Reader's Question

Dear Doc,
It seems like a lot of guys I talk to struggle with insecurity about their penis size and/or shape. I can explain to guys the statistics about average size (~5") and that helps, but I can't really answer questions about "normal" shape and its potential impact on their future married sex life. Some guys are concerned about having a curvature, including downward curving, or a turn to one side or the other, and how this might affect their future sexual relationship with their wife. Do you have any guidelines for when to counsel a guy?

Doc's Answer

As you correctly noted, the average size for an erection is about 5 inches (see my prior posting on this at http://tinyurl.com/6vzcjuc). Even at smaller sizes, a man basically has sufficient anatomic goods to satisfy his wife, assuming he actually listens to her about what satisfies rather than running on his assumptions.

As for the curvature question, two main issues come into play. One is congenital or acquired anatomic problems in young men, and the other is Peyronie’s disease, usually in men over forty years of age. In congenital or acquired bending of the penis -- the latter often from trauma causing penile fracture, aka broken penis (no, I am not kidding . . . cringe) -- there is a defect in one of the two tube-like membranes (tunica albuginea) covering spongy tissues in the penis (corpora cavernosa) that engorge with blood during erections. Since one side’s tube is smaller than, less elastic than, or otherwise tethered compared with the other side, erections curve/bend. Peyronie’s disease causes curving/bending of the penis through development of scar plaques on the tunica albuginea.

When is it time to seek medical advice? The Mayo Clinic says to consult a physician if erections hurt or if the bend is enough to interfere with sex. One might add significant psychological concern to this list, especially for those who do not have painful erections but don’t plan to have sex until marriage, and therefore won’t know yet if the curve would interfere with intercourse.

For congenital or acquired penile curving that is severe enough in younger men, surgical correction can be quite effective. For Peyronie’s disease Medline plus lists possible medical treatments (steroid injections, the medicine Potaba, radiation therapy, shock wave lithotripsy as with kidney stones, Verapamil injections, and Vitamin E) though none of these work very well. But surgery can be done, including penile implants, with better results.

Overall, however, men who have it tend to carry an exaggerated sense of the degree of their penis curving. For most young men who perceive abnormal bending, most won’t need to do anything.