The curvature of the penis can be ventral or dorsal, left or right and sometimes cases of vertical rotation of the shaft coexist with the curvature.
The cause can be congenital (5-8% of the population), that is present at birth, or acquired (3-4% of the healthy population but up to 20% in subjects with impotence, diabetes, vascular conditions etc.).
a) Congenital causes
In congenital causes there is an asymmetry in the development of the cavernous bodies which determines a curvature towards the shorter side.
The condition is present at birth but becomes evident after puberty once sexual development is complete and it does not change over time (recurvatuum penis)
b) Acquired causes
The acquired forms are determined by traumatic events which cause fibrosis (pathological increase of the fibrous, non elastic connective tissue, characterised by a massive presence of fibroplasts and a scarcity of cells and veins ) the cavernous bodies, traumatic breakages like a fracture of the penis but they are often a consequence of a disease named IPP (Induratio Penis Plastica) or Peyronie’s disease.
The precise origin of Peyronie’s disease is unknown but among the various hypotheses it is supposed that it is linked to repeated micro traumas in genetically predisposed subjects.
The condition is characterized by the formation a plaque or fibrous thickening located in any point of the penis lining (tunica albuginea).
The fibrous area is not extensible, therefore during erection it acts as a pivot and the penis curves toward the side with the lesion, which will be as accentuated as the plaque is evident.
Peyronie’s disease can evolve over time until it reaches a point where the disease is said to be stable and only then is it possible to intervene surgically.
The procedure: surgical correction of curvatures with an angle greater than 45°
The treatment for curvature of the penis is surgical and can be one of two types:
a) the size of the convex side is reduced so that it becomes the same as the concave side or
b) the smaller side is operated on and expanded using a patch (insert of material foreign to the penis).
With this technique, however, the risk of altering a delicate mechanism such as that of erection is high and therefore the method is reserved for cases of very striking curvature and in many cases the correction of the curvature is combined with the insertion of a penile prosthesis.
The Procedure: surgical correction of curvatures with an angle less than 45°
In the case of not particularly accentuated curvatures a procedure referred to as Nesbitt’s with its variations is used and consists in reducing the longer side, thereby correcting the curvature.
The result obtained from the procedure is a fundamentally straight penis which is certainly shorter that the pre-surgical condition.
Since reduction of length is often viewed negatively by the patient, correction of the curvature is combined with a penis elongation technique in order to have the straightening effect but at the same time avoiding the loss of length there by rendering the correction acceptable.
Since surgery of penis curvature involves the cavernous bodies there exists the slightest risk of altering the erectile mechanism so it is preferred to operate only on those curvatures which effectively render intercourse difficult or impossible, unless a slight curvature doesn’t result to be a source of great psychological discomfort.