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Free checklist

Peyronie's Symptom Checklist

A structured checklist that helps you organize what you're noticing — shape, pain, instability, function, emotional impact — into something you can describe clearly to a clinician.

Many men struggle to put words to what is changing, and that hesitation often delays the appointment that would clarify it. This checklist exists to bridge that gap. It groups the things patients report into five categories and asks you to mark what applies, so the conversation with a urologist can start from a clearer baseline.

The checklist is not diagnostic. It is a preparation tool. Marking items here is meant to help you describe what you are seeing and feeling, not to replace a clinical examination.

Categories the checklist covers

  1. Shape change: curvature, narrowing, or shortening

    Direction, degree, and whether it appears to be progressing.

  2. Pain: during erection, during intercourse, or at rest

    Active-phase pain is a key signal for clinicians evaluating disease timing.

  3. Instability: hinge effect or buckling

    Mechanical instability at the plaque site that affects penetration.

  4. Erectile and functional changes

    Whether erection quality, rigidity, or penetration has changed.

  5. Emotional and relationship impact

    Anxiety, avoidance, or relationship strain — real symptoms worth naming.

Bring the completed checklist to your appointment. It gives the clinician a clearer starting picture than open-ended recall.

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