By James Snyder, MD
As a preface, I should mention that Routine Infant Circumcision (RIC) is the reason/cause of some penile curvature in adult men (which is distinct from Peyronie’s Disease or Chordee — see below). The operators in this procedure may be medical students, nurses/midwives, obstetricians, pediatricians, or anyone who is being taught to do a “simple” infant circumcision. The fact is this procedure is often underestimated in terms of risk, and it is delegated to the least experienced operator. Removal of skin from the penis to reveal the Glans Penis is the primary goal, but the results/complications/mistakes of the operator may become evident only after years have passed and the subject is unable to obtain redress of grievances. The most careful RIC removes up to 1/3 to 2/3 of the skin of the normal penis. This skin does not regenerate as the child becomes an adult; the results can be tragic when the removal of skin leaves behind shortening, unequal and asymmetric coverage, curvature, and sexual crippling. Now I will proceed to a discussion of two well-known natural causes of penile deformities – Peyronie’s Disease and Chordee.
Peyronie’s Disease or the “Bent Spike Syndrome” begins as a thickening of the fibrous sheaths which surround the two erectile bodies of the penis. These erectile bodies are attached to the bony pelvis and continue through the length of the penis to attach to the Glans Penis. During sexual arousal, these bodies fill with blood to the limits of the fibrous sheaths which define the size and shape of the penis. At the same time, the urethra, a tube which conducts urine and semen from the bladder and prostate, also engorges with blood. These structures and their various functions are most easily understood by consulting books of Anatomy, such as Grey’s Anatomy or Grant’s Atlas of Anatomy, found in most libraries.
Peyronie’s affects the erectile bodies of middle-aged men, causing painful erections with curvature and distortions of the shape of the penis, which may prevent normal sexual intercourse. The condition is sometimes associated with Dupuytren’s contracture of the tendons on the palm of the hand. The cause of these conditions is poorly understood, and various treatments have resulted in incomplete cure of the disease which usually worsens over time.
Urologic specialists at the Mayo Clinic see about 700 patients yearly with this condition and have developed appropriate medical and surgical treatments which may include injections, traction, and surgery.
Chordee (pronounced Cor-DEE) is a curvature of the penis toward the feet (ventral or ventrally). This is a normal condition after conception when the embryo develops all the essential organs to support life and becomes a fetus. Early in this process, the sexual organs begin to develop and differentiate between males and females. At first, the phallus is curved ventrally in both sexes. The secretion of the male sex hormone, testosterone, by the fetal gonads causes the male phallus to enlarge, unwind, and take a more nearly straight form. Later, the skin which will become the scrotum folds to the midline and encloses the testicles, continuing this process and forming the tube which conducts urine, the urethra, similar to the action of a zipper until the distal end of the penis is reached.
The condition known as Hypospadias is a failure of this process to complete any or all of these described formations. In the most severe forms, the Chordee fails to resolve, and the distal penis remains close to its original form. More commonly, the penis is completely formed except for the ventral curvature, which may be more or less severe. In the milder forms, the curvature can be surgically corrected when the Urologic Surgeon makes a skin incision along the length of the penis on the dorsal or upper surface and removes or cuts out a series of wedges from the fibrous sheath of the erectile bodies. This may improve the shape or curvature of the penis to allow normal sexual function.
This is an abbreviated discussion of these conditions, which, fortunately for humanity, are not common. In my experience as a Urologic Surgeon, I have encountered these conditions only a few times. The best treatment options are available from experienced surgeons working at university medical centers.
James L Snyder, MD
Fellow, American College of Surgeons
Diplomate, American Board of Urology
Persons interested in learning more about Peyronie’s Disease and its treatment, including surgery and the use of injectable medication, may consult the Mayo Clinic website.