MEDICAL ARTICLE

Curvature of the penis Peyronie’s disease

By A.D.A.M. Medical Encyclopedia.

Curvature of the penis is an abnormal bend in the penis that occurs during erection. It is also called Peyronie’s disease.

CAUSES, INCIDENCE, AND RISK FACTORS

In Peyronie’s disease, fibrous scar tissue develops under the skin of the penis. The cause of this fibrous tissue is not known.

Fracture of the penis (injury during intercourse) can lead to this condition. Patients have a higher risk after surgery or radiation treatment for prostate cancer.

Peyronie’s disease is uncommon and affects men ages 40 – 60 and older.

Curvature of the penis can occur with Dupuytren’s contracture, a cord-like thickening across the palm of one or both hands. It is a fairly common disorder in white men over age 50. However, only a very small number of people with Dupuytren’s contracture develop curvature of the penis.

Other risk factors have not been found., however, people with this condition have a certain type of immune cell marker, which indicates that it may be inherited.

Newborns may have a curvature of the penis which may be part of an abnormality called hypospadias (this is different from Peyronie’s disease).

SYMPTOMS

You or your doctor may notice an abnormal hardening of the tissue below the skin, in one area along the shaft of the penis.

During erection, there may be:

• A bend in the penis, which usually begins at the area where you feel the scar tissue or hardening
• Narrowing of the penis
• Pain
• Problems with penetration or pain during intercourse
• Shortening of the penis

SIGNS AND TESTS

Your healthcare provider can diagnose curvature of the penis with a physical examination. The hard plaques can be felt with or without an erection.

The doctor may use injected medications to cause an erection or you may provide your healthcare provider with pictures of the erect penis for evaluation.

An ultrasound may show the scar tissue in the penis, but it is not necessary.

TREATMENT

At first, you may not need treatment. Some or all of the symptoms may improve over time or may not get worse.

Treatments may include:

• Corticosteroid injections into the fibrous band of tissue
• Potaba (a medicine taken by mouth)
• Radiation therapy
• Shock wave lithotripsy
• Verapamil injection (a medicine used to treat high blood pressure)
• Vitamin E

However, these treatments often do not help much, or at all.

If medicine and lithotripsy do not help and you are unable to have intercourse because of the curve of the penis, surgery may be done to correct the problem. However, surgery may cause impotence. It should only be done if intercourse is impossible.

A penile prosthesis may be the best treatment choice.

EXPECTATIONS (PROGNOSIS)

The condition can get worse and make it impossible for you to have intercourse. Impotence can also occur.

COMPLICATIONS

The condition may make intercourse difficult, painful, or impossible. Surgical correction may also lead to impotence.

CALLING YOUR HEALTH CARE PROVIDER

Call your health care provider if:

• You have symptoms of curvature of the penis
• Erections are painful
• You have a sharp pain in the penis during intercourse, followed by swelling and bruising of the penis

References

• Jordan GH. Peyronie’s disease. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 25.
• Jordan GH, Schlossberg SM. Surgery of the Penis and Urethra. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 33.
• Elder JS. Anomalies of the Penis and Urethra. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 544.
• Hellstrom WJG. Medical management of Peyronie’s disease. J Androl. 2009;30:397-405.

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.