Case Study: Symptomatic Ventral Penile Curvature (Chordee) in a Young Adult

Case at a Glance

A 22-year-old male presented with a history of a lifelong downward penile curvature, which recently became symptomatic, causing pain during specific types of sexual intercourse. The clinical picture suggested congenital ventral curvature, or chordee, warranting urological evaluation for potential surgical correction.

Patient's Story

The patient is a 22-year-old, 65 kg, 5'7" male in good general health. He reported a lifelong condition of a downward-curving penis. This anatomical variation had not caused him any functional issues or pain until he recently became sexually active. He presented with a chief complaint of dyspareunia (painful intercourse), specifically experienced during certain positions, such as the 'cowgirl' position, where his partner's movements created painful pressure on the erect penis. He also noted mechanical difficulty with penetration in other positions, such as when his partner was standing. Conversely, he reported no pain or difficulty with missionary, 'doggy style,' or 'reverse cowgirl' positions.

Initial Assessment

Upon initial consultation, the patient described the curvature as being directed straight downward, with an estimated angle of 10-20 degrees, and no lateral deviation. He made a key observation that upon retracting his foreskin, the skin on the ventral (underside) aspect of the penis appeared to be tethering the glans, actively pulling it downwards. This suggested that the cause of the curvature was related to the skin or superficial tissues rather than the corporal bodies themselves. The patient's young age and the lifelong nature of the curvature made acquired conditions like Peyronie's disease less likely.

The Diagnostic Journey

The patient's history and self-reported physical findings were highly suggestive of a congenital condition. A likely differential diagnosis raised by a consulting provider was chordee. A formal urological evaluation was recommended. A physical examination by a urologist would typically involve assessing the penis in both flaccid and erect states. An in-office artificial erection test, induced by an intracavernosal injection of a vasoactive agent (e.g., Alprostadil), would be performed to objectively measure the degree and direction of the curvature and to identify the precise point of tethering. The examination would confirm if the curvature was caused by a short ventral skin, a tight frenulum, or fibrous tissue along the urethra (Buck's fascia or tunica albuginea).

Final Diagnosis

Congenital Ventral Penile Curvature (Chordee). The patient's description of ventral skin tethering pulling the glans downward is characteristic of chordee without hypospadias, where the curvature is caused by developmental discrepancies in the tissues on the underside of the penis.

Treatment Plan

Given that the condition was now symptomatic and interfering with sexual function, surgical intervention was presented as the definitive treatment option. The patient was referred to a urologist specializing in reconstructive surgery. The standard procedure for this condition is a surgical chordee correction. This typically involves penile degloving (separating the skin from the shaft), followed by an intraoperative artificial erection to confirm the curvature. The surgeon then meticulously releases the tethering fibrous bands or short skin causing the bend. If this release is insufficient, a dorsal plication procedure (e.g., Nesbit procedure) may be performed on the longer, dorsal side to achieve straightness.

Outcome and Follow-up

Following surgical correction, the prognosis is generally excellent. The patient would be advised to abstain from sexual activity for a period of 4-6 weeks to allow for proper healing. Follow-up appointments would be scheduled to monitor wound healing and assess the cosmetic and functional outcome. A successful procedure would result in a straightened penis, resolving the mechanical issues and the associated dyspareunia, thereby improving the patient's quality of life and sexual satisfaction.