Congenital penile curvature is a form of the so-called penile deviations, in which the male member has deformities of varying degrees. Penile curvature] beyond the normal degree may be congenital or acquired through injury and requires treatment only in some cases. Congenital penile curvature should be distinguished from acquired penile curvature (IPP).
What is congenital penile curvature?
Congenital penile curvature is a deformity of the penis that can either be diagnosed in the newborn or does not appear until puberty. A distinction is made here between congenital penile curvature, which occurs at birth, and erectile atrophy, which does not develop until puberty. Important for the definition of penile curvature is the knowledge that slight bending of the flaccid or erect penis in any direction or corkscrew-like around its central axis is natural. Only from 30° is the penile curvature classified as clinically significant, and only from a deviation of 60° must the affected person expect sexual problems. Congenital penile curvature only requires treatment if the affected person suffers from pain or severe limitations during sexual intercourse.
Causes
The cause of congenital penile curvature is already evident in the name of the condition: it is congenital. This statement requires a more detailed explanation: in congenital penile curvature, the erectile tissue is asymmetrically pronounced, meaning that one side or even a whole erectile tissue is shortened. This leads to a different length of the two sides or erectile bodies during erection, which results in the curvature due to their growing together. A rare other cause is hypospadias, the shortening of the urethra.
Symptoms, complaints and signs
In congenital penile curvature, the affected person primarily suffers from a malformation of the penis. This malformation is thereby already present since birth and is not acquired. The corpus cavernosum is curved and does not look aesthetically pleasing. For this reason, many patients also suffer from psychological complaints, depression and reduced self-esteem due to the congenital curvature of the penis. Especially in adolescence, penile curvature can lead to severe psychological upsets. Furthermore, penile curvature is usually associated with severe pain during erection. This can lead to sexual unwillingness and irritability of the affected person. Tension with the partner can also possibly occur. However, penile curvature does not cause pain during urination or defecation. In some cases, the disease can also lead to male infertility. In this case, the patients are no longer able to father a child, which can also have a negative effect on the relationship with the partner. If the penile curvature is not treated, in the worst case it can lead to a complete loss of erection. As a rule, this loss can no longer be reversed.
Diagnosis and course
At this point, a brief digression is necessary on acquired penile curvature, which occurs in approximately 5% of men after injuries to the penis or as a result of the disease induratio penis plastica. In acquired penile curvature, a corpus cavernosum can no longer expand due to scarring and a lateral curvature of up to 90° occurs. Erection problems may also occur with this condition. Acquired penile curvature mostly requires treatment and offers a clue to the therapy of congenital penile curvature. Any change in the penis should be discussed with a specialist, either a urologist or a venereologist. The latter will look at the change after taking a detailed history, in which the time of the first appearance is also important, and will order further diagnostic measures. Imaging procedures such as X-rays or ultrasound are important in order to differentiate an acquired penile curvature from the congenital one. In order to perform the imaging procedures, the penis must be placed in an erect state using medication or a vacuum pump. Since the imaging procedures release a high level of X-ray exposure in the testicular area, the imaging procedures are avoided as much as possible in young patients.
Complications
In most cases, congenital penile curvature does not cause complications and other symptoms. Especially in children and teenagers, penile curvature is not dangerous and does not cause pain or other problems. In adulthood, the congenital curvature of the penis can lead to disorders during erection. In some cases, pain occurs during an erection or during sexual intercourse. In addition to acute pain and erection problems, congenital penile curvature is considered unaesthetic and thus can greatly lower the patient’s self-esteem. This can lead to psychological problems and, in the worst case, depression, which should be treated by a psychologist. Treatment is not necessary as long as the affected person is not in pain. An exclusively cosmetic straightening is usually not performed, because it shortens the penis and inflammation and scars can very easily occur during the operation. In addition, there is a great risk of loss of erection. Therefore, if the affected person only suffers from the curvature of the penis and does not feel any pain, surgery is not recommended. A direct cure of the symptom is not possible.
When should one go to the doctor?
A congenital curvature of the penis has existed since birth, but is usually not perceived as problematic by the affected person until puberty. In the case of only mild manifestation, young men even notice that the member looks curved only during their first erections. From a medical point of view, a visit to the doctor is not necessary if there are no other complaints such as pain during sexual intercourse or problems with penetration into the partner’s vagina or urination. Since a congenital curvature of the penis can cause a shortened urethra, it can happen in some cases that problems with urination that have already occurred before are explained by the fact that young men recognize the curvature during puberty. However, if the man is unable to penetrate the vagina due to a very pronounced curvature of the penis, a visit to the doctor is recommended. Relatively often, congenital penile curvature results in pain for the man during sexual intercourse, which is of course also a reason for a visit to the doctor. It should not even come to the point that the self-esteem and satisfaction of the affected patient suffer from the penile curvature. This is what happens when men with this problem wait too long to visit a doctor when the occasion arises, because accordingly they have many other unpleasant experiences during sexual intercourse and, last but not least, lose the desire for sexual intercourse as a result.
Treatment and therapy
A competent medical professional will advise his patient to undergo treatment only if the congenital penile curvature causes discomfort or problems during sexual intercourse. This is because, due to the side effects and risks of penile correction, which can range from bleeding and inflammation to scarring, pain and loss of erection, cosmetic correction should be considered medically nonsensical. The aim of the operation is not the normality of the curvature of the penis, this cannot be achieved by surgery, but the straightening of the penis to a curvature with which sexual intercourse and freedom from pain are possible. The operated person must mostly accept a shortening of his penis and/or its reduced sensitivity. In the case of an acquired curvature of the penis, various conservative methods are used, which may be worth trying if the patient is congenitally affected. These include taking or injecting medication, technical procedures such as iontophoresis or shock wave therapy, and mechanical procedures such as vacuum pumps and stretching devices. However, a cure for penile curvature is not possible in any case at this time and therefore is not a treatment goal of conservative therapy.
Outlook and prognosis
Congenital penile curvature is so complicated due to the irregular and thus problematic growth of the member that it will not improve spontaneously. Thus, spontaneous straightening or aesthetic improvement of a curved male member is not expected and has never been described. It has been shown over the course of several treatment meothods that all non-surgical measures are ineffective. Stretching devices, any medications, and other devices that promise improvement are not effective.In this respect, those affected by a congenital curvature of the penis can only accept their condition, insofar as they do not want to go down the path of surgery. Surgical treatment, in the case of severe impairment, usually brings success. Nevertheless, it carries risks. A congenital penile curvature corrected in this way does not recur in most cases. However, in rare cases it is recurrent, which depends on the reasons of penile curvature (shortened urethra, irregularly grown erectile tissue, etc.). In almost all cases, the perceived quality of life of those affected improves after the operation, as their own body sensation is evaluated more positively. In addition, the sexual life is mostly improved.
Prevention
Unfortunately, congenital penile deviation cannot be prevented because it is genetic. However, it is possible to prevent severe pain and discomfort during puberty if there is a family history of the condition by early examination in childhood and timely treatment of high penile curvature.
Follow-up care
Congenital penile curvature does not necessarily need to be treated. Only if severe discomfort or problems are present do doctors advise surgical intervention. If a certain curvature of the male member remains, the suffering is more psychological in nature. Shame about the abnormality usually occurs in front of sexual partners. Especially during puberty, depression and anxiety arise because of it. Aftercare can strengthen the self-confidence of those affected through psychotherapy. Aesthetic criteria do not imply a loss of function. Many sexual organs have minor curvatures. If a surgical procedure is performed, side effects may occur. Most often these are in the form of pain and a loss of sensation during the sexual act. During aftercare, doctors can diagnose these problems, but usually cannot cure them. Medications can at least be prescribed for pain. Sometimes there is also inflammation or bleeding at the scars. These are often triggered by sexual practices. Aftercare can only provide everyday tips. Often, the only thing that remains is the protection of the male member. If the operation proceeds without complications and no problems appear weeks or months after the operation, aftercare is not necessary. The congenital curvature of the penis has been successfully corrected permanently.
What you can do yourself
Since congenital penile curvature is caused by growth of penile tissue that deviates from the norm, self-help options are limited. It must be advised against attempts, with penis pumps, stretching devices or other, promising success, devices. It has been shown that they cannot straighten a curved penis. On the contrary, some of these methods are associated with a significant risk of injury. Likewise, there are no agents that can be ingested by injection, pill or ointment that can straighten the penis. A malformation cannot be corrected without surgical measures. Since the shape of the member will not change on its own in the case of a congenital penile deviation, it makes sense for those affected to deal with their situation and develop a way of thinking and acting that is more positive towards their penis. Methods to improve body image and increase self-acceptance can be used here, ranging from yoga to meditation. Talk therapies are also a possibility. Depending on the severity of the curvature, the sex life of those affected is often limited. Trying out other positions – or even sexual practices – with the sexual partner should definitely be done if there is sufficient trust and if the curved penis does not cause any discomfort. There are often still possibilities that can enhance the sexual life for those affected.
