Penile Indentation (Dent or Narrowing in the Penis)

What penile indentation looks like

The indentation is usually felt and seen best when the penis is erect. Common patterns are:

• A notch or dent on one side, often on the top or underside.
• Hourglass deformity (waisting): a band of narrowing all the way around the shaft, with normal width above and below.
• Loss of girth along a section of the shaft.

Many men also notice a firm, flat lump under the skin, which is the plaque. The flaccid penis often looks normal.

Indentation is reported in a large share of men with Peyronie's disease, often together with curvature. The narrowed area can make the shaft feel unstable or bend at that point (a "hinge") during sex.

Causes

Peyronie's disease

Peyronie's disease is the cause in most cases. It is thought to start with small, often unnoticed injuries to the tough sheath around the erection chambers (the tunica albuginea), for example from bending during sex. In some men, healing produces excess, inelastic scar tissue. During erection that segment cannot stretch, so the shaft curves toward it or is pulled inward.

Peyronie's has two phases:

• Active phase (first 6 to 18 months): pain with erections, the plaque may grow, and curvature or indentation can change.
• Stable phase: pain fades and the shape stops changing.

Risk factors include age over 40, diabetes, smoking, high blood pressure, Dupuytren's contracture of the hand, prostate cancer treatment and a family history.

Penile fracture

A penile fracture, a tear in the erection chamber during sex, can heal with scarring that leaves a dent or bend.

Other causes

• surgery on the penis, including Peyronie's surgery or implant surgery
• scarring from repeated injections into the penis for erectile dysfunction
• injury from catheters or instruments passed through the urethra
• rarely, infection or tumors

Penile indentation and erectile dysfunction

Indentation and erectile dysfunction are linked in two ways. Scar tissue can disrupt the mechanism that traps blood in the penis, so erections beyond the narrowed band may be softer. And the conditions that cause Peyronie's, such as diabetes and vascular disease, also cause erectile dysfunction.

How it is diagnosed

A urologist takes a history (when it started, pain, sex, injuries) and feels for plaque. You may be asked to bring photos of an erection from several angles, or the doctor may induce an erection in clinic with an injection to measure the curve and indentation. Penile Doppler ultrasound maps the plaque, shows calcium in it, and checks blood flow.

Treatment

There is no medicine that reliably removes plaque. Treatment aims to stop progression, straighten the penis and preserve function.

• Watchful waiting: reasonable when there is little deformity and sex is not affected. Pain usually settles on its own.
• Penile traction therapy: a device worn several hours a day can modestly reduce curvature and help preserve length. Vacuum devices are sometimes used too.
• Collagenase injections: approved in the US for curvature of 30 degrees or more in the stable phase. Some men see improvement in hourglass deformity too.
• Other injections: verapamil or interferon are sometimes used, with mixed evidence.
• Erectile dysfunction treatment: tablets help when erections are weak.
• Surgery: once the condition has been stable for at least 3 to 6 months. Plaque incision with grafting can correct indentation and curvature. Men with significant erectile dysfunction may do best with a penile implant, sometimes combined with straightening techniques.

Oral vitamin E, potassium aminobenzoate and many supplements are not recommended by the American Urological Association because they lack evidence of benefit.

Frequently asked questions

What causes a dent in the penis?

Most dents in the penis are caused by Peyronie's disease, where scar tissue forms in the lining of the erection chambers and pulls the shaft inward. Less common causes are a healed penile fracture, previous surgery, and scarring from injections. A urologist can confirm the cause with an exam and ultrasound.

Is penile indentation serious?

It is not life-threatening or cancerous. It can, however, cause curvature, pain, instability during sex and erectile problems. Early assessment helps because traction therapy and some treatments work best before the deformity becomes fixed.

Can penile indentation go away on its own?

Pain from Peyronie's usually goes away, and a small number of men see slight improvement in shape. Most indentation stays the same or worsens during the active phase, then stabilizes. Treatment can reduce deformity once the condition is assessed.

What is an hourglass deformity of the penis?

It is a band of narrowing that goes around the shaft, so the penis looks pinched in the middle like an hourglass during an erection. It is caused by scar tissue around the circumference of the erection chambers and can make the shaft bend or buckle at that point.

Does a dent in the penis affect erections?

It can. The scarred area can weaken the blood-trapping mechanism, making the part beyond the dent softer. Some men find the penis hinges at the narrowing. Erectile dysfunction treatment and, if needed, surgery can help.