Peyronie's Disease - What Causes a Curved Penis?

When scar tissue develops inside the penis, causing it to curve and to make erections painful, the condition is known as Peyronie’s disease.

Penises vary in size and shape. Many men have a curved penis which may not be noticeable in the flaccid or soft state, but it may be noticeable when erect. With Peyronie’s disease, however, the penis bends significantly when it’s erect, causing erections to be painful, and making it difficult or impossible to have sex.

The cause of Peyronie’s disease is unknown, but a number of factors may contribute to the development of the condition.

Men with Peyronie’s disease may also experience erectile dysfunction (ED), meaning that they are unable to get or sustain an erection well enough to have intercourse.

The condition can be very stressful for sufferers but Peyronie’s disease can be treated, and occasionally it resolves without the need for treatment.

There are a number of contributing factors that can cause the condition to develop.

Injury or a trauma of some sort sustained by the penis is thought to be one possible cause of Peyronie’s disease. This may be caused by:

• an accident
• a sports injury
• sexual activity which resulted in damage to the penis

As can happen when any injury heals, scar tissue can form which can develop into a thickened area. If scar tissue forms in this way in the penis, the thickened area is called a ‘plaque’. Scar tissue can’t stretch so this causes one side of the penis to bend when erect, forming the curved and sometimes painful erection that characterises Peyronie’s disease.

Peyronie’s disease can also develop over time and may not necessarily be be traced back to any injury or traumatic event involving the penis. Further research into the condition is going on and it’s thought that the condition could possibly be genetic, or could develop as a result of certain health conditions.

Men who have curved penises and erections may not necessarily be suffering from Peyronie’s disease. If you are still able to have sex and feel no pain when erect, then it is unlikely that you have the condition. The symptoms of Peyronie's disease make it difficult or impossible to have sex because the area(s) of hard scar tissue make it difficult to get or maintain an erection. Symptoms include:

• significant curvature of the erect penis
• area of thickness or a hard lump felt in the shaft of the penis
• loss of length or girth of the penis
• pain in the penis when erect (not everyone will experience pain)

If you experience any of these symptoms, talk to your doctor or a nurse at your local genitourinary medicine (GUM) clinic.

Erectile dysfunction - difficulty in getting or maintaining an erection - is a very common condition, which is estimated to affect around half of all men between the ages of 40 and 70.

Men with a naturally curved penis shape are no more or less likely to suffer from erectile dysfunction than the rest of the male population. However, those with a curved penis when erect caused by Peyronie’s disease may experience problems with erections and may find it difficult to get an erection or achieve one suitable for sex.

Erectile dysfunction is treated by getting to the cause of the problem. Peyronie’s disease is a physical condition, but the stress and anxiety over the condition can also impair sexual performance. There are treatments available for erectile dysfunction. If you are finding it difficult to get and sustain an erection or believe that you have symptoms of Peyronie’s disease, speak to your doctor who can diagnose you and recommend the best course of treatment.

If you have a slightly curved penis but have no problems with getting an erection and do not experience pain during sex, then treatment is probably not needed. If you have been diagnosed with Peyronie’s disease then you may need surgical treatment. Whether or not surgery is appropriate depends on how much pain and discomfort you are experiencing and how your sexual performance and sex life is being affected.

If you can still have satisfying sexual intercourse, you may not need treatment, because Peyronie’s disease can sometimes get better on its own.

There are a variety of treatments for Peyronie’s disease available depending on the severity of the condition. A non-surgical option is extracorporeal shockwave therapy (ESWT), which involves using a device that applies sound waves to the skin of the penis over the scar tissue to break it up and reduce the curvature and pain in the penis.

Surgical procedures for the treatment of Peyronie’s disease include:

• Plication procedures (also known as Nesbit’s procedure) - stitches are inserted under the skin of the penis on the opposite side to the plaque (scar tissue) to straighten the penis.
• Grafting - the scarred tissue is replaced or expanded using healthy tissue grafted from another part of the body.
• Penile implants - patients who suffer from Peyronie’s disease and erectile dysfunction may also be treated with a penile implant. These are inflatable devices or malleable rods which are inserted into the penis to straighten it and enable the patient to get an erection suitable for sexual intercourse.

As with any surgery, these procedures carry the risk of complications. These may include shortening of the penis, changes in sensitivity, scarring, or erectile dysfunction.

A drug for the treatment of Peyronie’s disease, Xiaflex, is currently approved in the US for the treatment of the condition. It is however currently unlicensed in the UK.