Penile curvature: when a bend is normal and when to see a GP

Penises vary a great deal in size, shape and direction. The NHS says there may naturally be a slight curve when the penis is erect, and many men who have never had any problem curve gently to one side or upwards or downwards. This is not a medical condition, and it does not need treatment.

A bend becomes a medical question when it changes, when it is large enough to make sex difficult or painful, or when it comes with a lump, pain on erection or erection problems. The NHS advises getting medical help if the penis curves a lot or erections are painful.

Peyronie's disease is the best known reason for a curve that develops or worsens in adult life. The NHS describes swelling that later causes a hard lump to develop on the shaft of the penis and stops it stretching during erections. If the hard area is on the top the penis curves upwards, and if it is on the bottom it curves downwards. The NHS also lists painful erections that can make sex difficult, problems getting or keeping an erection and other changes such as shortening and narrowing in the middle.

The NHS says Peyronie's disease mainly affects men over 40, but younger men can get it, and that it can affect any adult with a penis. The skin may also be thicker and less flexible in other places such as the hands and feet, and some men with Peyronie's also have a condition called Dupuytren's contracture.

The NHS says the cause of Peyronie's disease is not always known. It can sometimes happen if you injure your penis, and there may sometimes be a family history. It lists a higher likelihood in people who have diabetes, high blood pressure, high cholesterol, coronary heart disease or thickened blood vessels in the heart (arteriosclerosis), or who take certain medicines such as beta blockers or antidepressants.

Some men have had a mild curve for as long as they can remember, without any lump or pain, which fits with the NHS statement that a slight natural curve is possible. The NHS pages used for this guide are written about Peyronie's disease and do not describe congenital curvature in detail, so a clinician's assessment is the way to tell which pattern applies to you.

The NHS says to see a GP if you have swelling or a hard lump on the penis, the penis curves upwards or downwards when erect, or you have painful erections or problems getting or keeping an erection that make sex difficult. It adds that you should not feel embarrassed, because Peyronie's disease is a common problem that GPs are used to dealing with.

The GP will ask about your symptoms and will usually need to examine the penis. They may refer you for an ultrasound scan. A local NHS referral guideline suggests asking the patient to bring a photograph of the erect penis on an electronic device to the appointment, so that a clinician can see the curve, and lists penile cancer as a red flag to exclude. The same guideline notes there is little value in imaging tests before referral and says to treat any associated erectile dysfunction.

The NHS says that mild symptoms may not need treatment, but that treatment may be needed if symptoms are severe or causing problems such as pain during sex, depression or low self-esteem. Treatments include medicines to slow the growth of the hard area or to treat erectile dysfunction, a procedure that uses sound waves to break down the hard area, and surgery to straighten the penis. The NHS adds that it is not usually possible to straighten it to how it was before it curved.

There are also devices that may help, but the NHS says these need to be used every day for several months and are not usually available on the NHS. A local referral guideline from NHS Cornwall states that there is no effective medical therapy for Peyronie's disease and that surgery is usually reserved for those in whom intercourse is impossible, because penile shortening and loss of sensation typically result. That guideline predates the current NHS page, so it is best treated as one example of cautious NHS practice rather than a national rule.

A change in the shape of the penis can affect confidence, relationships and sexual function, and the NHS recognises depression and low self-esteem as reasons that treatment may be justified. Talking openly with a partner, and with a GP who deals with this regularly, helps. If erections are affected, treating erectile dysfunction is a separate step that can make sex more comfortable even when the curve itself remains.