Finally Facing It

Friday, March 03, 2017

Dear Patrick: Due to an accident in childhood, my penis bends at a sharp angle about halfway up the shaft. I am in my early 20s and still have not experienced intercourse. Everybody else seems to like it, so I would like to see what all the hype is about, LOL. But I am afraid of being ridiculed if I take my pants off. I’m also concerned about whether my erection would hurt my partner. To be honest, I have never gone to a doctor about this. It is a very personal and embarrassing thing to discuss with a stranger. Can you give me any pointers that might allow me to have a normal sex life? (I realize “normal” is a problematic word, but I think you know what I mean?)

—Finally Facing It


Dear Finally Facing It: I am not a medical professional, so I cannot diagnose your problem. You don’t say whether you can experience an erection without pain, and you also don’t tell me whether you are able to masturbate to orgasm. These are important facts that help to determine what is going on with your penis and whether or not it can be fixed. Since I don’t know these important details, I will try to give you enough general information below that some of it might be helpful to you or to another reader with a similar issue.

I also want to emphasize that no matter what is going on, whether your penis stays the same or becomes less curved, you can still have a good sex life and relationships. For most people, a good sex life consists of being able to give and receive pleasure. Just about everybody is capable of that. “Sex” is more than just intercourse; that is only one technique for satisfying yourself or your partner. So start to educate yourself about what your options might be. Many couples enjoy oral sex or mutual masturbation, for example, and rarely engage in intercourse.  

For some men, having a bent penis is simply their normal anatomy. An erection is caused when the corposa cavernosum, two long chambers of spongy tissue on either side of the penile shaft, fill up with blood. But these chambers are not necessarily the same size. One of them may be of a slightly different consistency than the other. If one of them fills up and swells sooner than the other, the erection will go off at a bit of an angle. If this doesn’t hurt, a man with a different-looking erection should be able to have intercourse like anyone else. As his penis enters his partner, their internal anatomy will accommodate the penile curve without being injured. Frequent stimulation and intercourse might even help the problem to resolve by breaking up scar tissue or thickness within the corposa cavernosum.

If, however, getting an erection is painful for you, it is time to see a urologist. You may have Peyronie’s Disease, a form of erectile dysfunction that causes pain along with an unusual bend in the shaft of the penis. Your childhood injury may have triggered the development of hard spots (scar tissue or plaque). These will hamper blood flow. If the penis is bent at too sharp an angle or struck with enough force, it can damage the structures that facilitate erection. Scar tissue builds up in the corposa cavernosum so they do not fill up normally or evenly as blood flows into the penis during sexual arousal.

Many men with a sharp bend in their penises got hurt during vigorous intercourse. If your erection slips out of your partner and you thrust forward before you realize you are not inside them, your erection will collide with the hard pelvic bones of your partner. This hurts like hell. But an ice pack is normally enough to keep the swelling down. Later, if you notice a permanent change in the appearance of your penis, find a good urologist.

Bends in the erect penis can also be caused by autoimmune disorders or an inherited fibrous tissue abnormality that creates problems with manufacturing collagen. Only a doctor can diagnose the origin of your anatomical difference and thus help you to get effective treatment. Some of these problems go away on their own. For example, Peyronie’s can resolve in one or two years. We don’t really know why, but the pain and curvature gradually diminish. Peyronie’s can also remain stable or get worse.  

To complicate the diagnostic picture, there is a rare disease called Dupuytren’s contracture that can cause genital abnormalities. This illness causes a thickening in the hand ligaments that makes the fingers contract. Xiaflex is a new drug approved to treat this contracture. It is also administered when the patient has a curve of more than 30 degrees in his erection. A series of injections helps break down the plaque or buildup of collagen that is interfering with a symmetrical erection. Injections of oral verapamil (a high blood pressure drug) or interferon have also been used to break down fibrous tissue. Your doctor might ask you to do gentle stretching exercises to increase the effectiveness of the injections. The use of penile traction and vacuum or pump devices is under exploration. Surgery is the last course of action. It’s recommended that you try all other treatment options for at least a year. Surgery can attempt to even up the erectile structures of the penis, but this might result in a shorter erection. Penile implants have also been used to attempt to create a more symmetrical appearance.

Natural supplements like acetyl-l-carnitine and coenzyme Q10 are being studied, but more work is needed to determine if they really help Peyronie’s to resolve. Vitamin E has been found to work no better than a placebo.

Do you have a general practitioner that you like? If so, you could ask him or her to give you a referral to a good urologist. Practice talking about the problem with them before you see a specialist. You will probably be surprised by how calm your doctor can be. Physicians who are phobic about male genitals don’t usually become urologists. Of course, the ideal doctor combines an open manner and nonjudgmental attitude with very good medical skills. Unfortunately, sometimes the better a doctor is at treating a problem, the less ability they have at reassuring a patient who is nervous or embarrassed. Many doctors expect you to find emotional support from another source. It’s okay to find a counselor you can speak with who can help you to sort out which doctor will give you the best balance of effective treatment and emotional support. A counselor could also help you to figure out how to break the old habits that have excluded sex from your life.

If you feel that you can’t talk to a partner on your own about these issues, a doctor or therapist may be able to help you educate them. There are many ways to be physically intimate. Having a supportive partner can make facing these issues easier, so don’t isolate yourself socially. Of course, you need a trustworthy friend or lover in order to share your issues. Take the time to make sure that the other person is sex-positive and will respect your privacy. There are a lot of kind and helpful people in this world. If you are going to take somebody home, pick one of these, not a cold-hearted beauty queen.

I recommend taking a massage class as part of your plan to become a good lover. There are two reasons for this. One is that being able to give a good massage helps you to learn how to touch other people. It’s nice to be able to make someone melt against your body, and feel their trust and pleasure. It’s also important to be able to receive touch even if you are not having sex. Most massage classes involve practicing on other students, so you can begin to sort out what kind of touch feels good to you and what does not. This is useful information to share with a lover.

If you run into additional problems as you face this issue, please feel free to write again.

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