This type of curvature is best treated with surgery. The type of surgery depends upon several factors. If there is Peyronie’s disease which has caused substantial shortening, or the penis is already short then there is likely to be further shortening when correcting a downward (ventral) curvature. The amount of shortening depends upon the degree of curvature. The more severe the curvature, the greater the amount of shortening. Studies have shown that the amount of length loss in men with curvature of less than 60 degrees tends to the in 1-1½ cm range, but when it is in excess of 60 degrees, more curvature is possible.
On the other hand if the curvature is severe (more than 70) and a grafting procedure is performed to correct it, there is a reported higher risk of erectile dysfunction, which approaches 50% of men undergoing grafting for downward curvature. For men with congenital downward curvature, these men typically have increased elasticity and long penises. In these patients, I always recommend a plication operation instead of a grafting procedure. This is because the degree of shortening in the man with congenital curvature tends to be less bothersome, and there is a substantially lower rate of postoperative erectile dysfunction with the plication procedure. For men who have Peyronie’s disease, severe ventral curvature and borderline erectile dysfunction, it is best to consider placement of a penile prosthesis with simultaneous straightening of the penis. In this circumstance, the prosthesis will support the straightening and allow satisfactory postoperative rigidity for sex.