Congenital penile curvature: causes, symptoms and surgical correction

Congenital penile curvature is a curvature of the penis present from birth, caused by asymmetrical development of the corpora cavernosa. Unlike Peyronie's disease, there is no plaque and no inflammatory process: it is a malformation, not an acquired condition. It usually becomes apparent after pubertal development, when the penis reaches its final size, and it is corrected surgically.

A little history: the Nesbit technique

In 1965 the American urologist Reed N. Nesbit, of the University of Michigan, described three young patients with an abnormal curvature of the penis on erection, caused by asymmetry in the size of the corpora cavernosa — an anomaly never before described in the literature. In his paper Nesbit clearly set out the technique for correcting it. Reports of the condition subsequently multiplied, and the Nesbit technique became the most widely used method of correction.

Cause: asymmetrical development of the corpora cavernosa

The precise cause is not yet understood. The malformation consists of an asymmetry of development between two opposing surfaces of the corpora cavernosa: one surface develops fully and is longer, while the opposite surface remains shorter, being incompletely developed. It is this difference in length that produces the curvature on erection, towards the side of the shorter surface.

Symptoms: the direction of the curvature

The curvature appears on erection, when the disproportion in length between the surfaces of the corpora cavernosa becomes evident. Its direction depends on which surface is less developed:

• Downward (ventral) curvature: the most frequent
• Lateral curvature, to the right or to the left: when the asymmetry involves a lateral surface of the corpora cavernosa
• Upward (dorsal) curvature: rare

In some cases the curvature may be complex: associated with rotation of the penis on its own axis, or involving two surfaces of the corpora cavernosa at once, producing the so-called “S-shaped” curvatures. Correcting these forms is a more complex problem and should be entrusted to surgeons with specific experience in the field.

Treatment: surgical correction

Treatment is essentially surgical. The principle of the operation is to restore symmetry between the two surfaces of the corpora cavernosa: the longer surface is shortened to match the length of the shorter one, thereby correcting the curvature. This is the basis of the Nesbit technique.

The reduction in length does not compromise sexual activity

Shortening the longer surface results in a slight reduction in the length of the erect penis, generally by 1 or 2 cm. In practice this causes no problem for sexual activity: patients with congenital penile curvature from asymmetry of the corpora cavernosa typically have a penis that is longer than average, so the loss of 1–2 cm is not a disadvantage.

Frequently asked questions about congenital penile curvature

What is the difference between congenital penile curvature and Peyronie's disease?

Congenital penile curvature is present from development, caused by asymmetrical growth of the corpora cavernosa: there is no plaque and no inflammation. Peyronie's disease is acquired, with a fibrous plaque that forms as a result of an inflammatory process. They are two distinct conditions, with different causes and course, even if surgical correction of the curvature may use similar principles.

When is congenital penile curvature noticed?

Usually after pubertal development is complete, when the penis reaches its final size and the curvature on erection becomes evident. Being congenital, the defect is present from birth but becomes apparent at this stage.

Can congenital penile curvature be corrected?

Yes, surgically. The operation shortens the longer surface of the corpora cavernosa to restore symmetry and correct the curvature. The slight reduction in length that results does not compromise sexual activity.

Is penile curvature always abnormal?

No. A degree of curvature on erection is normal. Congenital penile curvature is diagnosed when the curvature is marked and, in particular, when it mechanically interferes with intercourse. Specialist assessment determines whether and when to intervene.

Can complex curvatures be operated on?

Yes, but they require specific expertise. Complex forms — with rotation on the axis or simultaneous involvement of several surfaces of the corpora cavernosa (“S-shaped” curvatures) — are a more delicate surgical problem that should be entrusted to surgeons experienced in reconstructive penile surgery.

Have you noticed a marked curvature of the penis on erection? Ask Prof. Natali for a consultation or book an appointment at his practices in Florence and Empoli, Italy.

The information on this page is provided for general educational purposes and does not replace a medical examination, which remains the only diagnostic tool for correct and effective treatment.