Brief overview
- Symptoms: In congenital form, curvature of the penis is the main symptom; in acquired form, curvature, nodular induration, pain during intercourse, possibly tingling, erectile dysfunction
- Causes and risk factors: Congenital form: Gene mutation, often along with other genital changes. Acquired: Cause still unknown, possibly micro-injuries from accident; risk factors: faulty connective tissue metabolism, certain medications, hypertension, diabetes, hard intercourse.
- Diagnosis: medical history, physical examination, photograph of erect member, ultrasound, Doppler ultrasound, rarely X-ray and magnetic resonance imaging.
- Treatment: medication as tablets or injections, penis pumps or extenders, surgery in more severe cases
- Prognosis: Congenital: permanent curvature without surgery. Acquired: spontaneous disappearance or enhancement of curvature possible. Treatments usually respond well; surgery is rarely necessary.
- Prevention: If penile injury occurs, such as during sexual intercourse, see a doctor, have sudden onset of penile curvature clarified
What is curvature of the penis?
The acquired form of penile curvature is called induratio penis plastica (IPP, plastic hardening of the penis). Here, the corpus cavernosum is often bent upward, and in some cases, to the side. A synonym for IPP is Peyronie’s disease or Peyronie’s disease.
A congenital curvature of the penis is based on a defect in the genetic material. Therefore, it often occurs with other disorders of the male sex organ.
A specific cause for acquired penile curvature is not exactly known. Mainly 45- to 65-year-old men get penile deviation. Overall, penile curvature occurs in about one in 1000 men. However, experts suspect a much larger number of unreported cases.
Often, the curvature is only mild. Over time, however, it is possible for it to increase and painfully interfere with erection. In other cases, deviations regress spontaneously. A congenital curvature of the penis remains unchanged in most cases.
A slight curvature of the penis is not necessarily pathological. The male member is rarely completely straight and is naturally quite variable in shape.
Symptoms
The indurations develop within a few weeks to months – sometimes even “overnight”. They vary in size (usually one to three centimeters) and in some cases spread to cover the entire shaft of the penis.
If the connective tissue becomes scarred and hardened, experts speak of fibrosis. In fibrosis, connective tissue multiplies in a benign manner and is usually transformed from a soft, elastic tissue into a harder, scarred tissue. These changes (penile fibrosis) cause the tissue in the area of the plaques to shrink, thereby curving the penis to the diseased side.
Acquired penile curvature is thus more of a symptom than a disease. The extent of penile curvature is most visible on the erect penis. Occasionally, the penis bends in two directions (bidirectional penile curvature), such as upward and to one side.
If the curved penis deviates significantly from the straight axis, it is possible that there will be problems during sexual intercourse. In addition, the penis becomes less rigid from the plaques toward the glans, which experts refer to as decreased rigidity. Some patients complain of pain, especially during an erection and during sex. At rest, this penile pain is very rare. The curved penis does not restrict urination or urinary flow.
In congenital penile curvature, the curvature itself is the main symptom. Typical symptoms as in the acquired variant are rare. Most patients present to a doctor before or after their first sexual contact. Depending on the extent, sexual intercourse may be impaired – but this is rare.
For some patients, penile curvature is more of a psychological or cosmetic problem. The deviation from the norm may then be perceived as a burden. This is exacerbated by possible erectile dysfunction and problems during sex.
Causes and risk factors
As with the symptoms, a distinction must be made between the congenital and acquired forms of penile curvature. Proven causes of penile curvature are lacking so far. However, there are conjectures and clues that point to possible causes of penile deviation.
Congenital penile curvature
- Hypospadias: The orifice of the urethra lies below the glans, i.e. on the underside of the penis. Below the urethral opening, which is too deep, a thickened connective tissue cord, the chorda, runs towards the testicle. It curves the penis downward.
- Megalourethra: Balloon-like dilated urethra. Here, parts of the three erectile tissues of the penis are missing. As a result, the urethra widens enormously. This developmental disorder often results in an upward curvature of the penis.
- Epispadias: There is a second urethral opening on the penile shaft.
Scientists assume that a deficiency of male sex hormones (androgens) during embryonic development is responsible for these malformations.
Acquired penile curvature
The cause of acquired penile curvature, or Peyronie’s disease, is still largely unknown. However, experts have put forward a number of theories that attempt to explain a crooked penis.
Accident
Heredity
Whether some men are more susceptible to penile curvature than others due to their genetic makeup has not been clearly established to date. However, scientists have found that about 25 to 40 percent of men with acquired penile curvature also have Dupuytren’s disease. Dupuytren’s disease is a condition in which benign connective tissue growths cause nodules to form on the palm of the hand. The frequent simultaneous occurrence of both suggests a genetic link.
Metabolic disorders
Many men suffer unnoticed minute damage within the penis. However, not everyone develops acquired penile curvature. Some experts therefore assume a disorder of the connective tissue metabolism. This leads to the fact that not the original, elastic tissue fibers are used for repair, but harder fibers. The result of these remodeling processes can later be felt as typical nodules.
One study also shows a connection between blood sugar disease (diabetes mellitus) and the increased risk of developing penile curvature. Another study suggests that diabetics should expect a more severe course of induratio penis plastica. However, a sufficient number of patients is still lacking to really prove these correlations.
Little is known about factors that promote the development of acquired penile deviation. So far, the connection between the disease and risk factors has not been discovered. However, the following risk factors are discussed in scientific circles:
- High blood pressure
- @ Smoking and alcohol
- Age
- Hard sexual intercourse
- Medication (such as alprostadil for erectile dysfunction; here penile curvature is considered a side effect)
- Painful permanent erection (so-called priapism; in this case penile curvature is considered a late consequence)
Other possible causes
In addition to IPP, the following causes may lead to penile curvature:
- Urethral manipulation syndrome (caused by scarring, such as when objects are pushed into the urethra, injuring it)
- Tumors or metastases of the penis (penile carcinoma, penile tumor)
- Thrombosis of a penile vein or in the corpus cavernosum
Diagnosis and examination
If you have noticed a curvature of the penis, pain during sexual intercourse or typical hardening of the penis, you should consult a specialist in urinary and genital organs, the urologist. First, he will ask a few questions about the symptoms you are experiencing. In doing so, the urologist will not only address your physical changes, but will also ask about possible risk factors and your sex life:
- When did you notice the crooked penis?
- Has the curvature of the penis increased since the beginning?
- Do you notice the changes only on the erect penis?
- Can you feel small nodules or indurations along the penis?
- Do the changes cause you pain?
- Do you have problems during sexual intercourse? Does your erection remain during sex?
- Is your penis less stiff than it used to be, maybe only in some places?
Try to overcome your shame and answer the questions as openly and honestly as possible. This may seem difficult, however urologists are trained experts. They deal with problems and diseases of the male reproductive organ every day, in addition to kidneys and urinary tract organs.
Physical examination
After a thorough consultation with the doctor, an examination of the male member usually follows. During this examination, the physician assesses whether the curvature of the penis can also be seen in the non-erect state. Furthermore, he palpates the penis shaft and examines it for possible hardening or nodules (plaques). During this process, the penis is slightly stretched. In this way, the urologist determines not only the size, location and number of plaques, but also the length of the penis. This makes it easier to determine the further course of the disease.
