Penile Curvature
What is Penile Curvature?
Penile curvature refers to an abnormal bend in the penis, noticeable during an erection. While some degree of curvature is common and harmless, bends may indicate an underlying medical condition. The curvature can manifest in various directions – upwards, downwards, or sideways.
In certain cases, penile curvature can arise from congenital anomalies, developmental issues, or acquired conditions like Peyronie’s disease. The condition has the potential to cause discomfort, affect sexual function, and impact psychological well-being.
Types of Penile Curvature
Penile curvature can be broadly classified into two types:
Congenital Penile Curvature
This type is present from birth and is a result of developmental differences in the penile tissues. It usually becomes noticeable during puberty and often involves curvature towards the side with less developed tissue.
Acquired Penile Curvature
Most commonly associated with Peyronie’s disease, this type develops later in life. It results from the formation of scar tissue (plaque) in the penis, causing it to bend during an erection. Peyronie’s disease occurs in 2 phases, acute and chronic. During the acute phase of Peyronie’s disease, plaque formation occurs beneath the penile skin, usually spanning 6 to 12 months. The chronic phase is when the plaque stabilises and ceases to grow, preventing further curvature progression. The curvature can vary in direction and severity.
Causes and Risk Factors
Congenital Curvature
This is often due to imbalances in penile tissue development while in the womb. The exact mechanism is not fully understood, but it may be related to genetic factors or developmental issues during fetal growth. The curvature is present from birth but becomes more noticeable during puberty.
Peyronie’s Disease
This is the most common cause of acquired curvature and involves several factors:
- Physical Trauma: Minor injuries to the penis during sexual activity or accidents can lead to scar tissue formation, which is not always immediately noticeable.
- Genetic Predisposition: A family history of Peyronie’s disease increases the risk of developing the condition.
- Connective Tissue Disorders: Associated conditions like Dupuytren’s contracture can predispose an individual to Peyronie’s.
- Ageing: The risk increases with age, with older men being more susceptible.
- Medical Conditions: Diabetes, erectile dysfunction, and certain prostate treatments have been linked to an increased risk of Peyronie’s disease.
Symptoms and Signs
The symptoms of penile curvature vary but commonly include:
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Visible Curvature
The most apparent sign is a distinct bend in the penis, which is typically more noticeable during an erection. The direction of the bend can be upwards, downwards, or to either side.
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Pain or Discomfort
Many individuals experience discomfort or pain during erections or sexual activity. This symptom is particularly prevalent in Peyronie's disease, where the formation of scar tissue can cause discomfort.
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Erectile Dysfunction (ED)
In more severe cases, the curvature can interfere with sexual function, leading to difficulties in achieving or maintaining an erection. This can be a direct result of physical changes or a secondary effect due to pain or psychological factors.
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Changes in Penis Shape
Beyond curvature, other deformities such as narrowing, indentations, or an hourglass appearance might occur, altering the usual shape of the penis.
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Palpable Lumps or Hardened Tissue
Especially in Peyronie's disease, individuals may feel small, hard areas or lumps along the shaft, which are the scar tissue or plaques causing the curvature.
Diagnosis
Diagnosing penile curvature typically involves the following steps:
- Medical History Review: A healthcare provider begins by assessing the patient’s medical history, including any previous injuries, surgeries, or relevant family medical history.
- Physical Examination: A key component in diagnosing penile curvature is a thorough physical examination of the penis, both in its flaccid and erect states. This helps in identifying any visible curvature, indentations, or palpable plaques.
- Erectile Function Assessment: Questions regarding erectile function help in determining if the curvature is affecting sexual activity.
- Imaging Tests: In certain cases, imaging modalities like ultrasound may be used. For Peyronie’s disease, an ultrasound can help visualise scar tissue and assess blood flow within the penis.
- Erection Induction for Examination: If necessary, your doctor may induce an erection using injectable medication to better assess the extent of curvature.
- Additional Testing: In some cases, additional tests, such as blood tests, might be conducted to rule out underlying conditions that could contribute to the curvature.
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Treatment Options
Each treatment option is chosen based on individual patient characteristics, including the degree of curvature, presence of pain, erectile function, and the patient’s personal preferences.
Observation
- This involves regular monitoring of the condition. It is suitable for curvatures that do not progress and do not interfere with sexual function or cause discomfort.
Medical Therapy
- Oral Medications: These might include Vitamin E, L-arginine, or pentoxifylline, aimed at reducing inflammation or promoting blood flow.
- Injectable Drugs: Collagenase Clostridium histolyticum (brand name Xiaflex) is an FDA-approved treatment specifically for Peyronie’s disease, helping to break down the collagen that forms the scar tissue.
Traction and Vacuum Devices
- Gradual stretching can be achieved through devices like penile extenders or vacuum erection devices. These devices must be used consistently for several months to produce a noticeable effect.
Surgery
Indicated for severe cases or when non-surgical treatments fail. Surgical options include:
- Nesbit Procedure: Involves removing or pinching a piece of the tunica albuginea from the side opposite the curvature, helping to straighten the penis.
- Grafting: If there’s plaque or indentation, grafting replaces the scarred tissue with healthy tissue.
- Penile Prosthesis: For men with both Peyronie’s and erectile dysfunction, a prosthesis can offer a dual solution.
Dr Lee Fang Jann
Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders
He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).
- Bachelor of Medicine and Bachelor of Surgery (Singapore)
- Membership of The Royal College of Surgeons (Edin)
- Master of Medicine (Surgery) (Singapore)
- Fellowship of the Academy of Medicine (Urology)
- Clinical fellowship at Oxford Transplant Centre in the UK
Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.
Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.
Our Clinic Locations
Farrer Park Medical Centre, #08-05
1 Farrer Park Station Rd, Singapore 217562
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Sat: 8:30am to 12:30pm
3 Mount Elizabeth, #11-16 Medical Centre, Singapore 228510
Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm
Frequently Asked Questions (FAQ)
What causes penile curvature?
Congenital curvature is often due to developmental differences in utero. Acquired curvature, as seen in Peyronie’s disease, can result from physical trauma, genetic factors, and age-related changes.
Is penile curvature a sign of a serious health problem?
While mild curvature is usually not serious, curvature can indicate conditions like Peyronie’s disease, which may require medical attention.
Can penile curvature be corrected without surgery?
Yes, through traction therapy, medication, or lifestyle adjustments. Effectiveness varies based on the severity and cause of the curvature.
What are the surgical options for penile curvature?
Surgical options include plaque incision/excision, grafting, and in severe cases, penile prosthesis implantation.
Is penile curvature common?
Mild curvature is quite common and usually not a concern. Peyronie’s disease, a more severe form, is less common but not rare.
How is penile curvature diagnosed?
Through physical examination, patient history, and sometimes imaging tests like ultrasound.
What are the potential complications of untreated severe penile curvature?
These can include pain during erections, difficulties in sexual activity, and psychological distress.