When Does a Curved Penis Become a Problem?
We've all heard and seen the erectile dysfunction drug commercials that warn about erections lasting longer than four hours. But did you know an erection—even one that doesn't last four hours—with more than 30 degrees of curvature could also be a cause for concern?
As with an abnormally prolonged erection, an abnormally bent penis is a sign you should see a urologist.
Many men have a slightly curved penis when erect, and it's also normal for the penis to curve slightly to one side when it is flaccid. However, adult men who have a penis that's curved more than 30 degrees could have Peyronie's disease, a condition in which fibrous scar tissue, called plaque, forms under the skin of the penis and causes curvature in erections.
While the exact cause of Peyronie's disease is unknown, it's believed to occur due to microscopic injuries that happen during sex, according to Petar Bajic, M.D., a urologist at Cleveland Clinic's Center for Men's Health at the Glickman Urological and Kidney Institute. Peyronie's disease may affect up to 10 percent of men at some point in their lives, he said.
"When Peyronie's disease starts, in the first six months, there's often pain—pain in the area of the scar tissue, pain with erection, pain during sexual activity. That's due to inflammation from that initial injury," Bajic said, adding that after the first six to 18 months, the condition stabilizes and is unlikely to get any worse.
That's the norm, but Peyronie's disease presents in a number of different ways. Some men experience penile shortening or an indentation or a loss of girth. Bajic said he's even seen cases of Peyronie's disease where there is no curvature.
"Some men might come in because of the pain," he said. "Some might come in because one day they woke up and their penis was bent. Other men may have had this for a long time, and it's just becoming progressively difficult to have sexual activity with their partner."
It's important to note that not many men have a perfectly straight erect penis.
"We consider anything within 30 degrees to be in the realm of normal," Bajic said.
What is chordee?
Chordee is distinguished from Peyronie's in that it's a congenital penile curvature present at birth. It involves a disproportion of the "stretchiness" of one side of the penile tissue to the other.
"If one side of the penis is stretchier than the other, it's going to curve in the direction of the side that's less stretchy," Bajic said, adding that, unlike Peyronie's disease, chordee is not related to scar tissue.
Bobby Najari, M.D., a urologist at NYU Langone Health in New York City, said that chordee is generally something you notice at a younger age.
"It's more of a developmental abnormality," Najari said of chordee. "When someone comes in with penile curvature, the first thing to distinguish is, 'Is this a new phenomenon? Or is this something you've been living with for most of your life?'"
Neither Peyronie's nor chordee is a particularly serious or life-threatening condition. However, both generally require treatment because they do not usually go away on their own.
What causes penile curvature?
Physical injury to the penis and the underlying tunica albuginea, the connective tissue that helps hold the blood in place during an erection, contributes to the development of Peyronie's disease, said Brian Stork, M.D., assistant clinical professor in the Urology Department at Michigan Medicine, the healthcare system of the University of Michigan.
Injuries that can lead to Peyronie's are thought to occur during sexual activity, as the result of an accident or even during athletic activity, though the last one isn't supported by all doctors and health organizations. Stork said all of those injuries lead to "varying degrees of tearing of the tunica. This tearing oftentimes results in scarring, or plaque formation, as the body attempts to heal the injured tissues."
Many men are not able to pinpoint a traumatic event that caused their Peyronie's disease. In fact, said Bajic (who is among the doctors who don't propose that sports injuries lead to Peyronie's), 80 percent of men don't remember a specific injury that led to the condition.
Medical procedures that negatively impact the penis may predispose some men to Peyronie's disease, Najari said. Repeated procedures done through the urethra or pelvic surgeries, such as prostate removal, can adversely affect penis health in some men, he said, but not all.
"Peyronie's doesn't happen in the majority of those individuals, and by no means am I saying that it's the rule," Najari said.
Stork said there are no proven ways to prevent Peyronie's disease, but avoiding any injury to the penis is a good measure.
Treatment options for curvature
For chordee, surgery is the only effective treatment option and is performed by a pediatric urologist, typically when the patient is between 6 and 18 months old. The doctor essentially straightens the penis by removing the extra tissue that's causing it to bend. When surgery for chordee, which is a specific subtype of congenital curvature, isn't performed on an infant and the curvature becomes an issue for an adult male, surgery is a (potentially more-involved) option.
Congenital curvature not treated in an infant is often recognized as males get nearer to sexual maturity, when the curvature becomes more apparent during full erections. Surgery is the go-to treatment in such cases. Bajic said he performs at least one such surgery per month on adult males, and the procedures are safe and effective.
Surgery is also an option for treating Peyronie's disease, but it's the most invasive treatment and usually not the first choice. One of the least invasive options is a penile traction device, a stretching device that a man wears for 30 minutes twice a day for several months. The device pulls the penis straight outward and bends the penis in a direction opposite of where the Peyronie's is pulling it.
Another treatment option for Peyronie's is the injection of collagenase Clostridium histolyticum (brand name Xiaflex), an enzyme treatment that breaks down the scar tissue. This can improve curvature as well as sexual function. A urologist injects it directly into the scar tissue. Xiaflex treatment consists of a series of injections over the course of six months, Najari said.
"There are some people who would prefer taking care of it in a more expedient manner, in which case surgery can be an option," Najari said.
He added that the vast majority of his patients prefer to at least try the less invasive options first, and he most often treats Peyronie's with a combination of the traction device and injections.
Bajic said it's important for men to know that no treatment option is guaranteed to restore the penis to its pre-Peyronie's condition.
"The goal is to restore function and to address concerns the man has about the appearance of the erect penis," he said, "because changes in that area can lead to some significant body image issues and concerns, which can often lead to anxiety, depression and other issues."