The penis can become curved for three main reasons:
1) by a congenital disproportion (from birth) of the so-called corpora cavernosa (cylinders containing the erection tissue).
2) due to any type of trauma
3) due to the so-called Peyronie’s disease.
According to specialists, in the last two cases, the origin of the curvature is a hardening (fibrosis) of the tunica albuginea surrounding the erection tissue.
The tunica albuginea is a layer that has a certain capacity to distend when blood enters the penis during erection. If the penis is broken or injured in the course of trauma, usually during sexual intercourse, abnormal healing of the injury may occur, resulting in a hardened area (fibrosis), with a consequent loss of elasticity of the tunica albuginea. When blood enters the penis during erection, the affected part does not distend properly, which causes the penis to curl. Depending on the level where the problem originates (dorsal, ventral, lateral), the penis may curve upwards, downwards or to one side.
Peyronie’s disease
The same thing happens in Peyronie’s disease, with the only difference that this pathology has a still unknown origin, although it could be related to small traumas to the penis during intercourse throughout life and a possible genetic predisposition.
It is a pathology that usually occurs after the age of 50 and appears suddenly. The plaque of fibrosis can be single or multiple and usually appears in the dorsal part of the penis, which results in the curvature of the penis upwards (towards the belly), contrary to what usually happens in congenital cases, where the curvature is ventral (downwards).
What are the symptoms of Peyronie’s disease?
The first manifestation of the disease may be pain during erection, palpation of the fibrosis plaque or curvature of the penis. The pain is due to the initial inflammatory phase and usually disappears spontaneously within a few months. Rarely, problems with penile rigidity may also occur, although this is often due to a psychological factor when the patient has pain and/or curvature of the penis during erection. Also, depending on the severity of the problem, there may be difficulties in penetration during intercourse and the partner may experience discomfort.
This disease can evolve slowly until it stabilizes, at which point there are no more variations in the size of the plaque or in the degree of curvature. In exceptional cases, mainly those caused by trauma to the penis, the disease may remit completely spontaneously.
Diagnosis and treatment of curvature of the penis
The best way to document and objectify the curvature is by periodically taking photographs of the erect penis from different angles, taken by the patient himself, which will be very useful for the Andrology physician who must assess and follow the evolution of the problem. Penile ultrasound may also be indicated, especially when it is suspected that the fibrosis plaque may have calcified. This fact constitutes a worse prognosis, in terms of remission of the disease and the application of possible treatments.
It is very important to consult a specialist andrologist or urologist when the patient notices the first symptoms. It is at this stage that medical treatment administered orally or injected directly into the plaque can be established. Although a large number of general and local treatments have been tried throughout history, none have proven to be effective in making the fibrotic plaque disappear in the majority of patients.
Surgery for Peyronie’s disease
Given the failure of the possible treatments tried, the only possibility to straighten the penis is surgery. This should be proposed when there is evidence of stabilization of the disease, i.e. no change in plaque size or curvature in the last 6-12 months. If the disease continues to progress and corrective surgery of the curvature is performed, there is a possibility that the penis may become curved again. Mild curvatures that do not hinder penetration would not be candidates for surgery.
Penile straightening consists of puckering the convex part of the curvature, by means of different techniques applied to the tunica albuginea. In those cases where the curvature is very important, an opening can be made in the plate and the defect can be filled with a segment of tissue from the body itself (vein, labial mucosa, etc.) or with synthetic or biological material from another source. These surgeries are not exempt of causing a certain shortening of the penis or originating a new fibrosis of the tunica albuginea.
In those cases in which penile curvature is associated with erectile dysfunction due to the disease itself or to other pathologies (lesions of the penile arteries or nerves due to diabetes, hypertension, prostate surgeries, etc.), the placement of a penile prosthesis may be indicated, with or without correction of the curvature.
When penile curvature is congenital, i.e., from birth, the only therapeutic option is straightening surgery, provided that there is difficulty in penetration during intercourse.
Summary of penile curvature
To summarize, penile curvature is a pathology of congenital or acquired origin that occurs more frequently than one might think. The main symptoms are: indurated area in any part of the penis, pain and curvature during erection, erectile dysfunction and difficulty in penetration during intercourse.
As mentioned above, the diagnosis is made on the basis of the symptoms and palpation by the andrologist, as well as photographs to be provided by the patient. Although some treatments may be suggested, their efficacy is questionable. In severe cases, corrective surgery will be performed if the curvature makes sexual activity difficult.