Congenital penile curvature is a condition where the penis has an abnormal bend or curve present from birth. The bend can vary in degree and direction, becoming more noticeable when erect.
Understanding Congenital Penile Curvature
Congenital penile curvature is a structural anomaly that develops before birth, often resulting from an imbalance in the growth of the tissues that make up the penis. Specifically, it can involve the corpora cavernosa, the two chambers that fill with blood to create an erection, or the urethra, the tube that carries urine and semen. The exact reason for this uneven development is not fully known.
This condition differs significantly from Peyronie’s disease, which is an acquired curvature. Peyronie’s disease typically develops later in life, often in men in their 50s or 60s, due to the formation of fibrous scar tissue, or plaques, within the penis. In contrast, congenital curvature does not involve scar tissue and is present from birth, though it may not be apparent until puberty. Unlike Peyronie’s disease, congenital curvature usually does not involve painful erections or changes in the degree of curvature over time.
Some degree of penile curvature is common, present in 4% to 10% of male births. However, clinically significant bending, which requires intervention, is much less frequent. The curvature can occur as an isolated condition or alongside other developmental anomalies, such as hypospadias, where the urethra opening is not at the tip of the penis, or penile torsion, a twisting of the penis.
Recognizing Symptoms and Impact
A bend may be noticed during infancy, but it often becomes most apparent and problematic when a male reaches puberty and begins to experience erections.
The curvature can bend downward (ventral), upward (dorsal), or to the side (lateral). Some individuals may experience a combination of these directions or a rotational twist. The degree of the bend can range from mild to severe.
While a slight curve may not cause any issues, more pronounced curvatures can have functional consequences. In severe cases, the bend might lead to difficulty with urination. More commonly, sexually active individuals may experience challenges with sexual intercourse, including pain or difficulty with penetration. The appearance of the curved penis can also lead to psychological impact, such as body image concerns or anxiety.
Diagnosis and Treatment Options
Diagnosing congenital penile curvature primarily involves a physical examination by a healthcare professional, often a urologist. The patient’s medical history, including when the curvature was first noticed and any associated symptoms, is reviewed. Diagnosis involves evaluating the penis during an erection, which may be induced in a clinical setting or assessed through patient-provided photographs. Imaging tests are generally not needed, but can be used in complex situations to understand the underlying anatomy.
Not all congenital penile curvatures require treatment. Intervention is considered if the curvature causes functional difficulties, such as interfering with sexual intercourse, causing pain, or leading to significant psychological distress due to its appearance. For mild curvatures that do not cause any functional problems or distress, observation and reassurance may be sufficient.
When treatment is necessary, surgical correction is the primary approach for significant curvatures. The goal of surgery is to straighten the penis while preserving its length and sensation. Surgical techniques either shorten the longer side of the penis (plication procedures) or lengthen the shorter side by adding tissue (grafting procedures).
Plication Procedures
Plication involves placing sutures on the side opposite the curve to shorten the tunica albuginea, the fibrous sheath surrounding the erectile tissue. Examples include the Nesbit procedure and its modifications, which involve tissue excisions, and incisionless plication techniques.
Grafting Procedures
Grafting procedures, which may use tissue from the leg (saphenous vein) or bovine pericardium, are typically reserved for more severe curves, often exceeding 60 degrees, and aim to avoid penile shortening. These procedures are performed by urologists specializing in reconstructive or sexual medicine. Patients undergoing surgical correction have favorable outcomes, with high rates of successful straightening and minimal side effects.