By Tom Chiarella
First you remind the person what you are thanking them for.
Then you tell them why. That's it.
A good thank-you note is a clear and ruddy piece of prose. There are only
two moves involved. First you remind the person what you are thanking them for.
Then you tell them why. That's it. You sign off, sure. And you might throw in
an extra sentence or two for a laugh or a private joke. But it's mostly a
chop-chop exercise: two solid, sincere sentences, each touching...
The cause of chordee is unknown. During development in the womb, more elastic tissue may develop on the top half of the penis than on the bottom half. This can cause the penis to curve during erections.
Other developmental problems that can lead to chordee include:
Skin tethering, usually on the underside of the penis, making a straight erection impossible
Abnormal development of scar tissue in or around the urethra (urinary tube)
Often in chordee, the urinary opening also does not develop properly. Instead of the tip of the penis, the urinary opening may be on the underside of the penis (hypospadias).
Some doctors may use the term chordee for any downward curvature of the penis, including those not due to a problem with development. Most often, these forms of chordee occur in adulthood after surgery to correct some other problem with the penis.
Chordee may not be noticeable except during erections. That's especially the case in boys or men without hypospadias.
When hypospadias is not present, chordee may more easily go undetected until late childhood or adulthood.
Hypospadias often causes difficulty for a man or boy in controlling his urine stream. When significant hypospadias is present, he may need to sit down to urinate. Hypospadias also often results in abnormal ejaculation.
In adolescence and adulthood, chordee may cause pain or discomfort during sexual intercourse, for a man and his partner. Erections may not be of sufficient quality for sex in some men with chordee.
Surgery is the only effective treatment for chordee. The ideal time for chordee repair is before age 2. If chordee is detected prior to this time, surgery can usually repair chordee (and hypospadias, if present). The surgery will make possible the normal growth and development of the penis.
It can be done as outpatient surgery. After the surgery, a dressing will be wrapped around the penis to decrease swelling. The surgeon may ask that the child use a catheter instead of urinating for the first seven days after surgery.
Chordee repair is generally very successful in childhood.
If chordee is not diagnosed until adulthood, surgery can still be an effective treatment. Some men or older boys may require additional surgery to achieve a final repair of chordee.
If hypospadias is present, additional techniques are used during surgery to try to bring the urethral opening to its proper place at the tip of the penis.
In infant boys, correction of hypospadias is usually a routine part of surgery to repair chordee. In adult men, correction of severe hypospadias can be difficult, and may require multiple surgeries.