A Urologist’s Guide to Curved Penises and Peyronie’s Disease

By Dr. Josh

The human body comes in many shapes and sizes, and the penis is no exception. When it comes to their anatomy, many people don’t understand how variable penises can look. Some penises can lean, tilt, and/or curve, while others may be straight as an arrow. Penises are kind of like snowflakes: no two look exactly the same. While some are born with a natural curve to their penis, others may develop a curve later in life. Peyronie’s disease is a condition that causes curvature or indentations (among other visible deformities) in the penis that can make erections painful and intercourse difficult. Classically, Peyronie’s occurs after some kind of isolated injury (or an accumulation of minor traumas) to the penis. Sometimes, these injuries are recognized by an individual, and sometimes, they are not.

Peyronie’s disease is something I get asked about a lot because many individuals can have insecurities about how their penis looks. Maybe it’s because they look different than what they see in porn. Maybe it’s because a partner made an offhanded comment about a particular penile feature of theirs. No matter what the source, patients often want to know if their penis looks “normal.” While I hate that word as a way to describe any aspect of sexual health, it is helpful to distinguish between natural curvature and Peyronie’s. What follows is a discussion on the symptoms and diagnosis of and treatments for Peyronie’s disease to help you, fellow reader, to distinguish between a natural curve and a deformity that may warrant further investigation.

Understanding Normal Curvature

Many people have some degree of curvature to their erect penis, which is considered a normal variation in penile anatomy. It is essential to recognize that there is a wide range of normal penile curvatures, and a slight bend does not necessarily indicate a medical condition. Often normal variant types of curvature are congenital or something you’re born with. Congenital penile curvature is often detected in young males by parents when diapering or dressing them. Congenital curves can also become more apparent as puberty takes hold and the penis grows to its full adult size. Congenital curves can be quite variable. Most often, they may appear to point slightly downward, laterally or a combination of both. More severe cases can sometimes be associated with urethral abnormalities. If the curve is mild, it may go unrecognized for years until the person becomes sexually active. In general, congenital penile curvature does not warrant intervention unless it is severe and/or interferes with an individual’s ability to urinate normally.

Understanding Peyronie’s Curvature

While the pathophysiology of Peyronie’s is not completely understood, the condition is believed to involve a disordered wound healing response by the body.  This disordered healing leads to inflammation and improper deposition of collagen, resulting in an area of scarring sometimes called fibrosis or a plaque.

Collagen is the primary building block of your body’s skin, muscles, bones, tendons and ligaments and other connective tissues. Its main role is to provide structure, strength and support throughout your body.  When a plaque forms within collagen, the area becomes stiffer and less flexible than normal collagen.  This means that when the penis becomes aroused and fills with blood, the tissue cannot expand normally in these areas of fibrosis.  The end result of this lack of uniform expansion of the erectile tissue is penile deformity. The most common type of Peyronie’s deformity is a curve, but the condition can cause a number of different visible abnormalities.  Peyronie’s can lead to shortening of the penis because the penis cannot stretch as much when aroused if there is plaque present.  It can create an hourglass or twisted appearance.  Peyronie’s can even cause a hinge effect. Peyronie’s disease is thought to affect up to 10% of people with penises, often starting in middle age, though it can occur at any time.  Symptoms often develop gradually over time.  Let’s take a closer look at Peyronie’s disease, including its symptoms, causes, diagnosis, and treatment options.

Symptoms of Peyronie’s Disease

It should be apparent by now that the main symptom of Peyronie’s disease is a significant bend, curve, or other deformity in the penis that wasn’t there previously.  The deformity is typically most noticeable during an erection, though some may see the deformity while flaccid as well.  Other potential symptoms include: Localized pain in the penis, especially during erection or intercourse, Narrowing or indentation along the shaft, Shortening of the penis due to scar tissue, Erectile dysfunction, Difficulty having intercourse due to some change in the shape/appearance of the penis

Deformities often develop on the top or bottom of the shaft, but may occur on the side also.  Some develop hardened scar tissue that can be felt through the skin but sometimes deformity can occur without a palpable plaque.  The penile deformity may gradually worsen over time, or it may appear stable.  Symptoms sometimes appear suddenly after an injury, while other times Peyronie’s disease develops slowly without a known cause.

Phases of Peyronie’s Disease

Peyronie’s disease is often split into 2 stages: the acute phase and the chronic phase. During both phases, the bent/curved penis may cause problems with sex.

Acute Peyronie’s disease. The acute phase typically lasts between six and 12 months. During this period, scarring results in the initial appearance of a deformity.  That deformity may change appearance during this time and may even resolve completely.  During the acute phase, many individuals will experience penile pain, most commonly when erect but the pain can occur while flaccid also.

Chronic Peyronie’s disease. The scar is no longer growing during the chronic phase and the visible deformity appears stable.  Pain usually goes away during the chronic phase, but it can sometimes continue.  Erectile dysfunction may develop during this phase.

Causes and Risk Factors

As mentioned, the most common cause of Peyronie’s disease is injury. This can be a specific event in which the penis is injured during sex or masturbation. People will often describe this as hearing a pop, crack, or snap during sexual activity, typically while missing during attempted penetration of their partner. Sometimes, these injuries can result in visible bruising, swelling, or loss of erection. But other times, these injuries can be subtle and may go unnoticed. It’s important to remember that Peyronie’s can also result from an accumulation of micro-traumas over time. Aside from injury and trauma, Peyronie’s has also been associated with a number of other factors. Known risk factors for Peyronie’s disease include:

Family history and genetics – Having a close relative with Peyronie’s increases your risk. Certain types of Peyronie’s may be inherited in some families.  Around 20% of people with Peyronie’s have a family history, indicating possible genetic susceptibility.

Age – Most cases occur in people over 40, though it can develop at any age.

Prior hand injury – Some research links Peyronie’s to hand and foot trauma that caused inflammation and scarring in the palm or sole (a condition called Duputryen’s disease).

Prostate surgery or radiation – Procedures for prostate cancer may damage penile tissue and instigate Peyronie’s.

Erectile dysfunction – Some studies show a higher occurrence of Peyronie’s in individuals with ED due to reduced blood circulation.

Smoking – Some research connects tobacco use to higher risk, possibly by increasing inflammation.

Diabetes – Poor blood sugar control and tissue damage from diabetes may contribute to Peyronie’s.

Other medical conditions associated with increased risk of developing Peyronie’s include certain connective tissue and autoimmune disorders, Paget’s disease of bone, and systemic lupus erythematosus.

Diagnosis

 Peyronie’s disease is typically diagnosed through a thorough medical history, physical exam of the penis, and sometimes imaging tests.  But that process can start at home with a simple self-exam.  Generally, I counsel patients to examine their genitals at least once per month.  This is a good way to keep track of changes.  Regular self-exams are also a great way to screen for cancer.  If you suspect you may have injured yourself, take a minute to examine your junk and see if anything looks or feels different.  If you’re concerned, speak to a healthcare professional. Your healthcare provider should ask about symptoms, erection issues, family history, and medical conditions or injuries that may be related.  They should perform a visual inspection and manual palpation of the penis to check for scars and look for deformity, narrowing, calcification, or pain. The following tests may be used to confirm Peyronie’s disease:

Penile ultrasound – This uses soundwaves to produce an interior image of the shaft and identify scar tissue.

Duplex Doppler ultrasound – Measures penile blood flow to help evaluate ED.

X-rays – Can detect calcification in penile plaque deposits.

MRI – Provides clear 3D scans to pinpoint the location and extent of plaques or scar tissue.

Photographs – Can precisely document the extent of curvature for tracking over time.

If symptoms appeared suddenly after trauma, the presence of bruising, swelling and inflammation helps determine the injury’s connection to Peyronie’s development.  Your provider may also order bloodwork or conduct genetic testing to rule out related disorders, although this is rarely needed to make the diagnosis.

Treatment

While some milder cases resolve slowly without intervention (some estimates have this as high as 30% of cases), several treatment options are available for Peyronie’s disease.  The best approach depends on the severity, the outlook for progression, and the impact on sexual function. The goals of treatment include reducing penile curvature and scar tissue, improving the ability to have intercourse, and relieving pain.  Possible Peyronie’s treatments include:

Medications – Drugs to break down scar tissue or reduce inflammation are sometimes used early on.

Injections – Interferon, verapamil, or collagenase may be injected directly into plaques to soften scar tissue.

Surgery – This may be recommended for stable, severe curvature interfering with intercourse.  Procedures such as plication, plaque incision/excision with grafting, or penile prosthesis implantation can help correct deformities and restore sexual function.

Penile traction devices – These stretch the scar tissue carefully over time to straighten the penis.

Shockwave therapy – Pulsed acoustic waves are applied to break up fibrous plaques and promote healing.

Radiation – Some research indicates radiation can prevent scar progression and shrinkage.

The choice of therapy depends on factors like age, erectile function, plaque characteristics, degree of bother, effect on ability to engage in sexual activity, and insurance coverage.  Your provider may recommend a conservative wait-and-see approach for slow, mild cases with no erectile dysfunction.  Surgery is generally reserved for people with curvature severe enough to impede sexual activity after at least one year of stable disease.  Many patients will require months of treatment and follow-up care. Lifestyle measures like quitting smoking, pelvic floor exercise, and using penis traction devices and vitamin E supplements may also aid recovery.  However, the data are mixed on the efficacy of many of these treatments.  While home remedies and alternative medicine approaches lack proven benefits for Peyronie’s, some people find them worthwhile.  However, most should be used cautiously under medical guidance only.

Psychological Support

For many, Peyronie’s disease can take a heavy psychological toll.  Dealing with the changes to sexual function, self-image concerns, and uncertainty over progression often causes significant stress and emotional difficulty.  Talking honestly with your partner and connecting with medical/mental health professionals can help work through feelings constructively.  Support groups tailored to Peyronie’s can also provide invaluable peer empathy and advice.  With proper treatment, most individuals with the condition can regain sexual satisfaction and confidence.

Living with Peyronie’s Disease

Even after treatment, Peyronie’s can involve coping with residual penile curvature, ED, or shrinkage for some individuals.  While the outlook varies by case, many continue enjoying healthy sex lives through open communication with partners and using alternate sexual positions/aids as needed.  With time, shared understanding, and patience, couples often adjust to changes from Peyronie’s successfully.  Some find intimacy grows stronger when the emphasis shifts from performance to expression and creativity. While Peyronie’s can be emotionally difficult initially, most individuals regain fulfilling sex lives and relationships with proper treatment and support.  The condition does not otherwise affect longevity or general health.  With a proactive approach focused on restoring comfort and confidence, it’s possible to overcome Peyronie’s challenges.  From uncensored dialogue with your provider to new tools enhancing sexual function, solutions exist.  With the many evolving medical options for Peyronie’s disease, there is hope for reducing – if not reversing – penile deformity and ED.  While more research is still needed, the future continues looking brighter for those with Peyronie’s disease.

Conclusion

Understanding the difference between Peyronie’s disease vs. normal curvature is crucial for individuals concerned about their penile curvature. While natural curvature falls within a wide range of normal, Peyronie’s disease involves the development of scar tissue and often requires medical attention. If you suspect Peyronie’s disease or are experiencing symptoms, consult a healthcare professional to discuss your concerns and explore appropriate treatment options. Remember, seeking support from healthcare professionals and loved ones can help address the physical and psychological aspects associated with penile curvature, promoting overall well-being and sexual satisfaction.

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Dr. Josh

ASTROGLIDE’S SEXUAL HEALTH ADVISOR

Joshua Gonzalez, MD, is a board-certified urologist who is fellowship-trained in Sexual Medicine and specializes in the management of male and female sexual dysfunctions. These include issues surrounding hormone deficiency, menopause, sexual arousal, orgasm, ejaculation, libido/desire, sexual pain, penile curvature, and erectile function. Throughout his career, Dr. Gonzalez has focused on advocating for sexual health and providing improved healthcare to the LGBTQ community.