Congenital Penile Curvature & Peyronie’s Disease (Curved Penis)

What is a Curved Penis?

Article contributed by our health content partner dtapclinic.com. 

Having a mild degree of curving in the penis is common. The bend is usually mild and hardly noticeable, but in some men the bend could be up to 90 degrees. Severe curvature of the penis could lead to painful erections and affect one’s sexual function significantly. You can seek medical help to get a diagnosis and receive treatment to improve the condition, but most refrain from seeing a doctor, either due to embarrassment or lack of awareness.

The causes for penile curvature are congenital or acquired. Acquired curvature is mainly due to Peyronie’s disease, but can also be due to the healing process of a penile fracture.

Congenital Penile Curvature (CPC)

CPC is a relatively uncommon condition. It can be noted early in life by parents during diapering and dressing of their infants. Others do not discover the problem until sexual maturity, where they notice the curvature themselves. Often, the penile curvature is only observed in the erect state.

CPC can sometimes occur together with hypospadias, a urethral abnormality whereby the opening of the urethra is on the underside of the penis instead of the tip. Without urethral abnormalities, the prevalence rate is estimated to be as high as 4-10%. 

What causes CPC?

The cause of CPC is unknown, but is could be a result from excessive elasticity in one aspect of the penis as compared to the rest of the penis. For example, if there is more tissue elasticity on the top of the penis, it expands more than the rest of the penis during erection, resulting in a downward curve. The curve in CPC is typically downwards. 

Possible symptoms

CPC does not cause painful erections or erectile dysfunction, and there is no fibrous scar tissue that can be felt. Similar to the Peyronie’s disease, the curvature ranges from mild to severe. There can be discomfort experienced during sexual intercourse. Men may find that they are only able to have sex in one particular position. Other positions may not be possible due to the nature of the curve.

Complications

In severe cases, men may find sexual intercourse to be difficult or impossible due to the pain, the degree of curvature and/or erectile dysfunction. This can result in an inability to conceive with their partner, and also lead to stress on the relationship. The abnormal appearance of the penis and impaired sexual abilities can cause anxiety and diminish a man’s self-confidence. 

Treatment options

Medical literature suggests that CPC can only be treated surgically. The surgical method used is known as plication, which involves removing tissue and stitching the opposite side of where the curvature is.

There are no evidence-based non-surgical treatments described. However, from experience at DTAP, we have observed that Extracorporeal Shock Wave Therapy (ESWT) is also able to treat CPC with favourable outcomes. We have treated a considerable number of CPC patients with ESWT alone and achieved either full resolution or significant improvement in curvature. Subjectively, our patients are satisfied. 

Therefore, at DTAP we do offer ESWT as a treatment option for CPC. We would like to re-emphasize that this is not based on the medical literature, but rather from our personal experiences with previous patients. It is always recommended to visit a doctor for a detailed consultation, medical examination and assessment of treatment options before making an informed decision on which treatment to undertake.

Peyronie’s Disease

Peyronie’s disease is a non-cancerous condition resulting from fibrous plaques of scar tissue developing on the penile tissue. Peyronie’s disease is reported to affect as many as 1 in 10 men and is more common between ages 40 to 70, however, it can happen in younger men as well. 

Causes of Peyronie’s disease

The cause of Peyronie’s disease is not completely understood, however, there are several postulated causes and risk factors that could lead to its development:

• Repeated injury to the penis 
• Hereditary
• Age 
• Underlying medical conditions such as diabetes and connective tissue disease

Possible symptoms

• Curvature ranging from mild to severe
• Scar tissue
• Painful erections
• Erectile dysfunction
• Shortening of the penis

Complications

The complications are similar to that of CPC.

Treatment options

In mild cases without painful erections or disruption to one’s sex life, there may not be a need for any treatment. The curvature can be observed over time. In many cases, the curvature improves or resolves after a period of 1-2 years. However, if the curvature worsens and causes symptoms, then treatment should be considered.

Possible treatment options are:

• Extracorporeal Shock Wave Therapy (ESWT). This is a convenient, non-invasive and painless treatment option for Peyronie’s disease. Shock waves are targeted at the location of the fibrous plaque, and helps to break up the scar tissue. 
• Traction therapy. This is indicated only in the early phase of Peyronie’s disease, and involves using a traction mechanical device over a period of time to stretch the penis and correct the deformity.
• Non-surgical therapy. A number of oral medications have been studied, such as vitamin E supplementation, but results so far have been mixed. There is an FDA-approved injection containing collagenase clostridium histolyticum (Xiaflex), which breaks down the collagen within the fibrous plaque. However, there is a small risk of penile hematoma and penile fracture.
• Surgery. There are different surgical options that can be considered based on the severity of the condition and plaque location. Surgery is invasive and carries potential risks such as bleeding, infection, nerve damage and erectile dysfunction.