AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Question My penis used to be perfectly straight, but I woke up one
morning to notice it flopped over to the right. When I get
an erection it starts by bending to the right till its fully
erect, when it goes straight. Which is why I didn't worry
about it, but its been getting worse. I've noticed a hard
line almost like a vein which runs about halfway up my penis
slightly to the right, which isn't on the left side. also
the third chamber seems much smaller and less predominant as
it goes up my shaft than it used to be. I'm not imagining it
because I looked at an old picture and the middle chamber is defiantly less predominant.
I don't know where to go from here...
Answer Chris, the normal anatomy of the penis consists of 3 cylindrical bodies each wrapped in an elastic membrane. The 3 structures are the single corpus spongiosum (which contains the urinary canal (urethra) and the paired corpora cavernosa. The latter 2 become engorged with blood during sexual arousal, stretching the membrane that surrounds them (tunica albuginea).
Curvature of the penis to varying degrees occurs in about 50% of men. It is often congenital (born with the condition) but can be acquired due to injury or a disorder called Peyronie's disease. Curvature can be due to one of the corpora being shorter than the other or to the deposition of scar tissue in part of the tunica albuginea which acts like a bow string and prevents this area from expanding. I suggest that you see a urologist so that a proper examination and diagnosis be made. Generally, no treatment is necessary unless the curvature causes discomfort to you or your partner with sexual activity or if the curvature is so severe that you are unable to have conventional intercourse. I know of no successful conservative treatment if the problem is due to scarring from injury. The most common therapy is surgical correction which can either be done by slightly foreshortening the corpora on the side opposite the scarring (plication) or removing the scar tissue and placing a graft at that site. The latter is not as reliable as it heals with a varying degree of scar that is difficult to estimate and may not correct the problem. Generally, surgery is not done purely for cosmetic reasons. Therefore, if you otherwise function well sexually, an understanding partner is the best therapy.
The "hard line" that you are feeling could be early Peyronie's disease. This could easily be determined by urologic examination. to follow, is some information I have written on this disorder.
Peyronie’s disease was first described in the 1700’s. It is a common, benign disease of the penis of unknown cause characterized by the development of firm nodules (plaques) in the membrane surrounding the erectile bodies of the penis (corpora cavernosa). These nodules are masses of inelastic scar tissue. Although many men are asymptomatic, the nodules may act like a bowstring and prevent that portion of the corpora from expanding. The result is curvature or deviation of the penis with erection. In more severe cases, impotence may occur. In the majority of cases, however, discomfort in the lesions with erection disappears but the curvature persists. Many of these patients require no treatment. The severity of the curvature may also cause discomfort on the part of the patient's partner during sexual intercourse. By experimenting with various positions, several can usually be found that are tolerable.
The diagnosis is generally made by palpation. In questionable instances, medication can be injected into the penis to produce an erection followed by re-examination in the erect state. Specialized x-ray studies called corpus cavernosograms are sometimes utilized for further evaluation. Penile Doppler ultrasound may or may not demonstrate the lesions.
Many therapies have been tried including medications (POTABA, vitamin E, etc.), ultrasound, radiation, steroid injections, etc. but none works universally well. The most often used treatment is vitamin E 400 i.u. daily. Recently, however, the vitamin has received some unfavorable press regarding potential side effects and should not be taken without consulting your physician. Early in the disease, the injection of collagenases or the calcium channel blocker Verapamil into the plaque may cause improvement. Verapamil has also been used in a cream or gel form with some success. Surgery is reserved for severe cases where either the deformity is extreme or the man is impotent and wishes this corrected. Fortunately, these cases are in the minority. Surgical excision of the plaques of scar can be done but a tissue graft must be placed at the resected site. Graft shrinkage may result in recurrence of the problem. Great care must also be exercised at surgery not to damage the sensory nerves often entrapped in the scar. If a man is impotent, often the best solution is to place a penile prosthesis to correct the deformity and solve the impotence problem. As both types of surgery have complication rates, this treatment should be reserved for the most severe cases. I suggest that you consult with a urologist to confirm the diagnosis and to decide if any type of therapy is indicated at this time. Fortunately, the majority of cases stabilize on their own and do not require treatment. Good luck.
