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Genitals

Congenital penile curvature and torsion in children

Congenital penile curvature and rotation of the penis around its own axis: how much is normal and when corrective surgery is needed.

Written by: Dr. Parviz Hajiyev, pediatric urologist.

Quick answers

Is it an emergency?
No.
Is it normal?
Mild torsion and curvature are common and often cause no problems.
When is surgery needed?
If the curvature is more than about 30 degrees or the torsion is more than 90 degrees.
Can he be circumcised?
He should be evaluated first: the foreskin may be needed for the repair.

What is penile curvature?

During erection the penis may bend downward, upward or to the side. Congenital curvature often occurs together with hypospadias, but it is sometimes seen when the urinary opening is in the normal place.

Penile torsion is rotation of the penis around its own axis: the head of the penis and the urinary opening are not straight but turned to the side. It most often rotates to the left.

Causes

  • short skin or a short urethra on the underside of the penis,
  • uneven development of the erectile bodies of the penis,
  • uneven distribution of the skin over the penis.

When does it cause problems?

  • curvature of more than about 30 degrees can cause difficulty with sexual life in the future,
  • torsion of more than 90 degrees turns the urine stream to the side and causes cosmetic concern,
  • mild cases usually cause no problems.

Treatment

Significant curvature and torsion are corrected surgically: the skin of the penis is freed, the erectile bodies are straightened when needed, and the skin is redistributed. In babies, surgery is usually done at 6–18 months of age.

If there is curvature or torsion, see a pediatric urologist before circumcision: the foreskin may be used in the corrective operation, and a separate circumcision makes the correction more difficult.

Note for pediatricians and family doctors

Ventral curvature without hypospadias (chordee without hypospadias) and penile torsion should be recognized before circumcision, because the prepuce may be needed for the repair. Torsion is usually counterclockwise, to the left; torsion of less than 60 degrees is often only cosmetic. In adolescents, a photograph of the erection is useful for evaluation.

What happens at the visit?

  1. The direction of the penis, the position of the urinary opening and the distribution of the skin are examined.
  2. In babies, curvature is sometimes assessed during a spontaneous erection; in adolescents, with a photograph taken by the parent or the adolescent.
  3. If correction is needed, it is usually planned at 6–18 months of age or after diagnosis.
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Frequently asked questions

The penis is turned slightly to the left. Is this a problem?

Mild torsion is common and usually causes no problems. If the torsion is very marked or occurs together with hypospadias, correction is discussed.

Related topics

Sources

  • EAU Guidelines on Paediatric Urology, 2025: Congenital penile curvature.

This page is for education. Decisions about your child’s treatment are made together with the doctor after an examination.

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