Why is my erect penis bent?

Every penis is bit bent and a slight bend upwards is not just normal but desirable.

You may have a problem if your penis is bent to the left or right so much as to make it difficult or even painful to enter your partner during sex.  It could be condition called Peyronie's. This is not an Italian beer. Bent willies are very common and generally do not cause any problem with intercourse. It's a matter of finding what fits, so to speak. If the 'bend' is particularly bad, surgery can improve matters. 

What is Peyronie's disease?

A condition in which the penis becomes curved during an erection.

What are the main symptoms?

• Hard lumps, known as plaques, form in the fibrous erectile tissue of the penis.
• A plaque usually forms on the top of the shaft, causing the penis to bend upward.
• A plaque on the underside causes it to bend downward.
• If the plaque develops on both the top and the underside of the penis this can lead to indentation and shortening of the penis.
• The thickened area may be painful when the penis is erect.
• It can be difficult to get an erection (the plaques may obstruct blood flow in the penis). The anxiety caused by Peyronie's disease can also impair sexual performance and be a psychological cause of impotence.
• The pain and the bending of the penis may physically prevent sexual intercourse.

What's the risk?

There is no firm evidence on the number of men with Peyronie's Disease but it is thought to affect 1 to 9% of men.

• Men aged 50—60 are most at risk, although the disease occurs in younger and older men.
• There is some evidence of a familial link to Peyronie's disease — a man with relatives affected by the condition is more vulnerable to developing it.

N.B. The lumps in Peyronie's disease are benign and not linked to cancer of the penis. Nor is it caused by sexually transmitted infections, such as gonorrhoea.

What causes it?

Doctors are not entirely certain what causes Peyronie's disease. Many experts believe it is the result of damage to the penis, causing internal bleeding. There is some evidence that the elasticity of the penile tissues is reduced in older men and that minor damage may occur (without any obvious outward signs) during sexual intercourse. Some cases may be caused simply by turning over in bed while asleep with a nocturnal erection.

In mild cases the plaque does not advance beyond an initial inflammatory stage, but in severe cases tough fibrous tissue develops and calcium deposits may even build up.

While injury may cause some cases of Peyronie's disease, most cases develop slowly and after no apparent trauma.

Severe hypospadias, where the opening of the urethra is on the wrong part of the penis, can also cause curvature of the penis. This condition is different from Peyronie's disease, however.

How can I prevent it?

You can't, except perhaps by avoiding sexual acts which might damage or over-stretch the penis. 

Should I see a doctor?

If you notice lumps in your penis, you should go straight to your GP. There is no need to worry about having an examination: it may be embarrassing, but doctors are very familiar with Peyronie's disease. They can also rule out any other possible causes.

If you have only had the problem for a short time the doctor may ask you to come back in a month or so if the problem persists. But if you are in pain, or if the condition is affecting your sex life and relationship, insist on a referral to a consultant or to another GP with a special interest in sexual problems. There are also special NHS clinics to treat male sexual problems.

How is it diagnosed?

You will need to have a physical examination. No medical tests are usually necessary. 

What are the main treatments?

Surgery is the only treatment known to be effective. However, many men with Peyronie's disease need no treatment, because in its mild form the condition heals by itself in 6—15 months. Many doctors therefore suggest that men wait one to two years before having surgery. At the end of this period there may be a residual curvature of the penis but, if intercourse is possible without pain, no further treatment is usually required.

Prior to surgery some men try other treatments, as listed below, but their effectiveness is unproven.

• Your doctor can prescribe vitamin E tablets or potassium aminobenzoate, known as Potaba. Some improvement has been reported but their effectiveness remains unproven.
• The affected area may be injected with steroids or other chemical agents to attack the build-up of plaques. This can reduce pain, but steroids such as cortisone have led to unpleasant side-effects, including the wasting or death of healthy tissues.
• Radiation therapy has also been used. This can also reduce pain but appears to have no effect on the plaques and can also cause unpleasant side-effects.
• In the early stages of the disease the drug tamoxifen has been shown to reduce the build-up of plaques. However, the drug is usually given to treat breast cancer and is not licensed for the treatment of Peyronie's disease.

Surgery

About 10% of men have surgery. It's not usually considered unless you have been affected for a year and have difficulties performing sexual intercourse.

There are three operations available:

• Removal of the plaque and grafting with a patch of tissue. This can lead to erection problems, particularly loss of rigidity.
• Removal of tissue from the side of the penis opposite the plaque to cancel out the bend. This is known as the Nesbit procedure. After the operation the erect penis will be straight, but there may be some shortening of the erect penis.
• A device can be implanted in the penis to increase its rigidity. This may be combined with incisions and skin grafts if the penis is still not straight. This procedure is usually only required if there is softness (flaccidity) of the end of the penis (the glans penis) during erection. 

How can I help myself?

If the disease is affecting your sex life this may in turn damage your self-esteem and perhaps cause depression. It could also affect your relationship with a partner. You may find it helpful to talk your feelings through with your partner or with a counsellor experienced in sexual problems. 

What's the outlook?

Many men with Peyronie's disease will only be mildly affected and the condition will disappear with time. In severe cases surgery can correct the problem but you may be left with a shorter penis or it may not be as hard when erect. Although this may not prevent you from having sex it may still cause some anxiety. Counselling and discussing the situation with your partner can help. 

Where can I find out more?

Know Your Knob: all our penis health links

Free PDF of Size Isn't Everything - all penis FAQs answered

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MAIN IMAGE: It's a Google Beer by Richard Riley licensed under CC BY 2.0. Amended.