Penile curvature is a physical condition that, beyond aesthetic concerns, may create functional, emotional, sexual, psychosocial and relationship difficulties. It can also have a significant effect on quality of life.
The penis is almost never perfectly straight during an erection. Curvature may become a problem when it is aesthetically distressing, makes intercourse difficult or causes pain. Penile curvature may be congenital or acquired, most commonly in the form of Peyronie’s disease. Congenital curvature may occur together with other developmental abnormalities of the genital area, although it may also occur on its own. It is uncommon, affecting fewer than 1% of the general population, and is most often recognised during adolescence or early adulthood. It results from developmental differences in certain tissues and structures of the penis.
The acquired adult form is considerably more common and is estimated to affect approximately 10% of men.
In the acquired form, curvature is produced by an area of scarred connective tissue, often referred to as a plaque. In some cases, the hardened scar tissue does not cause curvature but instead leads to shortening of the penis or an hourglass deformity. Erectile dysfunction of varying severity may also occur, and erections can be markedly painful. In severe cases, major deformity, erectile dysfunction or substantial pain may make intercourse impossible. Injuries to the penis, including repeated microtrauma and an abnormal healing response, may contribute to the development of the condition. Certain disorders, such as Dupuytren’s disease, have been associated with Peyronie’s disease, and it is also seen more frequently in people with diabetes.
The direction and angle of penile curvature may vary. More complex patterns, including several simultaneous deformities, may also occur.
During assessment, photographs taken during a natural erection may be helpful. They allow the reconstructive specialist to evaluate several basic parameters without medically inducing an erection. Following a detailed consultation, additional specialised medical or imaging examinations may form part of the diagnostic process.
Before treatment, it is essential to clarify all relevant details and establish realistic expectations. When congenital penile curvature is severe enough to require treatment, the solution is generally surgical.
Conventional non-surgical treatments are available for acquired curvature, but oral or locally administered medication may have limited effectiveness in severe deformity. Newer medicines may provide relief in selected cases, particularly during the painful acute phase. If these methods are insufficient, surgery may be considered. Surgery is not appropriate while the disease is in an acute, unstable or painful phase. Stabilisation is the first priority, and reconstructive surgery can be planned later. Surgical techniques may shorten the longer side of the corpora cavernosa or, using more advanced reconstructive methods, lengthen the shorter side. When severe erectile dysfunction is also present, procedures involving penile prosthesis implantation may be considered.
Modern surgery for penile curvature is a demanding field of reconstructive surgery. It should be performed by urologists or uro-genital reconstructive surgeons with specific experience, including expertise in urological implants such as penile prostheses. Penile curvature no longer needs to remain a taboo subject.
Further information is available on the English-language website of our partner centre.