All About The Penis

Q: Ever since I was born, my penis has had a twist along the length of the shaft. When it lies on my pubic mound, there's almost a ninety degree rotation between the head of the penis and the shaft, and I'm sure it's getting worse as time goes by. Can you tell me what is wrong with my penis? I enclose a photo to help you understand my description.

A: The orientation of the shaft of the penis is defined by the raphe, the line of skin which normally runs along the middle of the underside of the penis. Normally, this runs into the glans at the site of the frenulum. However, in the picture of your penis which you sent me, your raphe ends at the side of your glans. There is, as you say, a ninety degree twist along the length of your penile shaft. 

It's also clear that your foreskin extends only halfway around the circumference of your penis, forming a hood rather than a complete cover over the end of your penis. All of this is rather characteristic of a condition called hypospadias, a congenital abnormality of the penis which varies in appearance from minor (where the opening in the glans is elongated into a slit, and the foreskin forms a hood around the top of the glans) to severe (where the urethral opening is only part way along the penile shaft). Hypospadias is often accompanied by this twist along the length of the shaft and/or a condition called chordee, where the glans of the penis is bent downwards towards the shaft, rather like it was nodding to the testicles! 

In days gone by, many men with hypospadias were never diagnosed until they chanced upon the discovery that their penis was different from most other men's - and although we might hope that today matters would be more enlightened, it's probably true that there is still the same level of shame and ignorance around this condition as there has been in previous generations.

What can one do about it? Well, probably not much. The classic dilemma is whether or not to have the abnormality of the penis surgically corrected. However, competent surgery on hypospadias tends to be difficult, and if not really needed to enable the owner of a hypospadic penis to have sex, might be best avoided. In some cases it can make matters much worse than they already are, especially if there is not much spare skin available to effect a repair. By the way, the need for such skin is an absolute contraindication to circumcision on any baby boy born with hypospadias.

The best place to get information and advice on hypospadias is the Hypospadias and Epispadias Association. (Epispadias is a much more severe condition where the penile opening is formed on the top of the penis shaft, near the base of the penis.)

You may at this stage be wondering if there is any form of penile twisting which is not related to hypospadias. Needless to say, with such a delicate part of the body, the answer is "yes". Peyronie's disease results from injury to, or uneven growth of, the erectile chambers:

It can sometimes be corrected by surgery, though this may leave the penis a little shorter than before.

And this appears to be a twist in the penis which has no relationship to hypospadias or Peyronie's.