Introduction. Many men with Peyronie's disease (PD) delay presentation to a urologist. The reasons for this are unclear. Aim. To define the differences in men who present early compared to those presenting in a delayed fashion and to determine predictors of delayed presentation. Methods. A retrospective analysis of all patients presenting for the first medical evaluation of PD. All patients underwent a standard history and physical examination and had a standardized deformity assessment. Demographic and PD parameters were recorded. Main Outcome Measures. Statistical comparison was used to define factors that were different between early and delayed presenters and multivariable analysis was used to define predictors of presentation > 12 months. Results. 482 patients were analyzed, 61% presenting < 12 months, 39% > 12 months. Mean patient age was 52 +/- 13 years and mean duration of PD was 17 +/- 30 months. Mean measured curvature was 42 degrees +/- 19 degrees. Multivariable analysis revealed that delayed presentation patients were significantly more likely to be older (odds ratio [OR] = 4.0), to be in long-term relationships (OR = 3.6), to have dorsal curvature (OR = 2.5), to have curvature < 45 degrees (OR = 3.3), to be heterosexual (OR = 2.0), and to have simple deformity (OR = 1.5). Conclusions. One-third of men with PD presented in a delayed fashion and they tended to be older, to be in long-term relationships, to have dorsal curvature, or to have simple deformity. Mulhall JP, Alex B, and Choi JM. Predicting delay in presentation in men with Peyronie's disease. J Sex Med 2010;7:2226-2230.