Bending and twisting of the penis

What’s normal?
An absolutely straight penis is unusual – most have a slight curve when erect. But this should not be more than about 25° from straight, like a banana. If your penis bends more than this, you might have Peyronie’s disease.

It is also quite normal and harmless for the penis to have a slight twist (usually anticlockwise).

Peyronie’s disease
A condition called Peyronie's disease, in which the penis becomes crooked when it is erect, occasionally develops in men. This can make sexual intercourse difficult, if not impossible. The condition is named after Dr François Gigot de la Peyronie (physician to King Louis XV of France) who wrote about it in 1743, but it has probably been around for much longer; sculptures dating from the 6th century BC depict angulated erect penises. It is estimated that about 1 in 100 men has Peyronie’s disease.

Peyronie’s disease most commonly occurs in men aged 50–60, but it can occur in young men and in old age. The cause is thickening of the fibrous tissue in the penis on one side. This means that, during an erection, one side of the penis cannot lengthen, and the penis will bend. The direction of the bend depends on the position of the thickening (which can often be felt as a lump or lumps when the penis is limp).

You may be able to feel the thickened area; it feels like a hard piece of toffee.

Will it get better? For the first 9–18 months after Peyronie’s disease starts, it is often quite painful, especially when the penis is erect. During this period, the thickened area increases in size. After this ‘active period’, it is unlikely to become worse. In 20% of cases, the penis will go back to normal without any treatment. Those who have had the condition for a long time feel no pain but sometimes have difficulty achieving an erection (perhaps because the lumpiness is obstructing blood flow in the penis).

What causes Peyronie's disease? No one knows why the thickening occurs, but it is not a cancerous condition, nor is it the result of sexually transmitted disease or of any odd previous sexual practices. It is more common in smokers. There seems to be a link with some other conditions. For example, men with Peyronie’s disease are quite likely to have Dupuytren’s contracture, a thickening of fibrous tissue in the palm of the hand. They are also quite likely to have raised blood pressure; some doctors think that the blood pressure itself might be responsible for the penis problem, while others blame the drugs used to treat blood pressure (particularly beta-blockers).

Treatments. There is no need to feel embarrassed about discussing the problem with your family doctor, because doctors are very familiar with the condition. It may be difficult for your doctor to assess how severe the problem is, because the curvature shows only when the penis is erect. If you have a digital or instant-picture camera, take a photograph of your erect penis and show it to your doctor. (You might wish to tell your doctor that you were advised to do this in a book written by a doctor.) If it is only mild and does not cause any inconvenience, no treatment is necessary.

Cocoa butter cream. Some men with mild Peyronie’s disease say that massaging cocoa butter cream (available from pharmacies) into the curved area is helpful.

Steroid injections. In the past, the most common treatment was steroid injection into the thickening, but this is now less popular.

Vitamin E tablets are sometimes recommended, but scientific evidence to show that they help is scanty. Do not take more than 250 mg of vitamin E a day, because higher doses may damage your health.

Tamoxifenis a medication that may reduce the thickened area. This medication is also used for breast cancer, but Peyronie’s disease is not related to breast cancer.

Sound waves are a new treatment for Peyronie’s disease. Preliminary research has shown that high energy sound waves reduce pain, and also decrease the size of the thickened area somewhat. More research is needed to see how effective this treatment really is.

Verapamil is a medication that is used to treat blood pressure. Injections of verapamil into the thickened area may help, but more research is needed.

Surgery to correct the deformity is the most effective treatment. In the usual operation, the surgeon cuts out some tissue from the opposite side to balance out the thickened area. After the operation the erect penis will be straight and 1–3 cm shorter than before when erect, but many men do not notice any difference. Studies have shown that only 58–88% of men are satisfied with the result of the operation, partly because it straightens the penis but leaves the thickened area in place so it may still be painful. Also, a few men have difficulty achieving an erection after the operation.

In another type of operation, the surgeon cuts a slit in the thickened area and inserts a piece of tissue (usually a piece of vein from the groin or ankle). This makes the area more flexible, and there is no shortening of the penis. However, 10–15% of men have difficulty in obtaining an erection after this operation.