What is Penis Curvature?
An abnormal curvature (bend) in the penis that occurs during erection is called Peyronie’s disease or penis curvature. The condition may cause problems with penetration and pain during intercourse. It begins as a localized inflammation and then hardens into plaque or a hard lump that reduces flexibility and causes the penis to bend during erection. The person may avoid sexual intercourse due to this discomfort. This disorder is mostly noticed in white men within the age group of 38 to 62 years of age. Peyronie’s disease or bent-nail syndrome is named after a French surgeon, François Gigot de la Peyronie who first discovered the disease.
Symptoms of Penis Curvature
The plaque formed on the penis is benign or non-cancerous. A plaque on the top or bottom of the shaft causes the penis to bend upward or downward. A plaque on the underside causes it to bend downward. In some cases, the plaque develops on both the top and bottom leading to shortening of the penis. Some men with Peyronie’s disease develop scar tissue on the hand or foot as well. The palpable symptoms are:
1) Narrowing of diameter of the penis with erection
2) Painful erection
3) Bend in the penis with erection
4) Thick band(s) of hard tissue within the penis.
Diagnosis of Penis Curvature
Penis curvature or Peyronie’s disease can be diagnosed by physical examination of the patient. In penis curvature (Peyronie’s disease) fibrous tissue or plaque develops on the lining of the erectile body of the penis (tunica albuginea). The cause of fibrosis is not known. This fibrous tissue causes a bend to develop during erection that is painful and can make intercourse difficult or impossible. The condition is not very common and affects men of 40 and years and above. The plaque is visible even if the penis is not erect. Also, the hard plaques can be felt with or without erection.
For proper evaluation, an erection is induced by injecting medication into the penis or by self-stimulation. The patient may also provide pictures of the erect penis for evaluation. Ultrasound of the penis would show the location of the lesions to evaluate the blood flow throughout the penis.
Causes of Penis Curvature
Peyronie’s disease or penile curvature is believed to be caused by vascular trauma or injury to the penis in some cases, unless it has a genetic cause.
Dupuytren’s contracture: In some men, a cord-like thickening across the palm of one or both hands causing the 4th and 5th fingers to pull in toward the palm. It has been noted that about 2% of men with Dupuytren’s contracture also suffer from penis curvature disorder. This is a fairly common disorder of white men over 50 years old.
HLA B27 reaction: Human leukocyte antigens B27 (HLA-B27) are proteins that help the body’s immune system tell the difference between the cells in the body and foreign bodies. Another risk factor for penile curvature is HLA B27 antigen which can adversely react with other hormones. In fact, studies have shown the link between the presence of this antigen and the condition of penile curvature, clearly indicating a genetic cause.
Weak and poor development: Weak and poor development of the spongy tissue (corpora cavernosa) is an added reason of bend in the penis. If the development of tissue on lower side is more than upper side or vice versa, the lesser-developed side will have more blood circulation. This improved blood circulation would force the apex over the furthest point of leverage resulting in penile curvature.
Restrictive clothing: When young males who put on tight underpants or underwear get erections, their organ is constrained from the usual outward enlargement. These men bend their organ over to the side to conceal an embarrassing erection. This affects the growth of the penile tissue as blood will flow better on one side than the other.
Injury: Sharp or recurring injury or trauma like hitting or bending can lead to blood loss in that particular region. This causes scar-tissue deposition in the tissue space that receives trauma. The injury can lead to pathologic fibrosis and subsequent penile curvature.
Age: Scar tissues can also form due to reduction in the collagen fibers. Collagen reduces with aging. This can lead to penile curvature as well.
Other causes: Therapy with vaso-active substances (group of circulating substances that regulate vascular tone), deficiency of vitamin E, the use of beta-blocking agents and autoimmune phenomena are some other factors contributing to the formation of penile curvature.
Types of Penis Curvature
Cases of Peyronie’s disease or penile curvature can be mild or severe. Symptoms may develop slowly or may manifest suddenly without warning or apparent cause. In severe cases, the bend in the penis during erection occurs because the plaque and inflammation makes the penis less flexible. In some of the milder cases, the inflammation may get cured on its own without resulting in pain or permanent disfigurement of the penis.
Treatment of Penis Curvature
Oral medication: Verapamil, an oral medicine usually prescribed for treating high blood pressure has shown to improve symptoms of penile curvature as well. An injectible form is usually used for the treatment of Peyronie’s disease. Vitamin E and an oral medicine called Potaba are also used sometimes.
Prosthesis Implant: Sometimes, to maintain the firmness of the penis, plastic cylinders which are biologically compatible, inserted into the penis with the help of a surgical procedure.
Shock wave Lithotripsy: This has also been used to treat Peyronie’s disease. This is a non-invasive procedure that uses shock waves to break up hard substances like the plaques on the penis.
Surgery: Since the blood is collected more in one part of the penis than on the other side, an expert urologist can open a blood vessel with surgery so that blood fills into the inadequate blood-filled part, thus straightening the penile curvature.
Indian herbal medication: Some Ayurvedic (Indian herbal) medications have proved to be extremely effective in easing the soreness from penile curvature. Indian herbal products like Shilajit Gold and Butea Superba help to expand the penile arteries and improve the blood circulation in the penis.
Penis massage oil: Penis massage oils, like Orgy massage oil, are available which help to increase the amount of androstenedione, which in turn controls the levels of testosterone. Massage oils containing vitamin E and other herbs help to regenerate the penile tissues and cells.
Radiation therapy/Steroids: Symptoms may go away to some extent with radiation therapy or corticosteroid injections into the fibrous band of tissue. But as there are other methods that have proved effective, these methods are not used very often.
Living with Penis Curvature
It is estimated that probably a large percentage of males between the ages of 40 and 70 may be having mild symptoms of penile curvature or Peyronie’s disease. Medical researchers believe that majority of the cases are not reported due to patient’s embarrassment and shame, hence are left unreported and untreated. The condition is progressive and leads to reduction in length and circumference of the penis and subsequent impotency.
Though sexual disorders are not life-threatening like other chronic physical diseases, they do have an adverse psychological effect in most men with the ailment. With proper treatment the pain decreases over time but in some cases the bend in the penis may remain. This makes sexual intercourse difficult although not painful. The sexual problems that occur will cause low self-esteem, emotional stress and put performance-pressure on the man. This will ultimately disrupt a couple’s physical and emotional relationship.
Prevention of Penis Curvature
Prevention of penile curvature or Peyronie’s disease is not truly possible. However, studies have shown that, those middle-aged men who engage in more vigorous and frequent intercourse are more at risk from Peyronie’s disease. Estimates show that the disease affects approximately 3% of the adult male population in the age group of 40 to 70 years.
The only probable way of preventing this disease is spreading public awareness about the disease and how it can be detected in the early stages. This could go a long way in preventing and well as curing the disease in the early stages before it has a negative impact on the man’s personal and professional life. It is not uncommon for men afflicted with Peyronie’s Disease to show signs of depression and withdrawal from their sexual partners. Also they would be unwilling to talk openly about their concerns with their partner or their physician. But, seeking out a mental health professional in the early stages is vital as a preventive measure.
Special, self-administered manual stretching techniques which exert gentle longitudinal force on the plaque are currently being studied in clinical trials. If successful, this would eliminate the need for medications and other therapies.