What is chordee?

Chordee is a congenital condition which results in the abnormal development of the penis, causing the penis to curve downwards or upwards. It happens at the very end or tip of the penis.

What are the symptoms of chordee?

There may be no noticeable symptoms of chordee, except during erections. The most noticeable symptom is when the penis curves downwards or upwards. This can make erections and sex quite difficult or impossible. Chordee may cause pain or discomfort during sexual intercourse.

Some men experience hypospadias, a condition where the urinary opening or urethra may be on the underside of the penis and makes controlling urine flow extremely difficult. It can also lead to abnormal ejaculation. Instead of being correctly positioned at the tip, the urethra opening can be found:

• Under the tip of the penis
• Along the bottom of the penis shaft
• Where the penis and scrotum are attached

Other symptoms might include:

• Penile torsion: the midline raphe located on the bottom of the penis shaft goes around the penis, rather than running along the shaft
• Skin tethering: the tissue around the urethra is very thin
• Webbed penis: the skin on the bottom of the penis is connected to the scrotum
• Dorsal preputial hood: the foreskin that should cover the whole tip of the penis, only covers the top

How is chordee diagnosed?

Chordee can be diagnosed at birth if the baby has a penis that curves sharply upwards or downwards. In older men it can be diagnosed when the penis curves downwards when erect, making it difficult to form erections and have sexual intercourse.

What causes chordee?

The exact cause of chordee is not known, but it is thought that during the baby’s development in the womb, more elastic tissue might develop on the top half of the penis. This can cause the penis to curve downwards during erections.

Other developmental factors that can lead to chordee include:

• Skin tethering, normally on the underside of the penis, making a straight erection impossible
• Abnormal development of scar tissue in or around the urethra
• Genetics may also play a role
• Circumcision done when a child’s penis is inflamed can also be a cause 

How is chordee treated?

Surgery is the only effective treatment. Surgery before the age of two is ideal to make it possible for the penis to grow and develop normally. Surgery can be done on an outpatient basis. The child may have to use a catheter to urinate for the first seven days after surgery and the penis will be dressed to decrease any swelling present.

If chordee isn’t diagnosed until adulthood, surgery can still treat it. Normal activity and sexual intercourse can usually be resumed after four to eight weeks. Some men may require additional surgery in the future.

If hypospadias is present, the urethra opening will be positioned in its correct place during the surgery. During recovery, pain medications may be prescribed to relieve any pain and alleviate infection.

What specialist treats chordee?

A paediatric urologist or adult urologist can diagnose and treat chordee.