Noticeable bending of the penis particularly on erection is seen in young men as well as in grown up men; in the former it could be manifestation of birth / developmental defect but in the latter group of men, it could be as a consequence of previous trauma (fracture penis) or Peyronie's disease.
This is one of the main causes of bending of the penis on erection. It was thought to be as uncommon as 3:1000 men and now is believed to be as common as 10%.
Three classical features of this condition are pain on erection in the early (acute) phase followed by awkward bending of the penis again noticeable only on erection making penetrative sexual intercourse difficult and a palpable lump in the penis with spontaneous resolution of pain on erection in this late (chronic) phase. In most cases, penile shortening is also noticeable and a significant number of cases also develop erectile dysfunction (ED). The natural history of this disease/condition entails up to 20% men notice complete resolution of the deformity / bending on erection over a period of 12 18 months but the in the remaining 75-80%, the penile deformity remains static and may require surgical / non-surgical intervention to amend matters.
Any lump or localised swelling of the penis must be fully assessed and investigated as in the absence of pain, it may raise the possibility of cancer particularly in the middle aged men or the elderly.
Inability to withdraw the foreskin is a very common problem amongst boys and men alike and can be noted as a secondary development even in the elderly. In boys, it could simply be a case of delay in separating
the adhesions between the inner and the outer layers of the foreskin, which is present at birth in all boys (physiological phimosis).
In young men, it could be due to previous infections/inflammations and could be a cause of discomfort particularly on erection making sexual intercourse difficult and less enjoyable. It could also lead to difficulty in passing water.
When a relatively older man (> 50 yrs) notices difficulty in withdrawing his foreskin (with / without bleeding), which previously caused no issues, then one must consider the possibility of a sinister cause unless proved otherwise and give this patient a full work up which may include circumcision; as it enables the Urologist to assess any hidden lump under the foreskin and rule out the possibility of cancer of the penis.