; intralesional collagenase (CCH/Xiaflex) to soften plaques and reduce curvature; injections such as verapamil or interferon; and combination approaches including modeling, PNT+PRP in small series. These treatments can reduce curvature modestly and in some studies preserve or add small amounts of length, but results are heterogeneous and often modest compared with surgery ^{[4] [3] [5] [12]}.

• Penile traction and vacuum devices: Recommended or considered by urological societies as reasonable options, especially early in disease; protocols vary (daily wear 30–90 minutes or longer) and benefit is usually incremental and requires patient adherence ^{[4] [13]}.
• Collagenase (CCH/Xiaflex): The only FDA‑approved intralesional drug in many jurisdictions and shown to reduce curvature in trials, but average curvature improvement can be modest (single‑digit to ~20 degree averages across studies) and many men have little change; satisfaction can be high for some but it is not a guaranteed length restorer ^{[3] [14]}.
• Other injections and biologics: Verapamil, interferon, PRP and percutaneous needle tunneling show preliminary or case‑series evidence; early reports suggest safety and some curvature reduction but the level of evidence is lower ^{[12] [5]}.

4. Oral drugs and adjunctive medical therapies — limited but ongoing

Several oral options (e.g., potassium para‑aminobenzoate “Potaba”, pentoxifylline) and daily low‑dose tadalafil have been studied; Potaba showed benefit in slowing progression/pain in older trials but did not reverse established curvature, and pentoxifylline and PDE‑5 inhibitor use have mixed or preliminary support in reviews ^{[15] [6] [7]}. Reviews emphasize that oral medications rarely produce large structural reversals and are best seen as adjuncts, particularly in early/acute inflammatory phases ^[5].

5. Emerging and combination approaches — hope, not guarantees

Recent and ongoing work explores combinations (traction plus injection or biologics), shockwave therapy, and new collagenase or enzyme formulations; small studies and narrative reviews report promising signals but limited high‑quality RCT data so far. The European and specialty guideline updates call for individualized, often multimodal approaches while acknowledging limited evidence for many newer options ^{[16] [17] [5]}.

6. Practical takeaways and what patients should expect

If your concern is visible or perceived shrinkage from Peyronie’s or other penile scarring, clinicians will usually evaluate with physical exam and sometimes duplex ultrasound, then discuss stage (acute vs. stable), goals, and realistic outcomes. Non‑surgical options can reduce pain, modestly improve curvature, and sometimes help preserve or slightly increase functional length, but none reliably reverse major shortening — surgery remains the definitive length‑restoring option for many severe cases ^{[9] [5] [18]}. Available sources do not mention home remedies or supplements as replacements for medical/ device‑based therapies (not found in current reporting).

If you want, I can summarize guideline recommendations for treatment sequencing (acute vs stable disease) or pull key data points (average curvature change, adherence time for traction) from any of the cited reviews.