Virtually all of the current modalities for treatment of Peyronie’s disease can be offered to patients who are on anticoagulant therapy including Coumadin. The primary precaution to using a type of invasive therapy such as intralesional injections is bruising. To reduce bruising, compression of the injection site should be maintained for at least 10 minutes. In addition for patients who are considering the use of vacuum therapy, either alone or in concert with intralesional injection, then one must be very careful to not initiate vacuum therapy for at least 48 hours after an injection and to limit the pressure so that they do not develop any significant subcutaneous bleeding. Should bruising occur, manual pressure can be applied directly over the area of black and blue and then with subsequent use of the vacuum device, a lower vacuum pressure should be used.