Ask the Doctor: ‘Can sudden penile curvature impact a man’s fertility?’

“Over the last number of months, I have noticed a curve in my husband’s penis. I asked him about it and naturally enough, he was a little dismissive. Needless to say, he’s not enthusiastic about seeing a GP, but I’m concerned by the fact it wasn’t there before (to my knowledge). It isn’t impacting intimacy, but I would have questions about fertility. Can you help me shed some light?”

Answer from Mr John Sullivan, Consultant Urologist, Beacon Hospital

It is rather common for a man’s penis to curve slightly, whether it be an acquired or congenital issue. Studies indicate upwards of 20% of men will report some form of penile curvature, the vast majority of which are not troubled by this and it rarely results in any functional deficit.

However, there is of course a smaller subset of patients, in which a curve is significant enough to prevent intercourse, thus impacting a satisfactory sex life and reproductive goals.

It is important to clarify at the outset that penile curvature itself is not directly associated with sperm functional parameters. However, if a curve is significant enough to prevent sexual intercourse or affect ability to achieve orgasm, this clearly does have implications.

In general, men tend to typically notice a “congenital curvature” (one present since birth) during puberty or early adulthood when they first start to experience regular erections. This type of curve does not cause any pain, is stable in severity and does not affect the ability to have satisfactory intercourse. Conversely, a curved penis that occurs more suddenly, is painful initially, and in which the bend continues to worsen over time, may point to a condition called Peyronie’s disease.

Peyronie’s is more common than we think, with upwards of 8% of men affected. In this condition, a fibrous scar, also known as a plaque, forms under the skin anywhere on the penis. It is initially painful in the acute phase with a worsening bend, and then settles into a stable phase with resolution of pain and stability of the curve, a process that can take upwards of 18 months.

It usually, but not always, occurs in men in later life and appears to be associated with recurrent microtrauma to the penis or a past significant penile injury (during sex, sports, a fall, or car accident). Certain individuals have a genetic predisposition and it is often associated with Dupuytren’s contracture of the hand (palmar fibromatosis).

Peyronie’s in its most severe form can cause penile curvatures greater than 90 degrees and thus prevents men from engaging in penetrative intercourse. It also is associated with venous leak erectile dysfunction.

Although it appears your husband’s curvature is not impacting your intimate relations at present, if the curve continues to progress, he should seek a consultation with a Urologist. Often certain minor surgical procedures can be undertaken to correct the curve and restore sexual function.

In any event, it is very important your husband has a male hormone profile and semen analysis performed. Penile curvature, as I mentioned above, is not directly linked to male subfertility, but he certainly should be assessed to identify any reversible male factor fertility issues. Upwards of 40% of a couple’s fertility problems are male factor-predominant.

We are always told about the importance of the female partner’s age in couples struggling to conceive (ovarian reserve, AMH levels, etc) but very little attention is focused upon the man’s sperm quality. There is now strong evidence in the literature to support the concept of “sperm ageing”. Functional sperm parameters decline with age and it is critically important, in my opinion, that all men planning a family undertake a basic assessment via their GP or Men’s Health specialist.

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