Updated: Mar 11
Dear Dr. K, My erections used to be straight and firm. Now my penis has a bend in it. What’s up with that?
Normal penises can have a slight bend or curvature in the non-erect or erect state. A newly developed bend or angulation in an erect penis is most often the result of a fibrous plaque that forms in the penis. This plaque is usually the result of some injury to the penis, most commonly during sex but also may occur following a sporting injury. This is called Peyronie’s disease (PD). The causative injury may be insignificant, or a man may feel a popping sensation in the penis, most often during sex, followed by pain and perhaps bruising. Inflammatory cells respond to the injury and lay down a matrix of fibrous tissue, forming a thickening in the lining of the penile shaft.
There may be a genetic factor involved as PD can be seen in family members. Dupuytren’s contracture in the hands and feet may result from a similar inflammatory response which may have an underlying genetic component. In the shaft of the penis are two chambers (corpora cavernosa) that are filled with a spongy material which fill up with blood during an erection. Each chamber of this spongy material is encased in a tough but elastic sheath (tunica albuginea) that expands as the spongy tissue fills with blood.
In Peyronie’s disease, a fibrotic plaque forms in the sheath. This plaque keeps that area from expanding normally and causes the penis to bend toward the plaque. In some cases, the plaque causes a girdle-like narrowing in the shaft. Not only can this make intercourse painful for both parties, it also may make it nearly impossible to insert the penis because it bends. PD also causes loss of length and girth of the penis.
In the past, treatment for PD involved injections directly into the plaque (not as much fun as it sounds) to try to soften and dissolve the plaque. Oral fibrinolytic agents have had varying degrees of success.
Surgery may not be the best answer
The plaque can be removed surgically. Surgery can result in permanent loss of length and girth. Multiple surgeries to remove the plaque may be necessary. Penile implants are used when these modalities are unsuccessful. The penile prothesis is implanted in the shaft of the penis. The implant is “inflated” manually via a pump in the scrotum. With the implant there is the potential for permanent loss of length and girth of the penis.
Low Intensity Shock Wave Therapy (Li-SWT) is a significant advancement in the treatment of PD. Li-SWT when applied directly to the area of the plaque, will promote softening and dissolution of the plaque as well as stimulating new blood vessel growth in the area. As the plaque softens, the bend in the penile shaft lessens, erections become firmer, and there is some return to the former size of the penis. With Li-SWT, there are no injections or incisions and the procedure itself is relatively painless.
Renewal Medical Centers of North Texas provides Li-SWT. Our staff and physician will be glad to provide you more information and answer any questions you may have about Li-SWT and whether you are a candidate for this therapy.