The most common symptoms of PD include penile pain; erect deformity and palpable plaque with or without erectile dysfunction. Penile pain is not always present in men with PD. The location of the plaque on the penile shaft usually explains the erect deformity. If the plaque is on the dorsum the erect penis will curve upward. The plaque may not be symmetrical such that it causes a complex deformity with an uneven dorsal curvature, which tilts or rotates to one side. The plaque may also limit the lateral expansion of the erect penis causing varying degrees of indentation including an hourglass deformity causing an unstable erection described as a hinge effect.