What is a Curved Penis?
The penis is naturally not completely straight, and there can be a slight curvature in any direction, without interfering with sexual activities. However, there are situations in which the penis acquires a degree of curvature that begins to deviate from its axis, becoming more noticeable and potentially making penetration difficult.
There are two types of curvature: congenital and acquired. Acquired curvature can occur spontaneously, known as Peyronie's disease, or it can result from trauma after a penile "fracture".
Congenital Curvature of the Penis
It is usually only discovered during puberty when the penis grows due to the action of testosterone.
The penis has two cylinders, which are the corpora cavernosa. In congenital curvature, one part of the corpora cavernosa grows more than the opposite part, causing the penis to curve. The penis is usually turned downwards, but it can be "turned" in any direction.
The cause is not yet well established, but it is theorized that it can occur due to a poorly developed urethra (hypoplastic), alterations in two tissues that cover the penis, the dartos and Buck's fascia, or disproportion in the corpora cavernosa, with one side growing more than the other.
Congenital curvature of the penis is usually associated with a penis of good volume, unlike the curvature of Peyronie's disease, in which men most often complain of a loss of penile size.
When the congenital curvature is upwards (dorsal), it is usually associated with epispadias, while when it is downwards (ventral), it is usually associated with hypospadias. However, congenital curvature of the penis can have the urethral outlet in a normal position.
The incidence of congenital curvature of the penis is 0.6%, but they are clinically significant in much less than that (1).
For diagnosis, photos showing the curvature are important for the doctor to be able to make a diagnosis and indicate the best treatment. In general, patients go to the doctor when the curvature is greater than 30º.
The treatment is surgical, but before that, the reconstructive urologist must assess the emotional aspects associated with the condition, check aspects related to sexuality, and understand what the patient's expectations are. Consultation with a psychologist is often necessary.
The satisfaction rate with the surgery ranges from 71-100% (2-3). It can be performed by plication or grafting. The plication technique consists of placing stitches on the side of the large curvature so that this part rectifies. In cases where the curvature is softer, this technique allows the penis to be rectified with a simpler and quicker surgery. The loss of penile size is practically imperceptible in these cases.
However, with more pronounced curvatures, if more angled, plication surgery can cause the penis to lose size. In these cases, surgery with graft placement may be chosen.
Another aspect to consider is whether the curvature is abrupt or smooth. Gentle curvatures can be corrected without grafting, without any significant loss of penile size. In the case of an abrupt curvature, the penis will lose some size if grafting is not carried out.
Graft surgery consists of making an incision in the corpus cavernosum where the penis curves, covering the resulting defect with tissue from the body itself (autologous) or from outside (heterologous).
- Yachia D, Beyar M, Aridogan IA, et al. The incidence of congen-
ital penile curvature. J Urol. 1993;150:1478-9.
- yirady P, Kelemen Z, Banfi G, et al. Management of congenital penile curvature. J Urol. 2008;179:1495-
- Leonardo C, De Nunzio C, Michetti P et al: Plication corporo- plasty versus Nesbit operation for the correction of congenital penile curvature. A long-term follow-up. Int Urol Nephrol 2012; 44: 55-
Peyronie's disease
It is a progressive disease characterized by the deposition of collagen replacing fibres of the tunica albuginea, the tissue that covers the penis. It has an acute phase, evidenced by an inflammatory process, occasionally associated with pain on erection or palpation of the plaque, as well as progressive enlargement of the plaque and curvature. This phase lasts up to a year and some patients resolve the curvature spontaneously.
From then on, the chronic process follows, where there is no further progression of the disease. Peyronie's disease has a huge impact on men and can cause depression, emotional and relationship problems
Men commonly complain that the penis has decreased in size and many lose rigidity in the portion of the penis beyond the plaque.
Treatment is surgical and the type of procedure should be discussed with the patient. Small curvatures, usually less than 30o, can be treated by plication, where stitches are applied to the opposite side of the plaque to straighten the penis. This is a simpler procedure, but there may be some loss of penile size.
Small curvatures, when associated with erectile dysfunction, can be treated with a penile prosthesis.
There is a penile modeling procedure in the surgery, where maneuvers can be used to try to rectify the penis by fracturing the plate.
The most commonly used procedure is the placement of a graft covering the plaque incision. In general, we use bovine pericardium. When the curvature is downwards (ventral), the most frequent, the vasculonervous bundle of the glans must be carefully dissected. When the curvature is upwards (dorsal), the urethra must be isolated to allow the graft to be placed.
In cases of erectile dysfunction, inflatable or malleable penile prostheses can be implanted in the same surgery as the graft or plication.
You should discuss with the patient the possibility of improving genital aesthetics in addition to the procedure, as this is a common complaint from patients.
The main surgical complications include tingling of the glans, erectile dysfunction and persistence of the curvature.