Definition of Curvature of the penis:

An abnormal curvature (bend) in the penis that occurs during erection is called Peyronie's disease. The condition may cause problems with penetration and pain during intercourse.

Causes, incidence, and risk factors:

In Peyronie's disease (curvature of the penis), fibrous tissue develops on the tunica albuginea (the lining of the erectile bodies of the penis). The cause of fibrosis is not known.

The condition occurs in about 388 of 100,000 men. The fibrous tissue causes a bend to develop during erection that is painful and can make intercourse difficult or impossible. The condition is relatively uncommon and affects men between 40 and 60 years and older.

An association has been noted with Dupuytren's contracture, a cord-like thickening across the palm of one or both hands causing the 4th and 5th fingers to pull in toward the palm. This is a fairly common disorder of white men over 50 years old. However, only 1 to 2% of individuals with Dupuytren's contracture develop curvature of the penis.

Other risk factors have not been identified. Also, there is an association with HLA B27 antigen cross-reactivity. A person with this condition has a particular type of immune cell marker that indicates the condition may be inherited.

Symptoms:

• Painful erection
• Bend in the penis with erection
• Narrowing of the diameter of the penis with erection
• Thick band or bands of hard tissue within the penis

Signs and tests:

Physical examination is sufficient to diagnose curvature of the penis. The hard plaques can be felt with or without erection. It may be necessary to use injectable medications to induce an erection for proper evaluation of the penile curvature.

The patient may also provide pictures of the erect penis for evaluation by the physician. Ultrasound of the penis may demonstrate the lesions in the penis, but is not necessary.

Treatment:

Symptoms may go away somewhat with radiation therapy or corticosteroid injections into the fibrous band of tissue. Verapamil, a medicine taken by mouth to treat high blood pressure, has been shown to improve the disease. An injectable form of the medicine is approved for the treatment of Peyronie's disease. Vitamin E and a medicine called Potaba (taken by mouth) are also sometimes used.

Shock wave lithotripsy has also been used to treat Peyronie's disease.

If medicine and lithotripsy do not help, and intercourse is not possible because of the curvature of the penis, surgery may be done to correct the curvature. However, such surgery carries a risk of impotence, and should only be done if intercourse is impossible.

Expectations (prognosis):

The condition is typically progressive and leads to inability to have intercourse. The disease is also associated with development of impotence.

Complications:

The condition may make intercourse difficult, painful, or impossible. Surgical correction may also lead to impotence.

Calling your health care provider:

Call your health care provider if symptoms indicating curvature of the penis occur, particularly if erections are painful.