In Germany, Austria, and Switzerland, it is estimated that several thousand men are affected by penile curvature. According to studies, around three to eight percent of men show typical symptoms such as palpable plaques or pronounced curvature, with prevalence increasing with age. However, many affected individuals do not seek medical help due to shame or lack of awareness, meaning the number of unreported cases is likely significantly higher. The editorial team of the Leading Medicine Guide spoke with Dr. med. univ. Franklin Kuehhas about this topic.
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Penile curvatures can be either congenital or acquired over the course of life and often have functional as well as psychological effects. A closer look at causes, progression, and treatment options shows how different these two forms can be.
„Penile curvatures can be divided into two main categories: congenital and acquired penile curvature. As the name suggests, the congenital form is present from birth but is usually only discovered during puberty, when the penis becomes a subject of interest for boys. This type of curvature affects about 0.2 to 2 percent of the male population. Problems often arise when affected young men begin to become sexually active, typically between the ages of 18 and 25. With the congenital form, the curvature is typically downward, less commonly upward or to the side. By contrast, acquired penile curvature—also known as Induratio Penis Plastica (IPP) or Peyronie's disease—usually develops over the course of life as a result of microtrauma. These injuries are often not attributable to a specific event but occur due to repeated minor trauma, frequently in men whose erectile quality is already declining. This can trigger a cascade of changes that culminates in the formation of scar tissue, causing the penis to curve over time. Acquired curvature affects nearly 10 percent of all men. Both forms of penile curvature can cause significant problems, especially when it comes to sexual activity“, Dr. Kuehhas explains at the beginning of our conversation and adds:
„Many men struggle with congenital or acquired penile curvature but do so in silence because the topic is uncomfortable. Regardless of the cause, the more pronounced the curvature, the more difficult penetration becomes. This leads to functional problems: buckling can occur, certain positions may not be possible, and pain during penetration can affect both the man and his partner. Such negative sexual experiences often create an aversion to intimacy because embarrassing situations can arise. Especially for men with congenital penile curvature, this can intensify feelings of insecurity about their sex life. They often do not dare to live out their sexuality or maintain close relationships with their partners. Interestingly, the curvature is usually only noticeable when erect, which adds psychological strain for many patients. Men often seek therapy for the first time between the ages of 18 and 25 after their initial sexual experiences, when they realize something appears to be different compared to others. With acquired forms of the condition, there are two phases: an acute phase and a chronic phase. The acute phase is critical because it marks the onset of curvature. In two-thirds of cases, the curvature can worsen over time, while in one-third it remains stable or improves in a small percentage of cases. This phase can last between three and 24 months. If no further changes are observed after three months, it is referred to as the chronic phase, during which effective straightening options can be discussed with the patient. Surgery should be avoided during the acute phase because there is a risk that the curvature will continue to worsen. Early surgical intervention may straighten the penis, but there is then the possibility that it will curve again“.
The pain reported by patients with Induratio Penisplastica is often attributable to the acute phase of the condition. These men experience pain in around 40 percent of cases.
„The causes of the pain include pulling and tension sensations in the area of scarring and the connective-tissue nodule that can develop during the acute phase. This pain is particularly uncomfortable during erections and can persist for between three and 24 months. Congenital penile curvature, by contrast, typically does not cause pain. Nevertheless, pain can also occur with this form during attempts at penetration, especially if someone tries to straighten the penis to facilitate penetration. Many patients find the sudden pain—previously unknown to them—irritating, as it is often accompanied by a dull pulling sensation that can affect sexual activity“, Dr. Kuehhas explains.
Penile curvatures that require treatment often present as a combination of functional and aesthetic problems. The most common symptoms include pain during erection or intercourse, which can sometimes be so severe that intimate contact is difficult or impossible. Marked deviations in penile alignment that go beyond what is considered normal are also noticeable and can trigger psychological stress as well as self-esteem issues.
Accurate diagnostics, individually tailored conservative or surgical treatment approaches, and empathetic communication with a specialist can alleviate physical symptoms while also reducing psychological and emotional strain. The goal is not only to correct the curvature but also to sustainably improve self-confidence, sexual function, and quality of life.
„When a patient presents for an evaluation of penile curvature, the priority is a precise diagnostic workup that always includes visualizing and assessing the curvature. A key part of the examination is the induction of an artificial erection. This is done using an injection of alprostadil, a liquid erectile medication that is injected directly into the penis to promote an erection. This state allows the physician to closely observe the degree of curvature as well as any rotation or indentation defects and to create documentation. It is important to inform the patient well in advance, as many men feel insecure when it comes to this intimate area. Unfortunately, even in the 21st century, penile curvature remains a taboo topic, which leads many patients to hesitate to see a urologist. Often they are told by their primary urologists that there are no treatment options, or they encounter statements such as ‘you’ll become impotent’ or ‘you’ll lose too much penile length.’ Such misconceptions are common, especially because not all urologists are familiar with the latest treatment options for Induratio Penisplastica or congenital penile curvature. Experience shows that it can be a great relief for patients to confide in a specialist who is knowledgeable about the condition and the relevant surgical techniques. An open conversation can reduce anxiety and provide a better understanding of the issue. Many patients ultimately discover that the situation is not nearly as bad as they had feared. At appointments, patients sometimes come alone, but partners are often present as well. In general, however, most patients choose to pursue diagnosis and treatment step by step on their own“, says Dr. Kuehhas.
With penile curvature, treatment depends heavily on the type and degree of curvature, the symptoms, and erectile function.
Dr. Kuehhas describes this as follows: „Regarding treatment for Induratio Penisplastica, the latest guidelines identify only one conservative therapy with proven positive effects: shockwave therapy. While this therapy can reduce pain symptoms during the acute phase of the condition, it does not reduce the curvature. That is why it is important for patients to have realistic expectations of such conservative approaches. It would be misleading to suggest that shockwave therapy will make the penis straight again—it will not. For men with congenital penile curvature, there are no conservative treatment options at all that would lead to straightening of the penis. In these cases, it is crucial to consider surgical straightening, provided the relevant prerequisites are met. This means that surgical intervention is the only option for effective treatment“.
Surgical procedures are necessary in cases of pronounced curvature, functional impairment, or severe pain. They aim to correct penile curvature, eliminate pain, and restore sexual function.
Dr. Kuehhas explains the primary surgical methods: „In the acquired form of penile curvature, Induratio Penisplastica, two fundamental surgical approaches are distinguished: penile-shortening techniques and procedures that preserve penile length, such as incision and grafting. It is essential to understand that Induratio Penisplastica is not only associated with curvature that causes problems with penetration and psychosexual issues, but that plaque and nodule formation in the connective tissue also leads to a measurable loss of penile length. About 80 percent of patients report losing roughly one to one and a quarter inches (about 2.5 to 3 cm). Therefore, it is important to evaluate the individual loss of penile length and determine whether it is distressing for the patient. If straightening with a given surgical technique would result in additional shortening, the patient may end up with a straight penis but still be dissatisfied because he feels he has only a ‘stub’ rather than his original length. The patient’s erectile status should also be assessed. If erections are good, length restoration or preservation through incision and grafting can be offered. In more severe cases, where there is major penile shortening or significant erectile dysfunction, it may also be necessary to implant a penile prosthesis. In advanced stages of Induratio Penisplastica, patients may no longer have a functional penis. A straight penis alone would not help in such cases if it is not also functional. That is why, in severe cases, a combination of straightening and penile prosthesis implantation may be required“.
Choosing the appropriate surgical approach depends on several factors: the severity of the curvature, erectile stability, the extent of scar tissue, and the patient’s individual expectations. The goal of every treatment is to optimize both function and aesthetics, relieve symptoms, and restore self-confidence and sexual quality of life.
„Surgery to treat penile curvature—whether congenital or acquired—typically takes between 2 and 2.5 hours and is performed under general anesthesia. In most cases, the procedure can be done on an outpatient basis, meaning the patient can return home or to a nearby pre-booked hotel the same day. A follow-up visit takes place after two days, during which the dressing is changed. For congenital penile curvature, the patient wears a continuous dressing for one week and then wears nighttime dressings for five weeks to support tissue healing. For acquired penile curvature, a continuous dressing for one week is usually sufficient. Because the glans is not wrapped in the dressing, urination generally works without problems and causes no significant pain. On a pain scale from 0 to 10, the sensation after surgery is around 2 to 3. The dressing may be somewhat uncomfortable but does not significantly interfere with everyday life. With regard to straightening, penile-shortening techniques shorten the longer side of the curvature to match the shorter side so that the penis becomes straight again. This method is often referred to as the Nesbit procedure. To restore penile length, the shortened side of the curvature is incised and adjusted to the longer, healthy side. The resulting defect is covered with an artificial material, typically bovine pericardium. This material is well established in medical practice and has been used in cardiac surgery for many years. The decision whether to perform a length-restoration procedure depends on several factors. As a rule, this technique is offered to patients with a curvature of more than 60 degrees, provided their erectile quality is good. This type of surgery is more invasive, which means not every patient is a suitable candidate. Discussions about which surgical technique is best for an individual patient are routine in clinical practice. The patient should understand why a particular technique is being recommended and the rationale behind it in order to make the best possible decision“, Dr. Kuehhas explains.
Specialized physicians ensure long-term treatment success for penile curvature and other genital surgical issues through close coordination of precise diagnostics, individualized treatment planning, and expertly performed procedures.
„For patients, it is of utmost importance to seek professional help and not struggle alone. A first step should be to make sure the physician is a specialist in this area. When selecting a suitable doctor, a few key factors can help: patients should ask how many penile-straightening surgeries the physician performs—or has performed—per year. This number can be viewed as a quality indicator; a physician who performs fewer than ten such procedures annually may not offer the same experience and expertise as someone who performs several hundred a year. Personally, I perform about 200 curvature corrections per year“, Dr. Kuehhas emphasizes, and concludes our conversation:
„The procedures described have been known for many years, as the condition referred to as Induratio Penisplastica or Peyronie's disease has in fact been documented since antiquity. The term Peyronie's disease comes from the personal physician of King Louis XVI, who first described the curvature. The specific penile-shortening technique, the Nesbit procedure, has been performed since 1964. Above all, however, the most important thing for patients is not to be afraid to talk about their problems and to overcome the shame that is unfortunately often associated with such taboo topics. There is a solution for every form of penile curvature, and professional help is the decisive step toward relieving symptoms and improving quality of life“.
Thank you, Dr. Kuehhas, for your enlightening words on the still-taboo topic of penile curvature!
- Highly specialized andrologist with an international reputation in reconstructive genital surgery.
- Focus on penile curvature, penile prostheses, penile lengthening/thickening, circumcision, hypospadias, vasectomy, scrotal lift.
- Pioneer of surgical techniques such as the STAGE and Egydio methods for minimal penile length loss.
- Treats functional and aesthetic concerns with high precision, discretion, and empathy.
- Practice in Vienna: modern equipment, individualized diagnostics, and treatment planning.
- International experience, publications, and lectures combined with personalized patient care.
Link: Congenital penile curvature
