"Is having a curved or crooked penis normal?" A very frequent consultation

The pathology known as congenital curvature of the penis is not an aesthetic problem but is a real problem that concerns sexual health. Many men suffer a lot of fear and embarrassment because of this problem when facing their first sexual relation.

Why does the curve of the penis appear?

There are different types of penile curvature. But they are all related to the disproportion between the three bodies that make up the penis. The composition of the penis consists of a spongy body through which the urethra passes and two cavernous bodies in which the blood that produces the erection is concentrated. These penile structures or bodies must be elastic and flexible. When one of these three structures has a shortening or elongation there is an asymmetric development of the penile bodies that result in a curve in the penis.

When the imbalance occurs in the spongy body the disproportion appears between the length of the urethra and that of the body of the penis, this causes, in most cases, that the meatus, that is, the urine outlet is somewhere in the penis that is not the limit of the glans. This type of asymmetry can become very traumatic in children with congenital curvature.

Types of hypostasies according to their position

In spite of this, it is not until adulthood, commonly between 18 and 25 years old, when sexual life begins and the patient realizes that this hinders their sexual relations, and that is why many boys come to the consultation in search of a correction of this curve that affects their sexual health.

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It also depends on the type of penile curvature, as there are certain curves that are actually more problematic both physically and psychologically. We must understand that these asymmetries or disproportions of the penis are really visible or problematic when the penis is erect.

For this reason it is also common to worry about this incurvation during adolescence, when erections begin to occur and then the problem becomes visible. Is common for the parents to accompany their child to consult in search of a solution. Dr. Cruz advises not to have surgery until adulthood unless the child has a psychological problem or the physiology is detrimental to the free development of the adolescent’s sexuality.

Types of curvature

Three types of curvature are described:

Dorsal lateral curve difference 01

Dorsal lateral curve difference 02

Dorsal lateral curve difference 03

Dorsal lateral curve difference 04

It is advisable to take certain things into account when assessing whether you suffer from a pathology related to penile curvature. It is completely normal not to have a totally straight penis and men should know that most penises are slightly curved. That’s why you have to set certain limits between what’s normal and what’s really a problem.

A curvature or deviation with an angle of less than 15 degrees is very common and should not be corrected or cause disorders unless it causes pain during erection or hinders sexual intercourse. When the curvature is greater than 30 degrees it can produce in the patient some difficulty in the sexual relation or discomfort in the penetration, besides the aesthetic concern of his penis in erection. Sometimes, the loss of axial rigidity due to the alteration of the geometry of the penis can make penetration difficult.

How to measure a penis curve

Solutions and treatments

The solution to the curve of the penis is surgery. Surgically there are two tendencies to balance the penis, they are lengthening or shortening. The most used and the one that gives less problems is the shortening. With this type of surgery, between 1 and 2 cm of penis are usually lost. The surgeries that lengthen the short part are less common because they are more complex. This type of surgery tends to reduce the penis by less than half a centimeter or even no reduction. The real problem with this type of surgery is that no synthetic implant has been obtained that correctly or faithfully replaces the natural tissues of the penis.

Lately we are implementing in our urological practice in Sevilla, a patch of albuginea from one side to the other. It consists of removing tissue from one side and putting it on the other, by way of transposition. In this way the cavernous body has the same coverage that it already had. This technique called “plication of the tunica albuginea” is having excellent results and the patients are really satisfied.

Normally these patients do not have a small penis, although in the ventral curvature or downward (which is the most common) if we talk about shortening, the man is used to seeing the larger side of his penis and not the other way around, so the psychological effect after the operation can be negative. Physician-patient communication is very important to reassure and avoid later problems.

Peyronie surgical treatment 01

Peyronie surgical treatment 02

Peyronie surgical treatment 03

Peyronie surgical treatment 04

There are many similarities between congenital curvature of the penis and Peyronie’s disease. It must be said that this disease of unknown origin usually occurs in adult men around the age of 50 and is characterized by a fibrous band in the tunica albuginea of the corpora cavernosa of the penis that prevents blood from arriving normally during erection, which causes decompensation with the other cavernous body and resulting in the curve of the penis.

VIDEO: What is and what is the treatment of Peyronie's disease or acquired curvature of the penis?

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However, although when choosing the surgery in each case can have both a similar solution, between congenital curvature and Peyronie’s disease there are differences that must be taken into account when operating. The most fundamental is the age of the patient. Scarring is faster in children than in adults, however, the erections of young boys are more intense than that of men around 50 years, so the postoperative and the risks of poor healing are different in both cases.