“Saxophone penis” is a term used when the penis gets twisted along its long axis, giving it the appearance resembling a saxophone. Many descriptive terms have been used for the appearance of the affected penis, such as “ram horn penis.”1
The cause for this shape is not well understood; however, the most likely sequence of events is as follows: the superficial penile arteries supplying the prepuce become branched, tortuous, and minute at the preputial ring. The ventral aspect of the preputial skin adjacent to frenulum is richly supplied by the frenular branch of the dorsal artery of the penis.2 The major lymphatic trunks draining the penis run along the dorsal penile vein. Long-standing inflammation leads to fibrosis of the lymphatics and the surrounding connective tissues. Owing to the poor blood supply on the dorsal aspect of penis compared with that of the ventral aspect, contraction of the connective tissues on the dorsal aspect of the penis occurs. This bends the penis dorsally. The corpora cavernosa, through its continuation as the crus penis, is attached to the ischial tuberosity, but the bulbospongiosis structure and the glans penis have no such solid attachments, so they also get diverted upward. The ventral aspect of the prepuce thus becomes the dependent part, and this being richly vascular, more extravasation of fluid occurs, leading to edema of the ventral prepuce, which further pushes the glans upward and outward, accentuating the dorsal curvature, thus leading to classical saxophone penis.1 The different conditions causing a saxophone penis, reported in the literature, are primary lymphedema, penile tuberculosis, and lymphogranuloma venereum in its tertiary stage.1
Maatouk I, Moutran R. Saxophone Penis. JAMA Dermatol. 2013;149(7):802. doi:10.1001/jamadermatol.2013.4175
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