Peyronie’s Disease (Curved Penis)

Peyronie’s disease, or congenital penile curvature, is the result of the development of a fibrous “plaque” or scar tissue between the elastic covering of the penis (tunica albuginea) and the corpora cavernosa of the erect penile tissue. The penis is a highly vascular organ, divided into three main structures: the paired corpora cavernosa, which fill with blood to cause an erection, and the spongy corpus spongiosum, which surrounds the urethra and lies on the underside of the penis.

During an erection, the erectile tissue fills with blood, causing the penis to lengthen and become rigid. If scar tissue develops in this tissue, it can restrict expansion in the affected area. This may result in curvature and pain during erection.

Symptoms

Symptoms of Peyronie’s disease include:

• Penile curvature
• Pain that worsens during erection
• Difficulty achieving or maintaining an erection
• The penis may be rigid up to the scar, while the distal part remains flaccid
• Constriction may create an “hourglass” appearance
• In severe cases, the curvature may make penetration painful or mechanically impossible

Causes

The exact cause of Peyronie’s disease is unknown, though several theories exist. Many patients recall a history of minor trauma during sexual activity, such as accidental impact against the partner’s pelvic bone. Repeated micro-traumas may lead to scar formation. A hereditary component may also exist. Approximately 10% of men with Peyronie’s disease have Dupuytren’s contracture—a similar scarring process in the penis and the fourth finger of the hand. Associations with the HLA-B27 histocompatibility antigen suggest a possible genetic or autoimmune component.

Clinical Course

The clinical course varies. In approximately 50% of cases, the disease is self-limiting and does not worsen. Plaque development usually stabilizes within 12 months and may resolve without treatment during this period.

Treatments

Non-Surgical Treatments

Medical therapies include oral medications such as vitamin E, Potaba, and colchicine, though their efficacy remains unproven. These may be attempted during the initial 12-month plaque stabilization period but can have contraindications. Intralesional injections of steroids, collagen, interferon, and verapamil have been studied but remain experimental.

Caution is advised, as injecting substances into the penis may worsen plaque formation. Radiation therapy and ultrasound have been used in patients with significant pain. While these methods can alleviate pain, they rarely improve curvature.

Surgical Treatments

Surgery is the only treatment proven to correct curvature and reduce pain long-term. Various reconstructive techniques exist and are tailored to the individual case:

• Corporal Plication: Sutures are placed opposite the curve to straighten the penis. Suitable for moderate curvature, minimal pain, and cases where length preservation is not the primary concern.
• Patch Corporoplasty: Scar tissue is excised and replaced with a graft (e.g., vein, skin, or synthetic material such as GORE-TEX) to correct curvature while preserving length. Often performed along with circumcision if needed.
• Penile Implantation: Recommended for patients with severe erectile dysfunction combined with Peyronie’s disease, allowing correction of both curvature and functional impairment.

Most procedures are performed in outpatient settings or with short hospital stays, under local or general anesthesia.