The penis can be curved, fundamentally, for three reasons:
1) by a congenital disproportion (from birth) of the so-called cavernous bodies (cylinders containing the tissue of the erection)
2) for any type of trauma
3) by the so-called Peyronie's disease
The tunica albuginea is a layer has a certain capacity of distension when blood enters the penis during erection. If a rupture or injury occurs during a trauma, usually during intercourse, an abnormal scarring of the lesion may occur, resulting in a hardened area (fibrosis), with consequent loss of elasticity of the tunica albuginea. When blood enters the penis during the erection, the affected part does not distend well, which causes the curvature of the penis. Depending on the level where the problem originates (dorsal, ventral, lateral), the penis can curve upwards, downwards or to one side.
Peyronie's disease is the same, with the only difference being that this pathology has a still unknown origin, although it could be related to small trauma to the penis during intercourse throughout life and a possible genetic predisposition.
It is a pathology that usually occurs from the age of 50 and appears suddenly. The fibrosis plaque may be single or multiple and usually appears in the dorsal part of the penis, which results in the curvature of the penis upwards (towards the belly), contrary to what usually happens in congenital cases, Where the curvature is ventral (downward).
With which symptoms Peyronie's disease manifests itself
The first manifestation of the disease may be pain during erection, palpation of the fibrosis plaque or curvature of the penis. The pain is due to the initial inflammatory phase and usually disappears spontaneously in a few months. Infrequently, problems can also arise in the rigidity of the penis, although often it is due to a psychological factor when the patient presents pain and / or curvature of the penis during the erection. Also, depending on the severity of the problem, there may be difficulties in penetration during intercourse and the couple may experience discomfort.
This disease can evolve slowly until its stabilization, at which time no further variations occur in plaque size or degree of curvature. In exceptional cases, particularly those caused by trauma to the penis, the disease may remit completely spontaneously.
Diagnosis and treatment of penile curvature
The best way to document and objectify the curvature is through periodic practice of erect penis photographs from different angles, made by the patient himself, which will be very useful for the doctor specialized in Andrology who must evaluate and follow the evolution of the problem. It may also be indicated the practice of an ultrasound of the penis, especially when it is suspected that the fibrosis plaque may have calcified. This fact constitutes a worse prognosis, in terms of remission of the disease and the application of possible treatments.
It is very important to consult the specialist andrologist or urologist when the patient appreciates the first symptoms. It is at this stage that some medical treatment administered orally or injected directly into the plaque. Although a large number of general and local treatments have been tried in the course of history, none have been shown to be effective in making fibrosis plaques disappear in most patients.
Surgery for Peyronie's Disease
Before the failure of the possible treatments tried, the only possibility to straighten the penis is the surgery. This should be proposed when disease stabilization is demonstrated, ie there have been no changes in plaque size or curvature in the last 6-12 months. If the disease continues to progress and curvature corrective surgery is performed, the penis may be bent again. Light curves that do not impede penetration would not be candidates for surgery.
The straightening of the penis consists of puckering the convex part of the curvature, by means of different techniques applied to the tunica albuginea. In cases where the curvature is very important, an opening can be made in the plaque and filling the defect with a segment of tissue of the body itself (vein, labial mucosa, etc.) or with synthetic or biological material from another source. These surgeries are not exempt from being able to cause a certain shortening of the penis or to originate a new fibrosis of the tunica albuginea.
In cases in which penile curvature is associated with erectile dysfunction due to the disease itself or other pathologies (lesions of the arteries or nerves of the penis due to diabetes, hypertension, prostate surgeries, etc.), the Placement of a penile prosthesis, with or without correction of the curvature.
When the curvature of the penis is congenital, that is to say, from birth, the only therapeutic option is straightening surgery, provided there is a difficulty in penetration during intercourse.
Synthesis about the curvature of the penis
By way of summary, the curvature of the penis is a pathology of congenital or acquired origin that occurs more frequently than can be believed. The main symptoms are: indurated zone in any part of the penis, pain and curvature in erection, erectile dysfunction and difficulty in penetration during intercourse.
As mentioned above, the diagnosis is made from the symptoms and palpation by the andrologist, as well as the photographs that the patient must provide. Although some treatments may be suggested, their efficacy is questionable. In severe cases a corrective surgery will be performed, if the curvature hinders sexual activity.