Penile straightening refers to medical procedures designed to correct an abnormal curvature of the penis that occurs during an erection. While a slight bend is common and generally not a medical concern, a pronounced curve can lead to functional difficulties and psychological distress. Curvature becomes medically significant when it causes pain, prevents successful penetration during sexual activity, or results in a noticeable shortening or deformity.
Understanding Abnormal Curvature
Curvature requiring intervention typically falls into two main categories: congenital and acquired. Congenital curvature, sometimes referred to as chordee, is present from birth and results from a developmental difference in the length or elasticity of the connective tissue sheaths surrounding the erectile bodies. This condition is usually noticed during puberty and does not involve the formation of scar tissue.
Acquired curvature is most frequently caused by Peyronie’s disease, which involves the formation of a fibrous plaque within the tunica albuginea. This plaque is composed primarily of disorganized collagen, leading to inelasticity and causing the penis to bend toward the scar tissue during an erection. Peyronie’s disease progresses through an acute phase, characterized by painful erections, followed by a chronic phase where the pain resolves but the deformity stabilizes.
Intervention is sought when the curvature angle exceeds 30 degrees, impeding intercourse, or when it is accompanied by significant pain or psychological burden. Diagnosis involves a physical examination and often includes inducing an artificial erection in the clinic using an injectable medication. This allows the physician to precisely measure the degree, direction, and complexity of the curvature for treatment planning.
Non-Invasive Treatment Options
Conservative treatment is generally reserved for patients in the acute phase of Peyronie’s disease or for those with mild curvature. The most widely studied non-surgical intervention is the use of injectable medications aimed at breaking down the fibrous plaque. Collagenase clostridium histolyticum (CCH) is the only medication approved for this purpose, indicated for men with stable disease and a curvature of 30 degrees or greater.
CCH is an enzyme mixture that selectively degrades the excess collagen making up the inelastic plaque. The injection is performed directly into the plaque, followed by modeling by the physician and patient to physically stretch the softened scar tissue. Treatment involves a series of injection cycles and is often combined with mechanical stretching exercises.
Mechanical therapies, such as penile traction devices (PTDs) and vacuum erection devices (VEDs), are also commonly used to remodel the tissue. PTDs apply a continuous, gentle force (mechanotransduction) to encourage cellular remodeling and tissue lengthening. Clinical data suggest that daily use of a traction device can reduce curvature by an average of 12 to 20 degrees and may help recover some lost penile length. VEDs create a negative pressure environment, drawing blood into the penis to expand the erectile tissue and stretch the tunica albuginea.
Surgical Correction Procedures
Surgery is considered the definitive treatment for severe or complex curvature that has stabilized and failed to respond to non-invasive therapies. The choice of surgical technique depends on the severity of the curvature, the presence of erectile dysfunction, and the patient’s existing penile length. All procedures require inducing a temporary artificial erection to ensure precise correction of the deformity.
Plication
Plication involves shortening the side of the penis opposite the plaque to match the contracted side. Techniques like the 16-dot plication utilize sutures placed in the tunica albuginea on the convex side, creating a tuck that straightens the shaft. Plication is generally reserved for patients with a curvature less than 60 degrees who have sufficient penile length, as this procedure results in a measurable degree of shortening.
Grafting
For more severe deformities, such as curvatures exceeding 60 degrees, or for patients with significant shortening, plaque incision or excision with grafting is the preferred method. This technique involves surgically cutting or removing the inelastic plaque and filling the resulting defect in the tunica albuginea with a graft material. Grafting materials include:
- Autologous tissue, such as a saphenous vein segment taken from the patient’s own body.
- Non-autologous substitutes like bovine pericardium.
- Collagen fleece.
Penile Prosthesis
The most complex cases, particularly those involving severe curvature combined with erectile dysfunction unresponsive to medication, are often treated with the placement of a penile prosthesis. An inflatable implant is inserted into the erectile chambers to provide rigidity, which often corrects the curvature through simple dilation. If a significant bend remains after implantation, the surgeon can perform an additional straightening maneuver, such as manual modeling, plication, or plaque incision, to achieve a functionally straight result.
Post-Treatment Expectations and Results
Post-treatment recovery varies significantly depending on the method used. Recovery from non-invasive treatments, such as CCH injections, involves minor bruising and localized pain, with the full result realized after the entire treatment cycle is complete. Patients typically resume sexual activity within a few weeks of the final injection and modeling session.
Surgical recovery is more involved, requiring patients to refrain from sexual activity for about six to ten weeks to allow for complete internal healing. While plication fully corrects curvature, it carries a risk of penile shortening, typically ranging from one to three centimeters. Grafting procedures minimize shortening but carry a higher risk of developing new or worsening erectile dysfunction, reported in 20 to 30 percent of cases, and a risk of temporary or permanent changes in penile sensation.
The success rate for achieving functional straightening, defined as the ability to engage in pain-free intercourse, is high for all surgical options, often exceeding 80 percent. A small degree of residual curvature may persist, and patients must maintain realistic expectations regarding cosmetic appearance and potential changes in sensation. Following surgery, some patients are encouraged to use a traction device for several months to help maintain length and prevent recurrence.