An absolutely straight penis is unusual – most have a slight curve when erect. But this should not be more than about 25° from straight, like a banana. If your penis bends more than this, you might have Peyronie’s disease.
It is also quite normal and harmless for the penis to have a slight twist (usually anticlockwise).
A condition called Peyronie's disease, in which the penis becomes crooked when it is erect, occasionally develops in men. This can make sexual intercourse difficult, if not impossible. The condition is named after Dr François Gigot de la Peyronie (physician to King Louis XV of France) who wrote about it in 1743, but it has probably been around for much longer; sculptures dating from the 6th century BC depict angulated erect penises. It is estimated that about 1 in 100 men has Peyronie’s disease.
Men with Peyronie’s disease often worry about starting a new relationship, because of embarrassment. It is important to realize that while you will be very aware of a slight physical change, your partner will be much less aware. Talk to your new partner about it and explain that it is not an infectious or cancerous condition.
Peyronie’s disease most commonly occurs in men aged 50–60, but it can occur in young men and in old age. The cause is thickening of the fibrous tissue in the penis on one side. This means that, during an erection, one side of the penis cannot lengthen, and the penis will bend. The direction of the bend depends on the position of the thickening (which can often be felt as a lump or lumps when the penis is limp).
If the thickening is on the top of the penis, the erection tends to curve upwards; this is the most common type.
If the thickening is on either side, the penis will bend towards the side that is thickened.
If there is thickening on both sides, the penis may develop an hour-glass shape, but this is unusual.
You may be able to feel the thickened area; it feels like a hard piece of toffee.
Will it get better? For the first 9–18 months after Peyronie’s disease starts, it is often quite painful, especially when the penis is erect. During this period, the thickened area increases in size. After this ‘active period’, it is unlikely to become worse, and the pain diminishes. In 20% of cases, the penis will go back to normal without any treatment. Those who have had the condition for a long time feel no pain but sometimes have difficulty achieving an erection (perhaps because the lumpiness is obstructing blood flow in the penis).
What causes Peyronie's disease? No one knows why the thickening occurs, but it is not a cancerous condition, nor is it the result of sexually transmitted disease or of any odd previous sexual practices. It is more common in smokers. There seems to be a link with some other conditions. For example, men with Peyronie’s disease are quite likely to have Dupuytren’s contracture, a thickening of fibrous tissue in the palm of the hand. They are also quite likely to have raised blood pressure; some doctors think that the blood pressure itself might be responsible for the penis problem, while others blame the drugs used to treat blood pressure (particularly beta-blockers).
Treatments. There is no need to feel embarrassed about discussing the problem with your family doctor, because doctors are very familiar with the condition. It may be difficult for your doctor to assess how severe the problem is, because the curvature shows only when the penis is erect. If you have a digital or instant-picture camera, take a photograph of your erect penis and show it to your doctor. Treatments that do not involve surgery are recommended during the first 12 months, while the scarring is developing. After that, when the scarring has finished forming, surgery is often the best option. If it is only mild and does not cause any inconvenience, no treatment is necessary.
Cocoa butter cream. Some men with mild Peyronie’s disease say that massaging cocoa butter cream (available from pharmacies) into the curved area is helpful.
Interferon-alpha-2A is a drug that may be able to decrease the size of the thickening when injected into the area, but more research is needed.
Steroid injections. In the past, the most common treatment was steroid injection into the thickening, but this is now less popular because of numerous side effects.
Vitamin E tablets are sometimes recommended, but scientific evidence to show that they help is scanty. Do not take more than 250 mg of vitamin E a day, because higher doses may damage your health.
Potassium aminobenzoate is another nutritional substance that is sometimes recommended, but it needs more research to see if it is effective.
Verapamil is a medication that is used to treat blood pressure. Injections of verapamil into the thickened area may help, by dilating blood vessels and so improving oxygen supply. More research is needed.
Colchicine is a medication that may reduce tissue thickening and reduce Peyronie symptoms, but it has side effects – diarrhoea and digestive problems (Trends in Urology, Gynaecology and Sexual Health 2009;14:17–21).
Tamoxifen is a medication that may reduce the thickened area, but the results seem poor. (This medication is also used for breast cancer, but Peyronie’s disease is not a cancerous condition.)
X-ray treatment has been used in Germany, and seems to be effective, with few side effects (Trends in Urology, Gynaecology and Sexual Health 2009;14:17–21).
Iontophoresis is being tried as a treatment for Peyronie’s disease. It involves placing the penis in a water bath, often containing a drug such as verapamil or lidocaine. A small electric current is then passed through the water. This treatment is safe, but is available only in some special hospitals and needs more research to assess its possible effectiveness.
Penis extender device. Use of a special ‘penis extender’ may improve Peyronie’s slightly. The drawback is that it needs to be used for a long time (several hours a day for several months) (Journal of Sexual Medicine 2009;6:558–66). The device may be available from some hospital clinics that deal with Peyronie’s.
Laser treatment is a method of thinning the area, but not much research has been done yet to see if it is effective or if there are any problems from the treatment.
Surgery to correct the deformity is the most effective treatment. Before deciding on surgery, the surgeon will carry out some tests. These might include an injection into the penis to make it erect so that the problem can be seen properly. The surgeon will probably suggest waiting several months before having the operation to ensure the condition is stable, i.e. not in the 'active' phase. Ultrasound or MRI scans might also be performed. In the usual operation, the surgeon cuts out some tissue from the opposite side to balance out the thickened area. After the operation the erect penis will be straighter (but not always restored to normal) and 1–3 cm shorter than before when erect, but many men do not notice any difference. Studies have shown that only 58–88% of men are satisfied with the result of the operation, partly because although it straightens the penis it leaves the thickened area in place, so it may still be painful. Also, a few men have difficulty achieving an erection after the operation.
In another type of operation, the surgeon cuts a slit in the thickened area and inserts a piece of tissue (usually a piece of vein from the groin or ankle). This makes the area more flexible, and there is no shortening of the penis. However, 10–15% of men have difficulty in obtaining an erection after this operation.
Written by: Dr Margaret Stearn Edited by: Dr Margaret Stearn Last updated:
Saturday, September 3rd 2011
In part 3 of Dr Phil Hammond's penis trilogy he discusses penis size and shape, including the cause of a bendy penis and what you can do about it. Click on the video below to find out more.
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