Penile Torsion

What is penile torsion?

Penile torsion is when a baby’s penis appears rotated or twisted. It almost always rotates to the left (counterclockwise). It happens when the skin and connective tissue of the penis don’t form as expected while a fetus is developing in the uterus. It’s a fairly common congenital (present at birth) condition.

Most people notice penile torsion in their children during foreskin removal (circumcision) or a physical examination. If you notice penile torsion, you should postpone circumcision until a pediatric urologist can examine your child. A pediatric urologist is a healthcare provider who specializes in and operates on conditions that affect children’s urinary and reproductive systems.

Are there different types of penile torsion?

Penile torsion can be a stand-alone medical condition, or it may come with other congenital conditions that can affect penises. These conditions may include:

• Hypospadias. Hypospadias is when the tube that carries pee and sperm out of your body (urethra) doesn’t develop properly at the tip of your penis.
• Congenital penile curvature (chordee). Chordee is when your penis has a severe curve, especially while erect.

Is penile torsion serious?

Penile torsion can range from mild to severe. If your child has severe penile torsion, their penis may rotate more than 90 degrees.

How common is penile torsion?

Healthcare providers and medical researchers estimate that penile torsion may affect 1.5% to 27% of babies with penises. Penile torsion greater than 90 degrees is less common — affecting less than 1% of babies with penises.

What are the symptoms of penile torsion?

Penile torsion causes the penis to turn or bend. But it usually has no other symptoms, especially if your penis rotates less than 90 degrees.

Is penile torsion painful?

Penile torsion usually doesn’t hurt.

Can penile torsion cause reproductive issues?

No, there isn’t any evidence that penile torsion affects your ability to have a biological child.

What causes penile torsion?

Healthcare providers and medical researchers can’t pinpoint one specific cause of penile torsion. But there may be an association with overexposure to female hormones, including estrogen, while the fetus is developing in the uterus.

There may also be a link between penile torsion and a lack of skin in the shaft of the penis and abnormal attachment of the connective tissues in the shaft, foreskin and scrotum (the pouch of skin behind your penis that usually contains your testicles).

What are the complications of penile torsion?

More than half of people with penile torsion have an abnormal urinary stream. This may cause:

• Pressure changes.
• A stream that points up, down or to either side.
• A stream that splits into two different directions.

Some adults with untreated penile torsion express dissatisfaction with how their penis looks.

How is penile torsion diagnosed?

A healthcare provider can usually diagnose penile torsion after a physical exam.

How do you fix penile torsion?

Penile torsion usually doesn’t require treatment, especially if the rotation is less than 90 degrees. But many parents may wish to explore treatment for their child for cosmetic reasons.

Penile torsion treatment involves surgery under general anesthesia. The surgeon may use different surgical methods depending on whether your child has other conditions that also require treatment, like hypospadias or congenital penile curvature. They’ll advise you on the best treatment for your child.

The most common surgical option is “degloving.” Degloving is a type of plastic surgery. The surgeon will remove some skin on your child’s penis and reattach it in such a way as to minimize the appearance of penile torsion.

Is penile torsion surgery safe?

All surgeries have some risks. But in general, penile torsion surgery is safe. Healthcare providers generally recommend penile torsion surgery when your child is between 6 and 18 months. Children younger than 6 months have more anesthesia risks, including:

• Nausea and vomiting.
• Learning, memory or behavior problems.

But you can have penile torsion surgery at any age. Some people choose to have surgery when they’re older for personal reasons.

Can penile torsion correct itself?

No, penile torsion can’t correct itself or improve as you age.

How soon after treatment will my child feel better?

It usually takes at least 10 days for your penis to heal after penile torsion surgery.

What can I expect if I have penile torsion?

The outlook for penile torsion is good. Mild cases of penile torsion have no long-term health issues, including sexual or reproductive issues. The outlook is also good for more severe cases that require surgery.

How do I take care of myself?

A healthcare provider will explain how to care for your penis after penile torsion surgery. This may include:

• Applying a small amount of petroleum jelly (Vaseline®) or skin care ointment (Aquaphor®) over the area at each diaper change. This helps prevent bacteria from entering the area.
• Using pain relievers a provider recommends for infants, such as acetaminophen suspension (Tylenol Infants’®).
• Gently washing the area with soap and warm, clean water as it heals.

When should I see a healthcare provider?

Schedule an appointment with a healthcare provider if your child has an abnormal urinary stream that may later affect their quality of life.

When should I go to the ER?

If your child has surgery to correct penile torsion, you should go to an emergency room if they have signs of infection, including:

• Frequently bleeding.
• Bleeding that doesn’t stop.
• Leaking that smells foul.
• They haven’t peed 12 hours after surgery.
• Fever.
• Chills.
• Pus around their incisions.
• Discoloration (red, purple or darker than the usual skin color) that may look like a skin rash.

What questions should I ask a healthcare provider?

• How serious is my child’s penile torsion?
• Does my child need surgery to correct penile torsion?
• What’s the complete list of risks for penile torsion surgery?
• Should I circumcise my child if they have penile torsion?