We evaluate all of our patients referred for penile curvature with a complete history and physical exam. In general, the actual curvature is not appreciated during a physical examination when the penis is flaccid. Therefore, we encourage our patients to bring digital pictures of the penis when erect from several different angles as this provides clear documentation of the extent of curvature. The following is an example of a patient with disabling curvature from Peyronie’s Disease (peyronie’s pictures below). Although the majority of patient with penile curvature secondary to Peyronie’s Disease have upward curvature, this patient had downward curvature when erect.
Erect Penis with downward curvature from Peyronie’s Disease
Lateral (to the side) and upward bend
Another view of disabling curvature
Young men are often referred with a diagnosis of Peyronie’s Disease and report that their curvature is life long. This is not Peyronie’s Disease, but rather Congenital Penile Curvature. Men with Conginital Penile curvature were born with a penis that is longer on one side than the other. Often the curvature is to the side but can be upward or downward. The penile length is usually very adequate and there is no plaque or scarring. When there is a history of hypospadias, and a patient reports downward curvature, or epispadias (a birth defect affecting the top of the penis) and the patients has upward curvature, this is also generally not Peyronie’s Disease. In contrast to a bent curved penis associated with an abnormality at birth, Peyronie’s Disease is an aquired condition characterized by an immature and mature phase.
When a patient develops a bent penis, the affected tunica albuginea first develops changes that are inflammatory. Often this area is under the skin along the top of the penis and can be felt as a plaque. This thickening, which may be tender to the touch, is not an infection of the penis and is not penile cancer, and is not sexually transmitted. Often, but not always, patients have pain with erections. This initial active immature phase may last over 12 months in contrast to the inflammation associated with many sports injuries that resolve after several weeks.
Eventually, the acute inflammation subsides. At that point, any pain generally resolves and any penile curvature that develops may also resolve. However, as the disease progresses and the scar matures and becomes more dense, it is not uncommon for the bend and curve in the penis to increase. Maturation of the Peyronie’s plaque can be associated with a change in penile curvature as the size and elasticity of the plaque changes. Stable mature disease is characterized by a resolution of any pain and an absence of change in curvature for at least 6 months.