Penile curvature

Florian Tiefenböck studied human medicine at the LMU Munich. In March 2014, he joined as a student and has supported the editorial team with medical articles ever since. After receiving his medical license and practical work in internal medicine at the University Hospital Augsburg, he has been a permanent member of the team since December 2019 and, among other things, ensures the medical quality of the tools.

More posts by Florian Tiefenböck All content is checked by medical journalists.

A penile curvature (penis deviation) can be congenital or acquired. Middle-aged men are particularly affected by acquired penile curvature. The causes have not yet been researched. Usually medication is used to stop the disease from progressing. In severe cases, surgery may be necessary. Find out everything you need to know about penile curvature here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. Q55N48

Curvature of the penis: description

With penile curvature, the penis is curved to one side (lateral), upward (dorsal) or downward (ventral). Many a penis is wound around its axis like a corkscrew. Curvature of the penis can be congenital and is medically called congenital penile deviation. In this case, the penis is usually curved downwards or forwards when erect. Doctors refer to an acquired curvature of the penis as induratio penis plastica (= plastic hardening of the penis). Here the erectile tissue is often bent upwards, in some cases to the side.

A congenital penile curvature is based on a genetic defect. Therefore, it often occurs with other diseases of the male genital organ. A specific cause of the acquired penile curvature is not known. Mostly 45 to 65 year old men get penile deviation. In Germany, around three percent of this age group have a crooked penis. Overall, penile curvature occurs in about one in 1000 men. However, experts suspect a much larger number of unreported cases.

Often the curve is only slight. Over time, however, it can intensify and painfully disrupt the erection. In other cases, deviations resolve spontaneously. Congenital penile curvature remains unchanged in most cases.

Curvature of the penis: symptoms

Acquired penile curvature is primarily characterized by palpable, nodular hardening, so-called plaques. They are usually on the top of the penis shaft, in rare cases on the bottom. The often elongated nodules arise from the tunica albuginea. This is a thin membrane that surrounds and holds together the erectile tissue of the penis (corpora cavernosa) as a connective tissue-like capsule. The hardening develops within a few weeks to months. They vary in size (usually one to three centimeters) and can spread over the entire penile shaft.

If the connective tissue becomes scarred and hardens, experts speak of fibrosis. In fibrosis, connective tissue multiplies benign and is usually converted from a soft, elastic into a harder, scarred tissue. As a result of these changes (penile fibrosis), the tissue in the area of the plaques shrinks and thereby curves the penis onto the diseased side. The acquired curvature of the penis is more of a symptom than a disease. The extent of the penile curvature is particularly visible on the erect penis. Occasionally the penis bends in two directions (bidirectional penile curvature), for example up and to one side.

If the crooked penis deviates significantly from the straight axis, this can lead to problems during sexual intercourse. In addition, the penis becomes less stiff from the plaques to the glans, which experts call reduced rigidity. Some patients complain of pain, especially when they have an erection and during sex. This penile pain occurs very rarely when at rest. Urination and the urine stream, on the other hand, are not restricted by the curvature of the penis.

Occasionally, with acquired curvatures of the penis, plaques can be found at the transition between the glans and penis shaft (lacerations). As a result, there may be hourglass-like constrictions in this area. In severe cases, this can damage the nerves and vessels running there. This leads to erectile dysfunction and the glans tingling or feeling numb.

With congenital penile curvature, the curvature itself is the main symptom. Typical complaints as with the acquired variant are rare. Most patients present to a doctor before or after their first sexual contact. Depending on the extent, sexual intercourse can be impaired. For some patients, the curvature of the penis is also a psychological problem. Those affected often find the deviation from the norm stressful. This is usually aggravated by a possible erectile dysfunction and problems during sex.

Curvature of the penis: causes and risk factors

When it comes to the causes of penile curvature, as with the symptoms, a distinction must be made between the congenital and the acquired form. So far, there are no proven reasons for penile curvature. However, there are assumptions and clues that indicate possible causes of penile deviation.

Congenital curvature of the penis

Congenital penile deviation is caused by genetic defects. It is hardly known exactly where or why the penis develops incorrectly.However, we now know that the connective tissue sheath (tunica albuginea) of the erectile tissue grows differently in length. The lower part is usually shorter than the upper part, which is why the male member is often curved downwards in congenital penile deviation. In some cases, the congenital curvature of the penis is associated with other diseases. Above all, these include:

Hypospadias: The mouth of the urethra is below the glans, i.e. on the underside of the penis. Below the too deep urethral opening, a thickened cord of connective tissue, the notochord, runs towards the testicle. It curves the penis down.
Megalourethra: urethra that is enlarged like a balloon. Parts of the three cavernous bodies of the penis are missing here. This causes the urethra to expand enormously. This developmental disorder often leads to an upward curvature of the penis.
Epispadia: There is a second urethral opening on the penis shaft.

Scientists believe that a lack of male sex hormones (androgens) during embryonic development is responsible for these malformations.

Acquired penile curvature

The cause of acquired penile curvature is unknown. However, experts have put forward a number of theories to explain how penile deviation can arise.

accident

During sexual intercourse, the penis can bend slightly, especially when an erection begins. This puts a strain on the connective tissue sheaths in the penis. As a result, the smallest damage and injuries (microtraumas) to the vessels in the penis can occur in these areas. There are invisible bruises. The tissue gradually becomes scarred as a result of an inflammatory reaction in the body. The inflamed erectile tissue is replaced and the typical plaques and thus the curvature of the penis develop.

Inheritance

Whether some men are more susceptible to penile curvature than others due to their genetic make-up has not yet been proven. However, scientists have found that around 25 to 40 percent of men with acquired penile curvature also have Dupuytren's disease. Dupuytren's disease is a disease in which benign connective tissue growths cause lumps on the palm of the hand. The simultaneous occurrence of both suggests a genetic connection.

Metabolic disorders

Many men suffer even the slightest damage within the penis unnoticed. However, not everyone develops acquired penile curvature. Some experts therefore assume a disorder of the connective tissue metabolism. This means that it is not the original, elastic tissue fibers that are used for repairs, but rather harder fibers. The result of these remodeling processes can later be felt as typical nodules.

A study by the medical faculty in Istanbul, Turkey, also shows a connection between blood sugar disease (diabetes mellitus) and the increased risk of developing penile curvature. The science magazine BJU International also published a study according to which diabetics have to reckon with a more severe course of induratio penis plastica. However, a sufficient number of patients has so far been lacking in order to be able to really prove these relationships.

Possible risk factors for penile curvature

Little is known about factors that favor the development of acquired penile deviation. So far it has not been possible to uncover the connection between disease and risk factors. However, the following risk factors are discussed in scientific circles:

high blood pressure
Smoking and alcohol
age
Hard intercourse
Medicines (e.g. Alprostadil for erectile dysfunction; here the curvature of the penis is a side effect)
painful permanent erection (= priapism, here the curvature of the penis is considered a late consequence)

Curvature of the penis: diagnosis and examination

If you have noticed a curvature of the penis, pain during intercourse or typical hardening of your penis, you should contact a urologist, a specialist in urinary and reproductive organs, as soon as possible. First, he will ask a few questions about the symptoms that arise. The urologist not only deals with your physical changes, but also asks about possible risk factors and your love life.

When did you notice the crooked penis?
Was there a trigger for the change, such as an injury to the penis?
Has the penile curvature increased since the beginning?
Do you only notice the changes in the erect penis?
Can you feel small nodules or indurations along the penis?
Are you feeling painful about the changes?
Do you have problems having sexual intercourse? Can You Maintain Your Erection During Sex?
Is your penis less stiff than it used to be, in some areas only?

Try to overcome your shame and answer the questions as openly and honestly as possible. That seems difficult, but urologists are trained experts. In addition to the kidneys and urinary organs, they also deal with problems and diseases of the male sexual organ on a daily basis.

Physical examination

After the detailed consultation with the doctor, an examination of the male member usually follows. The doctor assesses whether the curvature of the penis can also be seen in the non-erect state. He also feels the penis shaft and examines it for possible hardening or nodules (plaques). The penis is slightly stretched. In this way, the urologist can determine not only the size, location and number of plaques, but also the length of the penis. This allows the further course of the disease to be recorded better.

Car photography

In most cases, the extent of penile curvature can only be optimally assessed on the erect penis. Therefore, your doctor asks you to take photos of your penis yourself during an erection. In the so-called Kelâmi technique, the patient photographs his erect limb from above, from the side and from the front. This is the best way to see the angle and direction of the curvature of the penis. You will get the best shots if you take the photos with your legs apart and with a neutral background. It is best to ask your partner to take the pictures. Take pictures of your penis on a regular basis. This is the best way to determine the course of the disease and successful treatment.

Ultrasonic

The ultrasound examination (sonography), like the physical examination, is one of the classic methods of diagnosing a curvature of the penis. A small ultrasound head (7.5 MHz) is used to examine the non-erect penis. This allows the doctor to recognize a thickened cavernous body, deeper plaques and possible calcifications on the hardened areas. The subsequent treatment of the curvature of the penis is based on this.

Doppler ultrasound

The so-called Doppler ultrasound (duplex sonography) is necessary in order to be able to assess the blood flow in the penis. For this purpose, the erection of the penis is triggered in the doctor's office with the help of special medication. As a rule, substances are used that cause blood vessels to dilate (vasoactive substances, e.g. prostaglandin E1). The medication is injected into the erectile tissue of the penis. This procedure is medically called a cavernous body injection test, or SKIT for short. With this method, the doctor can assess a pronounced curvature of the penis. The urologist can also tell whether the blood flow into the erectile tissue is reduced or whether it flows out too quickly (penile circulatory disorders). The SKIT is also used to diagnose erectile dysfunction.

Other imaging procedures

These include special soft tissue images of the penis using X-rays, magnetic resonance imaging (MRI) or computed tomography (CT). However, these tests are not a common way to diagnose acquired or congenital curvature of the penis. Rather, they are used when a curvature of the penis could not be clearly determined beforehand or the urologist suspects another disease. The soft tissue of the penis can be shown particularly well in the MRI. Possible inflammation of the erectile tissue becomes visible early.

There are no significant differences between the examination and diagnosis of an acquired or congenital curvature of the penis. In the case of congenital penile curvature, the doctor uses the individual procedures to rule out other causes of penile deviation.

Curvature of the penis: treatment

There are currently no guideline recommendations from German working groups for the treatment of acquired or congenital curvature of the penis. However, there are numerous methods that, according to more or less good studies, are considered successful. The European Association of Urology (EAU) assessed this research on acquired penile curvature and published its results and recommendations in 2012.

Acquired penile curvature

Especially with induration penis plastica and the associated curvature of the penis, there are numerous ways to treat the crooked penis. In the first place is the drug intake of medication. In addition, there are numerous other options that can be used to stop the progression of acquired penile curvature without surgery. Surgery is the last resort.

Medication

The main aim of drug therapy is to stop the inflammatory processes in the penis. This should prevent the plaques from developing or enlarging in the first place. Medicines are used in the early stages of penile curvature. However, there is no drug that can reverse damage such as penile deviation. The respective substances are either swallowed in tablet form, injected into the erectile tissue or plaques, or act externally on the diseased penis.

Potassium aminobenzoate is the only preparation that is approved in Germany for the treatment of penile curvature. The treatment costs are covered by the statutory health insurance companies. This medication is given in capsules or as a water-soluble powder. Ingesting it produces less connective tissue and reduces immune cells that cause inflammation. As a result, plaques and penile curvature no longer increase. Early therapy for at least three months is particularly useful so that the induratio penis plastica can be consolidated in good time.

Penis pumps, penis stretchers

Penis stretchers pull either over special telescopic rods or elastic straps on the penis. Penis pumps build a vacuum. So you create a negative pressure that exerts a pull on the penis body. A daily wearing time of six to eight hours is planned. This should allow the healthy penile tissue to grow and at least partially remedy penile curvature. However, most doctors do not recommend therapy with these devices until the disease has stopped progressing. So far, good results have been achieved in some studies.

Creams, ointments, gels and other preparations listed on the Internet (herbs and the like) are not suitable for treating penile curvature. The effect of over-the-counter substances in particular is not known.

surgery

If therapy with medication or other non-surgical procedures fails, the curvature of the penis is surgically straightened. It is also crucial to what extent the penis is crooked and whether the patient really wants the operation. Despite the same penile deviation, some patients feel less impaired than others. Those affected often feel their limitations are worse than their sexual partners. In any case, surgery is only performed if the penile curvature is not expected to worsen (stable disease phase).

Penis curvature up to 60 degrees, plication process

If the penis is only slightly or moderately curved up to 60 degrees, two surgical methods are recommended. The first is the so-called Nesbit plication method. An oval part of the connective tissue of the erectile tissue is cut out (excision) and the resulting hole is stapled with a suture (plication). The second is the Essed-Schröder technique. It is less invasive because the surgeon does not do the excision. The skin on the outwardly curved side of the penis is pulled together and sewn in place. With both methods, the hardening (plaques) are left in the penis shaft. As a result, only a small amount of tissue is injured and the risk of subsequent erectile dysfunction is reduced.

However, contracting the healthy side inevitably shortens the penis length. In addition, a slight curvature of the penis can occur again after a successful operation. In some cases, patients also complain of pain in the operated area. An erection, in particular, would make the pain worse. Therefore, the doctors give erection-inhibiting medication in the first few weeks so that the procedure can heal well.

Penis curvature over 60 degrees

In such cases of severe penile curvature, the Nesbit and Essed-Schröder methods would shorten the penis too much. Therefore, the surgeons try to remove the plaques and thus the cause of the curvature of the penis. Hardened and scarred areas are cut up and removed. The resulting gaps are replaced.

This procedure is more complicated than the plication procedure. Therefore, nerves and blood vessels can be injured more easily. As a result, in some cases the affected person's erection worsens. Some patients complain of numbness in the penis. Even if the plaques are removed, the disease can break out again and lead to penile curvature. To prevent the operated and transplanted tissue from scarring, erections are regularly induced in the subsequent rehabilitation. They help keep the fabric stretchy.

Penile prosthesis

If a patient suffers from both penile curvature and severe erectile dysfunction, a penile prosthesis can be implanted. The operation takes place in several steps. First the prosthesis is inserted. These are cushions that are connected to a fluid-filled balloon in the abdomen as an artificial penile body. The erectile tissue can then be inflated with the liquid from the balloon via a pump in the scrotum. Silicone prostheses have proven less effective because the penis remains permanently stiff and cannot always be easily hidden.

As the operation continues, the surgeons check to what extent the curvature of the penis has improved. If the bend is still too strong, try to bend the penis straight by applying pressure (penile modeling). If necessary, the scarred tissue at the point of curvature is removed and replaced with other materials. Since the implantation of a penile prosthesis is a major procedure, the risk of complications also increases. These include, above all, sensory disturbances in the penis or wound infections.

Congenital curvature of the penis

A penis that has been crooked since birth can only be straightened surgically. Surgical intervention is required when patients are too impaired during intercourse. Here, too, the patient's wish is crucial. For many of those affected, the cosmetic point of view is sufficient as a reason for an operation. The plication methods according to Nesbit or Essed-Schröder are common.

Since complications such as bleeding, inflammation, scarring, pain and erectile dysfunction up to and including loss of erection can occur with any surgical treatment, those affected should carefully consider the decision. Talk to close people. In this way you can get another picture of your penis curvature. Make sure you get advice from your doctor and your health insurance company as to what costs you can incur or who will pay for the treatment.

Curvature of the penis: disease course and prognosis

Acquired curvature of the penis can take very different courses. Sometimes it regresses spontaneously, sometimes it remains with a very slight curvature, sometimes the disease worsens over time. Congenital penile curvature, on the other hand, does not change. Depending on the extent of the curvature, sexual intercourse is more or less restricted. However, it is crucial to deal openly with a curvature of the penis. Talk to a specialist you trust early on. Eliminate burgeoning fears and concerns by talking to him about possible treatments.

Discuss your views, plans, and thoughts with your partner. It is best to go to the doctor's appointment together. Many men feel that their sexual activity is less restricted by a curvature of the penis. Rather, they feel emotionally burdened by the visually crooked penis. This makes some people sad, depressed and unhappy and isolates themselves from those around them. To counteract this, visits to a psychotherapist can also be helpful. It can help to weaken the illness-related, psychological fixation on the penis and thus to achieve a better self-esteem.

You should also seriously consider the risks, especially of surgical treatment. Many sufferers are quick to have their penis curvature surgically straightened. Be aware, however, that complications such as infections or sensory disorders can occur in the penis. After surgery to remove plaques, erectile dysfunction occurs in over ten percent of cases. Information centers, support groups, doctors, therapists and close confidants can be of great help in dealing with a curvature of the penis in the right way.

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