What Is Penile Torsion?

Penile torsion is a condition whereby the penis is twisted or rotated on its axis. Most of the time, the twist occurs counter clockwise. The state is sometimes called wandering raphe as the middle raphe of the penis cloaks counter clockwise around the penis.

The raphe approaching 90 degrees may signify torsion under the foreskin.

The condition is usually present from birth and is noticed during infancy, occurring in 1 in 80 newborn males. It can also develop from an acquired abrasion following trauma, urethral construction, or circumcision.

Penile torsion can range from mild to severe, with a 90 degree or more rotation considered severe and warranting surgery. Parents of newborn boys are advised to seek medical attention if they notice any curvature in their child’s penis.

Though a standalone issue, congenital penile torsion can be associated with chordee, hypospadias, and hooded prepuce (incomplete foreskin). Peyronie’s disease can also cause penile curvature.

Penile Torsion Diagnosis

For a diagnosis to be made, a urologist or pediatrician will perform a physical examination on the child. Penile torsion is simply a curvature of the penis that’s usually harmless for the most part. However, it may be a sign of chordee, hypospadias, and Peyronie’s disease, which have other significant implications.

Therefore, the first step to take when you notice something unusual is to book an appointment with a trusted doctor. You’ll need to take your little one in for an examination, where the doctor will advise if the condition is mild or severe.

For mild cases, surgical treatment won’t be necessary. However, if the penile torsion is diagnosed as severe, you’ll need to plan for surgery. The good news is your doctor will advise accordingly and schedule surgery dates based on their review.

Is a Curved Penis Normal?

Having a certain degree of penile curvature when erect, either left or right, is normal for many men. However, a curved penis can be problematic if it causes pain or hinders regular sexual intercourse.

For children, parents should consult their doctor once they notice something abnormal with the penis. Consulting with doctors early enough will allow you to make necessary corrections before the condition worsens.

Causes of Penile Torsion

Penile torsion occurs when the connective tissue and skin of the penis don’t form correctly when a child is developing in the womb. Scientists haven’t yet linked the condition to any particular cause. However, overexposure of the male fetus to female hormones has been flagged as a possible cause of the ailment.

Symptoms of Penile Torsion

There are usually no symptoms associated with penile torsions, more so in mild cases. Parents will only notice a curvature of the penis when or changing the child’s diaper. However, no evidence that the condition affects reproductive performance has been found.

A skewed urine stream could also be a symptom of penile torsion. However, you might not notice this if your child has mild penile torsion. For severe cases, the urine stream will almost certainly be irregular, which often prompts parents to schedule appointments with specialists more often than not.

Conditions That Can Co-Occur With Penile Torsion

As previously mentioned, penile torsion can also be a sign of other conditions with different implications.

Chordee

Also known as congenital penile curvature, chordee is a bending of the penis noticed during infancy. It’s characterized by a sharp penis bend which is either downward or upward. The bend may begin from the base to the tip of the penis and is noticed during erections.

In some boys, the urethra is very thin toward the glans, making it necessary for doctors to create an artificial urethral opening (hypospadias).

Diagnosis

Chordee is diagnosed by inducing an artificial erection when the child is sleeping by injecting a saline solution into the penis’s erectile tissues. If the bending exceeds 30 degrees from a normal straight erection, then a positive diagnosis is made.

Urine and blood tests will also be done to ascertain your child’s general health.

Symptoms of Chordee

Chordie is identified by the upward or downward bending of the penis. The condition persists into adulthood if diagnosis or treatment isn’t made early enough.

• Wandering raphe: The midline raphe in some children may wrap around the penis, pulling it downwards. If the pull causes a curvature of 90 degrees and above, surgery will be recommended, which will be done during circumcision.
• Skin tethering: Skin tethering is when the urethra is smaller toward the tip of the penis. In this case, several surgeries may be done to create artificial hypospadias to allow the urethra to be reconstructed. The hypospadias will, after that, be repaired.
• Dorsal preputial hood: The dorsal preputial hood is when the foreskin only covers the upper side of the head of the penis and not the whole head. This condition is often diagnosed alongside hypospadias.
• Webbed penis: It’s also called penoscrotal fusion and occurs when the lower side of the penis becomes connected to the scrotum. This correction involves separating the scrotum and penis while covering the uncovered area with the foreskin.

Hypospadias

Hypospadias is a birth malformation where the opening of the urethra is located at the bottom of the penis and not the tip where it should be. The urethra is the tube inside the penis that carries urine from the bladder.

Since hypospadias and chordee can be interlinked, children with this condition may experience urine spraying out abnormally and might have to urinate while sitting. It can lead to humiliation as your boy can be teased by his peers.

In some cases, boys having hypospadias may not have their testicles descended to their scrotum. If not treated, it can lead to challenges later in life, such as difficulty urinating while standing or difficulty during sexual intercourse.

Treatment of hypospadias and chordee can go hand in hand.

The Centers for Disease Control and Prevention (CDC) estimates that 1 in 200 babies born in the US has hypospadias. Hence, hypospadias is one of the most common congenital disabilities.

There are three types of hypospadias, each depending on where the opening of the urethra is located.

• Sub-core: This occurs when the urethra opening is located near the head of the penis.
• Midshaft: This is a condition where the urethral opening is placed along the shaft of the penis.
• Penoscrotal hypospadias: This is when the urethral opening is located at the junction of the penis and scrotum.

Diagnosis

It’s challenging to diagnose hypospadias prenatally using ultrasonography. It may be mistaken for penile cyst, micropenis, chordee, or ambiguous genitalia. Hence, hypospadias should be confirmed postnatally when the baby is fully developed. A thorough systemic examination of a newborn will give a diagnosis for the condition.

Peyronie’s Disease

Unlike hypospadias and chordee, mostly diagnosed early in life, Peyronie’s disease develops in adults. It’s a noncancerous condition where fibrous scar tissue grows on the penis and causes a torsion when erect. However, the bend is significant and painful.

Having a painful erection may cause erectile dysfunction and make it difficult to enjoy sex. It can also lead to the shortening of the penis. It can, in turn, cause anxiety and stress.

The disease requires treatment and will worsen if not attended to by a doctor—early diagnosis and treatment help improve symptoms, which can be irritating.

Symptoms of Peyronie’s Disease

The most common symptoms of Peyronie’s disease are:

• Scar tissue: Also called plaque, scar tissue is felt like either a collection of hard tissue or hard lumps under the shaft of the penis. This usually occurs when healthy tissues are replaced after injury or disease.
• Significant penis bend: Apart from bending downward or upward, a patient’s penis might also bend to one side, which can be painful.
• Erection difficulty: Patients with Peyronie’s disease might struggle to get and maintain an erection, thereby leading to a poor sex life.
• Penis shortening: The condition can lead to a significant shortening of your penis, which might create the need for further treatment.
• Pain: Patients diagnosed with the condition might experience pain in the penis, which tends to occur either with or without an erection.
• Deformities: Some men might experience indentations, a narrow penis, or one that has a narrow band at the shaft, making it look like an hourglass.

These symptoms may either develop gradually or appear at once. Penile curvature might stabilize after 3 to 12 months, while erectile pains can improve in one or two years. However, scar tissue formation, penile curvature, and shortening are more likely to remain.

Factors That Lead to Penile Torsion

Like other congenital penile conditions, there’s no specific known cause for penile torsion. However, there can be some risk factors.

Scientists believe penile torsion may be caused by abnormal growth of the dartos fascia or strange skin attachment, causing the penile shaft to appear disoriented. Severe adhesions between the corpus cavernosa and the pubic bone, especially from previous surgeries or circumcision, are also a suspected cause of the disease.

Risk factors of penile torsion may be similar to chordee, hypospadias, and Peyronie’s disease.

These include genetic factors, especially if the issue is congenital. A combination of the child’s genetic and the mother’s contact with particular environments, eating or drinking certain foods, or taking certain medications during pregnancy are also possible causes.

Women who use fertility treatment products also increase their child’s chances of developing penile torsion at the time of birth.

Can Penile Torsion Correct Itself?

Penile torsion cannot correct itself. Those with minor cases can live everyday life with no issues in the functionality of their penis. However, those with extreme cases of penile torsion will need to undergo surgery.

A doctor may recommend surgery to parents of a child with penile torsion if they deem it necessary. The child can still grow up generally without complications since the condition typically doesn’t affect urinary functionality. For adults, treatment will only be recommended if you have difficulty enjoying sexual intercourse.

Treating Penile Torsion Through Surgery

There are various surgeries to treat penile torsion. However, your doctor will recommend the best one for your son. Penile plastic surgery, known as penile degloving, is the most popular procedure.

Penile degloving involves repositioning the penile skin to minimize how the penile torsion appears. However, it’s mainly effective in minor penile torsion cases, and if done in severe cases, a recurrent condition is highly likely.

Surgeries involving folding the tunica albuginea to a direction opposite the angle of curvature have also shown positive results in treating penile torsion. However, this technique hasn’t been popular due to the risk of harming nerves, valves, and erectile tissue.

Complications When Treating Penile Torsion Through Surgery

Similar to other surgical procedures, treating penile torsion through surgery comes with its risks and disadvantages. In this section, I’ll look at some of the complications that can occur if corrective surgery is undertaken.

Bleeding

Though severe bleeding is rare, the risk of bleeding is always there in any surgery. By the time the procedure is done, and discharge is completed, bleeding shouldn’t occur unless the wound is aggravated before healing fully.

But in case your child continues to bleed after corrective surgery, be sure to consult with your doctor and seek immediate assistance.

Reaction to Anesthesia

Some people may react differently to anesthesia, with some not reacting at all. Reactions to anesthesia, such as nausea, vomiting, and chills, are always possible in any surgical procedure. There can also be postoperative cognitive loss, minute hyperthermia, or breathing problems.

Infection

Doctors will take all the necessary precautions to prevent infections. However, the risk of having one is there. It can happen after the surgery if you don’t keep your wound cleaned regularly. And, if neglected, it can require additional surgery to repair.

To prevent infection, you should first ensure that the patient’s blood sugar levels are within the normal range. Washing hands before handling the wound will also help prevent infection by keeping germs at bay. You should also use clean clothing to cover your injury and protect it from germs.

Penis Becoming Shorter

Depending on the extent of the condition which warrants the type of surgical procedure done, your child’s penis might end up becoming shorter after the surgery. This commonly occurs when the surgery is handled by an inexperienced professional.

Urethral Diverticulum

Urethral diverticulum is a sack formation along the urethra that looks like a balloon. This sack can fill up with urine and can cause an infection and pain on the penis. Diverticulum is a source of great discomfort and will need correction through additional surgery.

Need for a Second Operation

More complications may arise from the surgical wound, warranting a follow-up operation to correct the issue. This can be an infection due to poor hygiene while cleaning the wound or excess movement that tears up the adhesions. The torsion may also persist, requiring a second operation.

How To Avoid Penile Torsion

It’s not possible to avoid penile torsion since it’s a congenital disability. If the case is severe, surgery is the only sure treatment. However, most patients don’t warrant any treatment, and you can live without any complications.

As mentioned, penile torsion has other related medical conditions. For to-be parents, knowing if your family has a history of the illness may help assess the likelihood of your child having the ailment. Changes in lifestyle such as quitting smoking will also reduce the chances of getting other related complications like Peyronie’s disease.

Effects of Penile Torsion

You can comfortably live with mild penile torsion without any effects. On the other hand, severe penile torsion can have implications on your sexual life. It’s made worse if torsion is coupled with other related conditions like hypospadias or Peyronie’s disease.

You may experience erectile dysfunction, making it hard to get or maintain an erection. Erectile dysfunction makes it hard to get children or for both you and your partner to enjoy sexual intercourse. It can be frustrating, leading to depression.

The appearance of a curved penis may be unappealing and cause anxiety, also affecting sexual performance.

If an erection is achieved, intercourse may be painful, especially if the angle of curvature is high.

Conclusion

Penile torsion is where the penis is twisted or rotated on its axis, with the twist mostly occurring counterclockwise.

While the condition is usually manageable when mild, it’s highly advisable to consult a doctor to determine its extent.

There are no specific known causes of the condition. However, surgery is the most effective way to treat penile torsion.