Advice: If the patient is unable to penetrate, or there is troublesome discomfort for either partner on penetration, refer.
Refer To: Urologist.
Congenital penile curvature
Differing amounts and angles of curvature exist, and most are not troubling. As a rule of thumb, as long as intercourse is possible and not problematic, things are best left alone. For patients who are distressed or concerned, urological referral is warranted, more often for reassurance than treatment.
Acquired penile curvature
Two forms exist, with different aetiologies, but similar clinical management:
- Post traumatic (untreated penile fracture, or sub-clinical injury)
- Peyronie’s deformity
Peyronie’s affects about 3% of males, and is the most common cause of erectile deformity. It can be painful in the early stages until the fibrotic process has burnt-out, it is distressing, and may be associated with erectile dysfunction.
Various treatments have been tried. Most cases do not need surgical treatment, as long as penetration is possible. Surgery is only considered in a small subset of patients and the following criteria need to be met:
- Stable, non-progressing disease (minimum 6 months from onset)
- Pain should be absent, which indicates the disease has stabilised
- Erections should be adequate, even with the curvature
- Penetration is not possible or is uncomfortable for one or other partner
Please feel free to refer patients at any stage of the disease, as the explanation and counselling process can be protracted.