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Penile curvature, as the name suggests, refers to all states of the penis other than right angles. That is, the penis is deformed to the right, to the left or up and down, instead of having an erect form. More precisely, all deformations other than right angles are considered penile curvature. At the moment of erection, the penis should harden at 90 degrees, i.e. at a right angle. However, this is not exactly the case in patients with penile curvature. When a man has an erection, the penis hardens at different angles instead of at right angles. Therefore, it is fair to say that for every 90-degree angle there is a certain amount of deformation of the penis.
Penile curvature occurs in two different ways. The first is congenital curvature and the other is curvature that occurs due to various causes. Both deformations can be treated and the penis can be restored to its proper shape. In other words, whether penile curvature is congenital or acquired does not constitute an obstacle for the treatment. Now, let’s take a closer look at both forms of penile curvature.
The penis can have a shape that differs from person to person. It is normal to be slightly to the right or left in the erect (hardened) position. Penis curvature in sexual intercourse is a common aesthetic problem. This situation is seen in two groups. The curvature can be congenital (congenital penile curvature) or acquired.
Although the cause of Peyronie’s disease is not known exactly; the most common cause is trauma during sexual intercourse. As a result of these traumas, tears occur in the sheath covering the corpus cavernosum (the structure that provides blood flow in the penis) called tunica albuginea and fibrous plaque forms during the healing process in the sheath. This formation can usually occur on the dorsum of the penis (the back of the penis) or sometimes on the side of the penis. This condition causes angulation and curvature of the penis in erection. As a result, the erect penis can become asymmetrical, bending forward, backward or sideways.
Research suggests that gene activation and connective tissue disorders related to healing also cause Peyronie’s disease. Vitamin E deficiency, long-term use of certain medications such as propranolol, methotrexate, diabetes, gout, long-term smoking and surgical interventions on the urinary tract have been claimed to trigger the disease.
In Peyroni’s disease, the curvature can sometimes be very pronounced, making coitus impossible and uncomfortable for the partners. Penile mass and curvature do not occur in all men and are not of the same severity. It is a progressive disease. At first, pain is felt during erection and this painful period disappears without treatment. When a person begins to feel the hard plaques on the penile shaft, he or she also notices a tilt and angulation of the erection. For this reason, if there is pain or mass sensation in the penis without delay, you should consult a doctor without hesitation, without any doubt and distress. Because every time you spend can negatively affect your sex life.
Anamnesis and physical examination are sufficient for the diagnosis of Peyronie’s disease. Plaque can be felt by hand. When taking a history, the time and form of the disease (chronic or acute), the progression of the disease, medications and habits are evaluated. In the sexual history, it is questioned whether the patient has any difficulty in achieving an erection. Ultrasound can help to determine the exact size and location of the plaque.
To treat the disease, it is first necessary to know its stage. There are two stages of the disease. In the first of these, characterized as the unstable period “active phase, acute inflammation phase”, the patient feels pain with erection. This first phase lasts for about 12-18 months.
In the second and stable phase, the chronic inflammation phase, the disease is fully established. This is the period when there is a significant curvature of the penis, erectile dysfunction and the size of the plaque does not change.
It is important to know the stage of the disease when choosing treatment. This is because it has been reported that in some patients the symptoms may disappear spontaneously, but in 50% the disease progresses.
Patients presenting with Peyronie’s are more likely to be treated with oral medications if they are in an active period and injections to stop the curvature from progressing further. These patients enter the chronic phase after about 1 year. In the chronic period, the only reason for treatment is that the unchanged angle makes sexual intercourse difficult or the curvature of the penis causes problems between partners. The preferred treatment method in this period is surgery.
If the disease is in the unstable stage or if the size of the plaque is small, there is a slight penile curvature, there is no pain and there is no sexual dysfunction, drug treatment may be recommended. Drug therapies are preferred in early stage patients. But it is also true that they have not been very successful. The aim is to prevent progression, reduce pain and maintain erectile capacity.
It is still one of the most popular treatments for early-stage disease. Because it has virtually no side effects, is easy to use and inexpensive. It is thought to reduce the production of molecules called free oxygen radicals, which are responsible for the formation of the hard plaque structure in penile tissue.
It is a substance that inhibits the formation of abnormal fibrotic tissue. It should be used between 3 and 6 months. It is also an expensive drug that can have side effects on the gastrointestinal tract.
Colchicine: Suppresses the inflammatory response in tissue, decreases collagen production and increases its breakdown. It has gastrointestinal side effects and may cause diarrhea.
Tamoxifen This non-steroidal anti-estrogen drug has been shown to reduce fibrosis by suppressing inflammation and the production of scar tissue. It has gastrointestinal side effects and may cause hair loss.
In this form of treatment, the medicine is injected directly into the penile plaque and is an alternative approach to oral treatment. This is called intralesional injection therapy. It is a more popular treatment option, especially among men who do not want to undergo surgery or in the early stages of the disease.
Cortisone injection into the plaque, extracorporeal shock wave therapy (its usefulness in improving curvature and reducing plaque length is controversial. However, some alternative techniques such as penile traction and vacuum devices (to prevent shortening of the penis length) are also used.
Surgical treatment is recommended when the erect tissue in the penis no longer regresses and intercourse is difficult due to deformity of the genitals.
It is applied to patients in the stable period of the disease and who do not benefit from drug treatments. In addition, if the curvature of the penis is more than 45 degrees, the patient has erectile dysfunction and there is a serious shortening of the penis length, surgical treatment is considered first.
Surgical treatment of Peyronie’s disease includes surgical correction of the curvature of the penis and penile prosthesis implantation in patients with Peyronie’s disease and erectile dysfunction. The criteria for surgical treatment are as follows:
– Severe penile curvature that has persisted for more than a year,
– Penile curvature or erectile dysfunction has progressed and remained stable for the last 3 months,
– The presence of penile curvature that prevents sexual intercourse,
– Severe shortening of the penis length.
Patients with Peyronie’s disease with erectile dysfunction and vascular insufficiency usually undergo penile prosthesis placement.
It is applied in patients with Peyronie’s disease and signs of erectile dysfunction. In patients with low degrees of penile curvature, prosthesis placement alone is sufficient. In low-grade penile curvatures, if prosthesis placement alone does not correct the curvature, patients may require additional surgery such as cutting the plate or closing the opening with a patch depending on the size of the cut plate.
Today, 3-piece inflatable penile prostheses are generally preferred in developed countries. After 3-part prosthesis applications, patient and spouse satisfaction reaches 90%.
Operations can be performed under general or regional (spinal/epidural) anesthesia.
When patients first come to the doctor with complaints that they have difficulty in intercourse, that they cannot have intercourse in some positions, that they or their partner have pain during intercourse, while some of the patients apply to the doctor because the curvature will prevent intercourse or because they are uncomfortable with the curvature without ever having sexual intercourse. The diagnosis is made by observing the curvature with physical examination during erection. (or the patient is asked for a photograph of this curvature)
Congenital penile curvature is when the penis is curved in one direction from birth. These penises are usually normal or longer than normal. Patients usually realize this in their early 20s when they start to be sexually active and apply to us for correction.
Correction is performed if the curvature is more than 30 degrees and interferes with sexual intercourse or if the curvature does not cause functional problems but is uncomfortable in appearance.
Corrective surgeries are usually performed by shortening the long (convex) side because the penis is long. This surgery is performed under general or spinal anesthesia. Since the penile skin is opened from the circumcision line, it does not leave a separate scar. After surgery, the patient can be discharged on the same day and return to daily work the next day. It is important for good wound healing that the patient does not have sexual intercourse for about 4-6 weeks.
Penile curvatures are either congenital or develop later. The disease that causes later penile curvatures is called Peyronie’s disease. In the tissues outside the erectile bodies at the base of the penile structure, fibrous (connective tissue) plaque forms in the cartilage-like tissue of the penis, i.e. under the sheaths around the penis, causing curvature in the erectile penis. It is usually the bending of the penis to the side during erection. The fibrous plaque may be on the top or both sides of the penis. Wherever it is, the erect penis is bent downwards.
Penile traumas, sudden and hard movements during sexual intercourse, penile fracture, sexual activity, masturbation, vascular inflammation such as vasculitis can lead to Peyronie’s disease. In Peyronie’s disease, the curvature can be extremely pronounced and interfere with sexual intercourse. This is often uncomfortable for partners. Not all men have a mass and curvature of the penis and not everyone has the same severity of the disease.
Penile curvature is a rapidly progressive disease. At first, pain is felt during erection and this painful period disappears without a doctor’s intervention. When a person starts to feel the hard plaques on the penile shaft, he or she notices a curvature and angulation of the penis during an erection. Therefore, if there is pain and a feeling of a mass in the penis, a doctor should be consulted without any doubt or problem. Because every passing period can negatively affect sexual life. Although it can occur at any age, Peyronie’s disease usually occurs at 50 years of age. Although there is a hereditary predisposition to the disease, it can also occur in people with no family history of the disease.
From an aesthetic point of view, that is, if a person is uncomfortable with his penile appearance and therefore avoids undressing in the presence of his partner and cannot have intercourse, this indicates that a problem needs to be corrected. Peyronie’s disease is diagnosed by cavernosography to determine the location and size of the fibrous plaque.
Penile curvature may be congenital or may occur due to a series of diseases, surgical interventions or trauma during sexual intercourse.
Congenital curvature of the penis: The anatomical structure of the penis consists of two spongy tissues containing the blood vessels that provide erection and a spongy tissue containing the urethra. In the womb, one of these spongy structures may have growth and developmental delay. This causes penile tilt during erection towards the side where the growth is small.
In addition, hypospadias, popularly known as “prophet’s circumcision”, where the urethra is located lower than it should be, can also cause penile curvature. In these patients, the development of the spongy tissue in which the urinary tract is located is usually smaller. During an erection, a downward curvature of the penis occurs.
Subsequent penile curvature: Penis size and deformities are often caused by Peyronie’s disease later in life. Peyronie’s disease is a condition that progresses with calcification in the spongy tissue containing the blood vessels that provide hardening in the penis and in the outer sheath surrounding this tissue, which provides hardening. Apart from the age factor, penile surgical interventions can also cause size, size, shape and deformity and curvature of the penis.
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