Erections Pointing Up/Down

Normally, when the penis is erect and rigid, it will be point forward, upward, and toward the center.  However, it is not uncommon for some men to notice that the penis points more downward rather than upward.

 

Curvatures of the penis can orient an erect penis outside of the normal erect position.  However, in this section we will deal primarily with deviations that are not due to curvatures. 

UPRIGHT POSITIONING OF ERECTIONS

(Erection Angle)

Many men wonder how “upright” an erection should be.  This can depend on a few issues that are unique to each man which we will discuss in this section:

  • Rigidity of the erection

  • Penis size

  • Tightness of suspensory ligaments

  • Scrotal skin pulling down on the penis

  • Strength and tone of muscles in the root of the penis (namely the IC & BS muscles)

 

The angle at which the erect penis is compared to the pubic bone is called the penile-pubo angle or simply the erection angle.  Measurements of the erection angle are from the perspective of a man as he is standing rather than sitting or lying down.  A 0° angle would have the penis pointing straight up, touching a flat abdomen.  A 90 degree angle would have the penis pointing directly to the front.  A 180 degree angle would have the penis pointing directly downwards to the floor.

 

90% of men have an erection angle between 30° and 120° when standing.[i]  This is considered the “normal” range, which allows for intercourse without pain, difficulty, or discomfort.  Most men feel that an erection should be more upright rather than downward and this is most common with two-thirds of men having erections that points above horizontal when standing.   One study[ii] performed in over men from their 20’s to 60’s found the following:

  • 5%   have erections <30°        "Completely Upright"

  • 31% have erections 30°-60°    "Mostly Upright"

  • 30% have erections 60°-85°    "Above Horizontal"

  • 10% have erections 85°-95°    "Horizontal"

  • 20% have erections 95°-120°  "Below Horizontal

  • 5%   have erections >120°       "Downward"

Angles with Percentages.jpg

Erections angles that pull forward more than 20 degrees (Acute Angle Erection) or cannot rise more than 140 degrees (Penile Drop) can cause intercourse difficulties.

The uprightness of an erection is determined by a number of factors.  These include rigidity, penis size, tightness of the penile ligaments, scrotal skin attachment, natural curvatures of the penis, and age.

 

Rigidity

 

Men with non-rigid erections may notice an erection that is not as upright as they may expect.  Men who can’t get past stage 2 (filling stage) will not notice any rise, while men who cannot move past stage 3 (rising stage) may notice erections that are below but close to horizontal.  Men who can achieve stage 4 (full but not rigid) may not see erections rise above horizontal.  These can often be corrected by treating the underlying causes of erectile dysfunction.

 

Penis Size

 

The size of a penis also affects how upright an erection will be.  In younger men going through puberty, the size of the penis is smaller and doesn’t weigh as much, so gravity’s effect on the erection is minimal.  Young men just going through puberty may have an erection that in some cases is nearly upright.  However, as adulthood approaches, the penis becomes larger and gravity has a greater effect on the heavier penis and pulls the erection more downwards.  By adulthood, it is rare for a penis to be completely upright.  Men with a larger penis (not just length but thickness) tend to have erections that are less upright due to the penis weighing more.  Longer penises are also associated with looser penile ligaments, thus tipping the penis root forward exposing some of the root of the penis outside the body tilting the shaft of the penis forward rather than upward.

 

Penile Ligaments

 

The fundiform and suspensory ligaments in the root of the penis support the penis when erect by preventing the base of the penis from pulling away from the body, thus helping the penis remain more upright and stable during an erection.  Depending on how tight or loose these ligaments are in addition to where they attach to the pubic bone, determines how much they hold an erection upright.  The tightness differs from one man to the next and this tightness often decreases with age as men have this ligament stretched over repeated erections over the years and engage in sexual activity which can loosen these ligaments.  This causes men to experience erections that are less and less upright as they age.  The image below shows the location of the ligaments as well as the penis at a 45 to 60 degree penopubic angle.

 

Penile Ligaments.jpg

Scrotal Skin Attachment

 

Just as loose ligaments can cause less support of an erection, tight skin on the underside of the penis attaching to the scrotum can pull an erection downwards.  Men who have penoscrotal webbing have scrotal skin that attaches to the shaft of the penis thus “pulling” an erection downward toward the scrotum.  If severe, surgery can be performed to correct this abnormality.

Webbing.jpg

Penis Root Muscles

 

The IC and BS muscles in the root of the penis work to stabilize and hold an erection upright.  The IC muscles in particular can be flexed to pull an erection into a more upright position.  However, this tension cannot often be held for more than a few seconds at a time.  So men may vary in how upright their erections are based on contractions of the IC muscles. Image below copyrighted by Veisland Medical Images and used by permission.

Penile Muscles.jpg

In fact, when comparing two studies that looked at erection angle, one was self-reporting and the other used visual measurements.  It’s interesting to note that in the self-reporting group angles were higher than visually observed by the researcher.  This may possibly be due to these self-reporting men contracted their IC muscles to pull an erection that pointed downwards into at least a horizontal position.  The results of this study are as follows: [iii]

Angle Table.jpg

Natural Curvatures

 

Sometimes, the angle of an erection is affected by a penile curvature.  An upward (dorsal) curvatures can cause the penis to bend upwards thus making the erection look more upright while a downward (ventral) curvatures can point an erection lower.  Since 45 percent of men have a natural curvature of their erection, the erection angle is often affected for these men.  For example when looking at erections that are “upright” 0-85°, 64% who have a straight erection fall into this group compared to 91% of men with an upward curvature and only 32% of men with a downward curvature.  On the other hand, 36% of men with a straight penis have an erection that is horizontal or lower in 9% of men with an upward curvature compared to 68% of men with a downward curvature. [iv]  So having a natural curvature of the penis was a large factor in erection angle. 

 

Age

 

As teens continue to mature and as men age, they will often notice the pubo-penile angle increases (the penis becomes less upright).  As stated previously, this is often due to the fact that when full adulthood is reached the penis is larger and heavier and the ligaments tend to not be as tight after repeated erections year after year.  In addition, as men become sexually active, the penile ligaments undergo more stretching during sexual activity which results in looser ligaments and hence erections that don’t pull as tight and upright to the body as they used to.  In addition, as men age, erectile dysfunction can occur which reduces the rigidity of erections which also increases the erection angle.  So noticing increases in the erection angle (tendency to be less upright) is a completely natural consequence of aging and doesn’t require treatment in and of itself.  

 

Typically the “uprightness” of an erection has little to no bearing on sexual function.  However, there are two conditions that can interfere with intercourse.  This can occur when either the penis is too upright (Acute Erection Angle) or not upright at all (Penile Drop). 

 

ACUTE ERECTION ANGLE

In this disorder, the penopubic angle is less than 20 degrees and stands almost completely upright against a man’s body AND cannot pull forward from this tight angle.  This can make it difficult to engage in sexual activity by not allowing the penis to pull forward during intercourse causing pain with most sexual positions.  This is most often caused by the penile ligaments being too tight.  The image below is a 10 degree angle.  


Angle 10.jpg

Counseling and sexual therapy are often given as first line treatments to help a couple determine comfortable positions that allow for intercourse.  However, in cases where this does not resolve the sexual pain or dissatisfaction then surgery can be performed to release some of the tightness in the ligaments, thus allowing the erection to pull more forward. [iv]

 

 

PENILE DROP

Penile drop on the other hand is a condition where a man is able to achieve an erection, but the suspensory ligaments do not pull the penis into an upright position.[vi]  Rather, the erect penis points downward.  Slight drops up to 120 degrees are typically not treated as intercourse is often still possible.  However, treatment is sought in men with a drop greater than 140 degrees (anything lower than the following figure). 

Angle Drop.jpg

Penile drop can occur for a few different reasons – a downward curvature of the penis, a congenital defect in the suspensory ligament, or acquired through penile injury. Ventral (downward) curvatures are perhaps one of the most common causes of penile drop and treatment of the curvature along with any correction of defects in the suspensory ligament can correct the downward angle. 

Men with penile ligaments that are not attached properly (or at all) typically have a rigid erection that points nearly straight down as seen in the image to the right which is 160°. Surgery can be performed to attach the ligament properly. 

Angle Drop.jpg

For men who simply have a suspensory ligament that is too loose, surgical shortening of the ligament allows it to pull an erect penis into a more upright position.  There are reported cases of men who have injured or torn their suspensory ligaments.  This has occurred during an event when the erect penis was forced downwards with enough force to break, tear, or detach the ligaments.  An injury such as this should be treated by a medical professional so that the ligament can be fixed.[vii]  Another cause of the erect penis pointing downwards can occur due to the skin of the scrotum rising onto the underside of the penis and pulling it downwards (penoscrotal webbing).

[i] J Sex Med. 2014 Jul;11(7):1863-6.

[ii] Sparling J, Penile Erections: Shape, angle, and length, Journal of Sex & Marital Therapy, (23)3, 1997. 195-207

[iii] Sparling J, Penile Erections: Shape, angle, and length, Journal of Sex & Marital Therapy, (23)3, 1997. 195-207

[iv] Sparling J, Penile Erections: Shape, angle, and length, Journal of Sex & Marital Therapy, (23)3, 1997. 195-207

[v] https://www.ncbi.nlm.nih.gov/pubmed/19796061 (12/26/18) The Journal of Sexual Medicine 2010;7:1311-14

[vi] J Sex Med. 2012 Feb;9(2):618-24. 

[vii] BJU Int. 2007 Jan;99(1):117-20.The penile suspensory ligament: abnormalities and repair. Li CY1, Agrawal VMinhas SRalph DJ. https://www.ncbi.nlm.nih.gov/pubmed/17227497 (3/18/17)

Images on this page from top to bottom include:

  1. Elen Bushe/Shutterstock.com (modified)

  2. Elen Bushe/Shutterstock.com (modified)

  3. Elen Bushe/Shutterstock.com (modified)

  4. Veisland Medical Images and used by permission.

  5. Original table

  6. Elen Bushe/Shutterstock.com (modified)

  7. Elen Bushe/Shutterstock.com (modified)

  8. Elen Bushe/Shutterstock.com (modified)