penile curvature

Penile curvature: description

In penile curvature, the penis is curved to one side (lateral), upwards (dorsally) or downwards (ventrally). Some penis is also corkscrew wound around its axis. A penile curvature can be innate and is called medically congenital penile deviation. In this case, the penis is usually bent downwards or in the erected state forward. An acquired penile curvature doctors call Induratio penis plastica (= plastic hardening of the penis). Here the erectile tissue is often bent upwards, in some cases also to the side.

A congenital penile curvature is based on a defect in the genetic material. Therefore, it often occurs with other diseases of the male genital organ. A specific cause for the acquired penile curvature is not known. Mainly 45- to 65-year-old men get a penile deviation. In Germany about three percent of this age group have a crooked penis. Overall, penile curvature occurs in about one in every 1,000 men. However, experts suspect a much larger number of unreported cases.

Often the curvature is only light. Over time, however, it can strengthen and disrupt the erection painfully. In other cases, deviations spontaneously return. Congenital penile curvature remains unchanged in most cases.

Penile curvature: symptoms

An acquired penile curvature is characterized mainly by palpable, nodular hardening, so-called plaques. They are usually at the top of the penile shaft, in rare cases at the bottom. The often elongated nodules arise from the tunica albuginea. It is a thin cuticle that surrounds and holds together the corpora cavernosa of the penis (corpora cavernosa) as a connective tissue-like capsule. The hardening occurs within a few weeks to months. They have a different size (usually one to three centimeters) and can spread to over the entire penis shaft.

Scarring and hardening of the connective tissue, experts call fibrosis. In a fibrosis connective tissue proliferates benign and is usually converted from a soft, elastic to a harder, scarred tissue. Through these changes (penile fibrosis) the tissue shrinks in the area of ​​the plaques and thereby bends the penis on the diseased side. The acquired penile curvature is thus more of a symptom than a disease. The extent of penile curvature is especially visible on the erect penis. Occasionally, the penis bends in two directions (bidirectional penile curvature), for example, upwards and to one side.

If the crooked penis deviates significantly from the straight axis, this can lead to problems during intercourse. In addition, the penis becomes less rigid from the plaques to the glans, which experts call reduced rigidity. Some patients complain of pain, especially during an erection and during sex. At rest, these penile pains occur only very rarely. Urination and the urinary stream, on the other hand, are not restricted by penile curvature.

Occasionally can be found at acquired penile curvature plaques at the transition between the glans penis shaft and (Schnürfurche). As a result, hourglass-like constrictions may occur in this area. In severe cases, it can damage the nerves and vessels that run there. This leads to an erectile dysfunction (erectile dysfunction) and the glans tingles or feels numb.

In congenital penile curvature, the curvature itself is the main symptom. Typical complaints as with the acquired variant are rare. Most patients present themselves before or after their first sexual contact with a doctor. Depending on the extent of sexual intercourse may be affected. For some patients, penile curvature is also a psychological problem. Deviation from the norm often affects those affected as distressing. This is mostly compounded by a possible erectile dysfunction and problems with sex.

Penis curvature: causes and risk factors

The causes of penile curvature, as with the symptoms, differ between the innate and the acquired form. Proven reasons for Penisverkrümmungen missing so far. However, there are assumptions and clues that point to possible causes of Penisevviation.

Congenital penile curvature

The reason for a congenital penile deviation are defects in the genetic material. Where or why exactly the penis develops incorrectly, is hardly known. However, it is known today that the connective tissue envelope (tunica albuginea) of erectile tissue grows differently long. Most of the lower part is shorter than the upper part, which is why the male member is often curved downwards in congenital penile veining. In some cases, congenital penile curvature is associated with other diseases. These include above all:

• hypospadias: The mouth of the urethra lies below the glans, ie at the bottom of the penis. Underneath the urethral opening, which is too low, there is a thickened band of connective tissue, the chorda, leading to the testicle. She bends down the penis.
• Megalourethra: Balloon-like dilated urethra. Here are missing parts of the three erectile tissue of the penis. As a result, the urethra expands enormously. This developmental disorder often leads to a penile curvature upward.
• epispadias: There is a second urethral opening on the penile shaft.

Scientists believe that a lack of male sex hormones (androgens) during embryonic development is responsible for these malformations.

Acquired penile curvature

The cause of acquired penile curvature is unknown. However, experts have come up with a number of theories to explain how penile deviation can arise.

accident

During sexual intercourse, the penis can easily bend, especially in the beginning erection. This burdens the connective tissue envelopes in the penis. As a result, the smallest lesions and injuries (microtrauma) of the vessels in the penis can occur at these sites. There are no visible bruises. Through an inflammatory reaction of the body, the tissue gradually scarred. The inflamed corporal tissue is replaced and there are the typical plaques and thus the penile curvature.

heredity

Whether some men are more susceptible to penile curvature than others by their genotype has not been proven to this day. However, scientists have found that about 25 to 40 percent of men with acquired penile curvature also suffer from Dupuytren’s disease. Dupuytren’s disease is a condition in which benign connective tissue proliferations result in nodules on the palm of the hand. The simultaneous occurrence of both suggests a genetic link.

Metabolic disorders

Many men go unnoticed the smallest damage inside the penis. However, not everyone develops an acquired penile curvature. Some experts therefore assume a disturbance of the connective tissue metabolism. As a result, it is not the original, elastic fabric fibers that are used for repair, but harder fibers. The result of these remodeling processes can later be felt as typical nodules.

A study by the Faculty of Medicine in Istanbul, Turkey, also shows a connection between the blood sugar disease (diabetes mellitus) and the increased risk of developing penile curvature. The scientific journal BJU International also published a study, according to which diabetics have to reckon with a more severe course of induratio penis plastica. However, there is still a lack of sufficient patients to be able to really prove these connections.

Possible risk factors of penile curvature

Factors that favor the development of acquired penile vagina are poorly understood. So far one could not uncover the connection between illness and risk factors. However, the following risk factors are discussed in the scientific community:

• high blood pressure
• Smoking and alcohol
• Age
• Hard sexual intercourse
• Medications (for example, alprostadil for erectile dysfunction, where the penile curvature is a side effect)
• painful permanent erection (= priapism, here is the penile curvature as a late episode)

Penis curvature: diagnosis and examination

If you have noticed a penile curvature, pain during sexual intercourse or typical indurations on your penis, you should contact a specialist in the urinary and genital organs, the urologist. First, he will ask some questions about the complaints that occur. The urologist will not only talk about your physical changes, but also ask about possible risk factors and your love life.

• When did you notice the crooked penis?
• Was there a trigger for the change, for example, an injury to the penis?
• Has the penile curvature increased since the beginning?
• Do you notice the changes only on the erect penis?
• Can you feel small nodules or indurations along the penis?
• Are the changes causing you pain?
• Do you have problems with sexual intercourse? Can you maintain your erection during sex?
• Is your penis less stiff than before, sometimes only in some places?

Try to overcome your shame and answer the questions as openly and honestly as possible. This seems difficult, but urologists are trained experts. In addition to the kidneys and urinary organs, they also deal with problems and diseases of the male genital organ every day.

Physical examination

After the detailed discussion with the doctor, an examination of the male member usually follows. The doctor assesses whether the penile curvature is seen even in the non-erected state. Furthermore, he scans the penile shaft and examines him for possible hardening or nodules (plaques). The penis is stretched slightly. Thus, the urologist can not only determine the size, location and number of plaques, but also the penis length. As a result, the further course of the disease can be better recorded.

car Photography

In most cases, the extent of penile curvature can only be optimally assessed on the erect penis. Therefore, your doctor asks you to photograph your penis during an erection. In the so-called technique according to Kelâmi, the patient photographs his erect limb from above, from the side and from the front. This is the best way to tell the angle and direction of penis curvature. For best results, take the photos wide-legged and with a neutral background. It is best to ask your partner or partner to take the pictures. Photograph your penis at regular intervals. This is the best way to determine the course of the disease and successful treatment.

Ultrasonic

Ultrasound (ultrasonography), like physical examination, is one of the classic methods of diagnosing penile curvature. Using a small ultrasound head (7.5 MHz), the non-erect penis is examined. This allows the doctor to detect a thickened cavernous shell, deeper plaques and possible calcifications on the hardened areas. After that, the later treatment of penile curvature is directed.

Doppler ultrasound

The so-called Doppler ultrasound (duplex sonography) is necessary to be able to assess the blood flow in the penis. In addition, in the doctor’s office the erection of the penis is triggered by means of special medicines. Substances which cause vasodilation (vasoactive substances, for example prostaglandin E1) are generally used. The drugs are injected into the erectile tissue of the penis. This procedure is medically called cavernous injection test, SKIT for short. By this method, the doctor can assess a pronounced penile curvature. In addition, the urologist can detect whether the blood flows less in the erectile tissue or flows out too fast (penile circulatory disorders). The SKIT is also used to diagnose an erectile dysfunction (erectile dysfunction).

Further imaging procedures

These include special soft tissue images of the penis using X-rays, magnetic resonance imaging (MRI) or computed tomography (CT). However, these examination methods are not among the usual methods to diagnose an acquired or congenital penile curvature. Rather, they are used when a penile curvature could not previously be clearly established or the urologist suspected of another disease. Especially on MRI, the soft tissue of the penis can be displayed well. Possible inflammations of the erectile tissue are thus visible early.

There are no significant differences between the examination and diagnosis of acquired or congenital penile curvature. In the case of an innate penile curvature, the doctor excludes other causes of penile deviation by the individual procedures.

Penis curvature: treatment

For the treatment of an acquired or congenital penile curvature, there are currently no guideline recommendations of German working groups. However, there are many methods that, according to more or less good studies, are considered successful. The European Association of Urology (EAU) has assessed this research on acquired penile curvature and published its findings and recommendations in 2012.

Acquired penile curvature

Especially with the Induratio penis plastica and the associated penile curvature, there are numerous ways to treat the crooked penis. First and foremost is the drug intake. In addition, there are numerous other options for stopping the progression of acquired penile curvature without surgery. An operation is the last resort.

drugs

With a drug therapy is to be achieved, above all, to stop the inflammatory processes in the penis. As a result, the plaques should not even train or enlarge. Medicines are used in the early stages of penile curvature. However, there is no drug that can undo damage caused as the Penisdeviation. The respective substances are either swallowed in tablet form, injected into the cavernous body or the plaques or act on the diseased penis from the outside.

Potassium aminobenzoate is the only preparation that is approved in Germany for the treatment of penile curvature. The treatment costs are covered by the statutory health insurance. This medicine is administered in capsules or as a water-soluble powder. By taking less connective tissue is produced and immune cells are contained, which cause inflammation. As a result, plaques and penile curvature no longer increase. An early therapy for at least three months is particularly useful, so that the Induratio penis plastica can be strengthened in time.

Penis pumps, penis stretcher devices

Penis stretchers either pull on special telescopic rods or elastic bands on the penis. Penile pumps build up a vacuum. So you create a negative pressure that exerts a pull on the penis body. A daily wearing time of six to eight hours is provided. This is intended to grow the healthy penis tissue and at least partially correct a penile curvature. However, most doctors do not recommend therapy with these devices unless the disease progresses. In some studies, good results have been achieved so far.

Creams, ointments, gels and other preparations listed on the Internet (herbs and the like) are not suitable for the treatment of penile curvature. The effect especially of over-the-counter substances is not known.

surgery

Failure to therapy with medication or other non-surgical procedures, the penile curvature is surgically straightened. It is also crucial to what extent the penis is crooked and whether the patient really wishes the surgery. Despite equal penile deviation, some patients feel less affected than others. Often sufferers feel their limitations worse than their sexual partners. In any case, surgery is only performed if no worsening of penile curvature is to be expected (stable disease phase).

Penis curvature up to 60 degrees, plication procedure

If the penis is only slightly or moderately curved up to 60 degrees, two surgical methods are recommended. The first is the so-called Nesbit plication method. On the non-diseased side, an oval part of the connective-tissue cavernosal envelope is excised and the resulting hole is stitched (plication). The second is the Essed-Schröder technique. It is less invasive because the surgeon does without the excision. The skin of the outwardly arched penis side is contracted and sewn. In both methods, the hardening (plaques) are left in the penile shaft. As a result, only a small amount of tissue is injured and the risk of subsequent erectile dysfunction is reduced.

By contracting the healthy side, however, the penis length is inevitably shortened. In addition, it may come after a successful operation again to a slight penile curvature. Patients also complain of pain in the operated area in some cases. Especially an erection would make the pain worse. Therefore, the doctors give in the first few weeks erection-inhibiting drugs, so that the procedure can heal well.

Penis curvature over 60 degrees

In such cases of severe penile curvature, Nesbit’s and Essed-Schröder’s procedures would shorten the penis too much. Therefore, the surgeons try to eliminate the plaques and thus the cause of penile curvature. Hardened and scarred areas are cut and removed. The resulting gaps will be replaced.

This procedure is more complicated than the plication procedure. Therefore, also easier nerves and vessels can be injured. As a result, in some cases, the affected person’s erection worsens. Some patients complain of numbness on the penis. Even if the plaques are removed, the disease can break out again and lead to penile curvature. So that the operated and transplanted tissue does not scar, erections are regularly induced in the subsequent rehabilitation. They help to keep the fabric stretchy.

penile prosthesis

If a patient suffers from both penile curvature and severe erectile dysfunction, a penile prosthesis may be implanted. The operation takes place in several steps. First, the prosthesis is used. These are pillows that are connected as artificial penile erectile tissue with a fluid-filled balloon in the abdominal cavity. Via a pump in the scrotum, the erectile tissue can then be pumped up with the fluid from the balloon. Silicone prostheses have proven less effective because the penis remains permanently stiff and can not always be easily hidden.

As the surgery progresses, the surgeons examine the extent to which the curvature of the penis has improved. If the bend is still too strong, try to bend the penis by pressure (penile modeling). If necessary, the scarred tissue at the point of curvature is removed and replaced with other materials. Since the implantation of a penile prosthesis is a major procedure, the risk of complications also increases. These include above all emotional disorders on the penis or wound infections.

Congenital penile curvature

A penis that has been crooked since birth can only be surgically straightened. Surgical intervention is required when patients are overly impaired during intercourse. Again, the desire of the patient is crucial. Many sufferers are satisfied with the cosmetic aspect as a reason for surgery. The usual methods of plication according to Nesbit or Essed-Schröder are common.

Since any surgical treatment can cause complications such as bleeding, inflammation, scarring, pain and erectile dysfunction or even loss of erection, sufferers should think twice about making the decision. Talk to close confidants. So you can win another picture of your Penisverkrümmung again. You should also be advised by your doctor and your health insurance, what costs you can pay or who is responsible for the treatment.

Penis curvature: disease course and prognosis

An acquired penile curvature can be very different. Sometimes it returns spontaneously, sometimes it stays at a very small curvature, sometimes the disease worsens over time. Congenital penile curvature, however, does not change. Depending on the degree of curvature, intercourse is more or less restricted. However, it is crucial to deal with a penis curvature open. Talk to a specialist of your confidence early on. Eliminate budding fears and fears by talking to him about possible treatments.

Communicate your views, plans and thoughts with your partner. It’s best to go to the doctor’s office together. Many men are less restricted in their sexual activity due to penile curvature. Rather, they feel emotionally burdened by the visually crooked penis. As a result, some sufferers become sad, depressed and unhappy and stay away from their environment. To counter this, visits to a psychotherapist can also be helpful. It can help to alleviate the illness-related, mental fixation on the penis and thus to achieve a better self-esteem.

Also take a serious look at the risks, especially the operational treatment. Many sufferers are quick to surgically straighten their penile curvature. Be aware, however, that complications such as infections or emotional disturbances on the penis may occur. After surgery to remove plaques, erectile dysfunction occurs in over ten percent of cases. Information centers, support groups, doctors, therapists, and close associates can be of great help to get you on the right path penile curvature deal.