Penile curvature

Congenital penile curvature refers to bending of a structurally normal penis due to corporal disproportion (relative asymmetry of the corpora cavernosa). Besides this isolated curvature, bending may occur together with hypospadias or epispadias, which are discussed on their own pages.

Curvature may be ventral, dorsal, lateral, or in multiple planes (“corkscrew” deformity). It is usually most evident during erection, though resistance to manual straightening is often noticeable in the flaccid state as well.

Diagnosis is confirmed by artificial or pharmacological erection, commonly induced with prostaglandin E1 (PGE1). PGE1 erection allows adequate rigidity and duration to map the deformity precisely and to plan correction. Photographs of the erect penis may document direction and severity before surgery. On examination, no fibrous plaque or scar is expected in isolated congenital curvature - unlike Peyronie's disease, where a plaque is often palpable.

Penile angulation can impair intercourse (pain, difficulty, or complete inability), and may cause significant psychological distress. Surgical correction aims for a straight, functional penis with acceptable cosmesis.

In children, straightening is often achieved by plication of the tunica albuginea on the convex (longer) side. In adolescents and adults, options include plication with incision of the tunica, or grafting the concave side of the corpora to avoid penile shortening when a longer segment needs expansion. Surgery is typically performed with pharmacological erection (PGE1) to assess curvature before, during, and after correction. When function is preserved and the issue is mainly appearance, surgery may be pursued for cosmetic goals. In typical congenital curvature repair, penile sensation and the ability to obtain erections are preserved when surgery is performed carefully.

As with any penile surgery, risks include bleeding or hematoma, infection, wound healing problems, or recurrent or residual curvature (sometimes requiring revision). Altered penile sensation is uncommon but possible. Outcomes depend on deformity severity, technique choice, and healing. Revision principles are individualized after examination and, when useful, repeat assessment with pharmacological erection.