Penis problems
 This section deals with particular problems with the penis. For general questions on erections, size, coming etc, try the Tool-Kit.
Balanitis
Cancer of the penis
Hypospadias
Paraphimosis
Peyronie's disease
Phimosis
Priapism What are penis problems like? (real comments from real people)
What's circumcision like? (real comments from real people)
Have your say about penis problems Erectile dysfunction (impotence), premature ejaculation and sexually transmitted infections are dealt with in other sections of malehealth.co.uk. BalanitisWhat is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?An unpleasant, irritating but seldom serious inflammation of the head of the penis. Top of Page What are the main symptoms?- The head of your penis (glans) is inflamed – red, sore and itchy.
- White or red blotches or lumps may appear.
- The glans may also look shiny or waxy.
- In severe cases it may also be swollen.
- The foreskin may become pale and thickened and stick to the glans (known as balanitis xerotica obliterans)..
- A foul-smelling discharge.
Top of Page What's the risk?Balanitis is a common condition in uncircumcised men and is usually associated with poor hygiene. It is unusual in circumcised men. Top of Page What causes it?- Poor personal hygiene: if you don't wash under the foreskin, a cheesy substance called smegma accumulates. This can become infected and cause irritation. This problem is more likely to occur when the foreskin is too tight to allow it to be retracted over the end of the penis to enable the glans to be washed thoroughly.
- Thrush (candida): a milder form of balanitis is caused by an allergy to thrush in a woman's vagina.
- Psoriasis: this skin disease can occur on the penis without you having it anywhere else. On the glans it looks red and shiny, while elsewhere it is usually white and scaly.
- Irritation: balanitis can sometimes be caused by sensitivity to perfumes in soaps and detergents.
- Bacterial infection: streptococcal bacteria in a woman's vagina can be transmitted during sexual intercourse.
- Rough handling: strenuous sexual activity, particularly masturbation, can make the penis sore and prone to infection.
- Allergy: some men are allergic to rubber, spermicides, deodorants and topical medications (those applied to the skin).
- Medication: some drugs, such as penicillin, can cause balanitis.
- Diabetes.
Top of Page How can I prevent it?Your best bet is to wash your penis thoroughly every day, especially if you are uncircumcised. Top of Page Should I see a doctor?You should see your doctor, not least because severe balanitis can be a sign of diabetes, a serious illness that needs to be treated as soon as possible. You also need to be sure that the problem hasn't been caused by a sexually transmitted infection which produces similar symptoms. Top of Page What are the main treatments?- If your balanitis is caused by thrush, an anti-fungal treatment can help.
- Antibiotics can clear up balanitis caused by bacterial infections.
- If it is caused by psoriasis, your doctor can prescribe a steroid cream.
- Your doctor can arrange a test to identify the cause of your allergy.
- If the problem is recurrent, and due to a tight foreskin, then circumcision may be advised.
Top of Page How can I help myself?- Use a mild, unperfumed soap.
- Put two handfuls of salt in the bath, but nothing else such as bubble bath, bath oils, or disinfectants
- Wash your underwear with non-biological washing powder or liquid.
- Heterosexual men should ask their partners to visit a doctor or a genitourinary medicine (GUM) clinic to check whether they have thrush.
Top of Page What's the outlook?Balanitis is usually mild. Once the cause has been identified, it can usually be cleared up easily. Top of Page Who else can help?There are no organisations that deal specifically with this problem and you should see your doctor if the condition doesn't clear up soon. But if circumcision is suggested it is not something to be entered into lightly especially when there may be a less invasive alternative treatment. You might want to check out the following site: NORM UK
Web site: www.norm-uk.co.uk
PO Box 71
Stone
Staffordshire ST15 OSF
Tel: 01785 814044 (open Monday to Friday, 9 am–7 pm)
E-mail: info@norm-uk.org
Provides anti-circumcision and foreskin "restoration" information. Top of Page Cancer of the penisWhat is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?Just about every man's worst nightmare. Top of Page What are the main symptoms?- A lesion (lump) on the penis, which may look like a wart or spot; occasionally the lesion may be painful.
- A painless sore on the penis.
- Pain and bleeding may occur with advanced disease.
Top of Page What's the risk?Penile cancer is very rare – there's just one case for every 100,000 men each year in the UK – but uncircumcised men over 60 are at greater risk. Top of Page What causes it?The exact cause of penile cancer is unknown. However, build-up of smegma (a smelly, cheese-like substance) under the foreskin is believed to be a factor because it can lead to chronic (i.e. long-term) inflammation. The disease is almost unknown among men who were circumcised shortly after birth. Top of Page How can I prevent it?Your best bet is to wash your penis thoroughly every day, especially if you are uncircumcised. Top of Page Should I see a doctor?You should see your doctor immediately if you find a lump on your penis. Your GP will perform a physical examination that can rule out any other conditions. He or she can refer you on to a hospital specialist for more detailed assessment. Top of Page What are the main treatments?The treatment depends on the size and location of the tumour. The first step is usually removal of the lump combined with circumcision. If the lump is too large to be removed without causing disfigurement then the surgeon will take only a small portion for analysis (biopsy). If penile cancer is confirmed then other options are possible: - If the tumour was completely removed during the initial operation, then the condition can often be managed by a series of regular check-ups.
- If some cancer cells have been left behind then it may be appropriate to give X-ray treatment (radiotherapy) to the penis to avoid the need for further surgery.
- In advanced cases, then some or all of the penis may need to be removed (partial or total penectomy).
- If the disease has spread to involve the rest of the body then chemotherapy may be required. You will need to go into hospital for the first few doses of the chemotherapy drug to check for adverse side-effects.
Top of Page How can I help myself?If you are uncircumcised, you should clean behind your foreskin regularly. Top of Page What's the outlook?The outcome can be good if you are diagnosed and treated early. However, cancer of the penis often spreads to other parts of the body in the early stages of the disease. If the disease has not reached the lymph glands then between 65% and 90% of men survive for five years or more. If a partial or total penectomy is performed then a new exit point for the urethra (water pipe) will have been fashioned at the time of surgery (this procedure is known as a urethrostomy). Sexual functioning can be maintained even when a large part of the penis has been removed, although your erection will be impaired. You will need time to get used to the appearance of the penis. It is likely to be distressing at first and counselling may be helpful. Joining a support group of other men affected may also help. Top of Page Who else can help?CancerBACUP
Web site: www.cancerbacup.org.uk
3 Bath Place
Rivington Street
London EC2A 3JR
Tel: 0808 800 1234 (open Monday to Friday, 9 am–7 pm)
A patient support organisation producing excellent literature. Their help and information line is staffed by cancer nurses. It also offers cancer counselling services. Cancer Research UK
Web site : www.cancerresearchuk.org/
Cancer Research UK
P.O. Box 123
Lincoln’s Inn Fields
London WC2A 3PX
Major research organisation with a very informative website for patients. Guide To Internet Resources for Cancer
Web site: http://www.cancerindex.org/
This is a comprehensive overview of everything on the Internet on cancer. Institute of Cancer Research
Web site: www.icr.ac.uk
123 Old Brompton Road
London SW7 3RP
Tel: 020 7352 8133 Macmillan Cancer Relief
Web site: www.macmillan.org.uk
Tel: 0808 808 2020
Its site contains patient information and links to other organisations. Top of Page  Hypospadias
What is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?A congenital (i.e. present at birth) defect in which the opening of the urethra isn't at its normal place at the end of the penis. Top of Page What are the main symptoms?- The opening of the urethra (the passage for urine and semen) is on the underside of the head of the penis (glans). Normally it is at the end of the penis, in the middle of the glans.
- The middle of the glans is just a blind dimple.
- In 65% of males with hypospadias, the opening is on the underside of the head of the penis, near where it joins the shaft.
- However, the opening can be anywhere along the underside of the shaft or even at the root of the penis near the testicles.
- The penis may bend at the end when erect.
- The foreskin is often abnormal. Part of it may be missing on the underside of the penis, so it looks like a hood.
- You may have difficulty directing your stream of urine.
Top of Page What's the risk?the usual estimate is that hypospadias affects about one in every 300 males but there is evidence that this is increasing. It usually runs in families. If a boy has hypospadias, his brothers have a one in twenty chance of also having it. Top of Page What causes it?Hypospadias is present from birth but its cause is unknown. Hypospadias results from a failure of the penis to develop in the normal fashion. Normally the penis develops in two halves, which fuse along the underside (this accounts for the line that runs along the underside of the penis from the scrotum to the end of the foreskin) – this process is usually complete by the 15th week of gestation in the mother's womb. If this process stops during its progress then hypospadias is the result. One theory links this birth defect to the impact of certain pollutants on male foetuses while still in the womb. Top of Page How can I prevent it?You can't. Top of Page Should I see a doctor?Severe hypospadias, where the opening is near the testicles, should have been noticed at birth and corrected by an operation at the age of 12–18 months. But babies with slight hypospadias, where the opening is on head of the penis, do not always have an operation. However, even slight hypospadias can be irritating and embarrassing. You should see your GP who can refer you to a urological surgeon. This specialist will be able to give you more information and discuss your options, including surgery. Be aware that if your son is diagnosed with hypospadias at birth then a circumcision should not be performed, because the foreskin is often used to provide tissue for the hypospadias repair. Top of Page What are the main treatments?Surgery can redirect the urethra and create a normal opening on the glans. The goal of surgery is to correct the cosmetic appearance of the penis and to allow urine to be passed normally. Top of Page How can I help myself?If you have an uncorrected hypospadias there's little you can do besides discuss the problem with your doctor or others with the condition. If your child is affected, discuss the options with a paediatrician. Top of Page What's the outlook?After surgery you should have no further problems. However, surgery is sometimes complicated by the formation of a fistula (a hole in the repair through which urine can leak). Top of Page Who else can help?There is now a full section on hypospadias on malehealth. Click here to read more about living with hypospadias. Top of Page ParaphimosisWhat is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?A painful condition in which the foreskin can't be pulled back over the head of the penis. Top of Page What are the main symptoms?- The retracted foreskin becomes stuck behind the head of the penis (glans) and cannot be pulled forward again, leaving the glans exposed.
- The penis becomes swollen and painful.
Top of Page What's the risk?You are at risk if you are uncircumcised or have not been properly or completely circumcised. Top of Page What causes it?Paraphimosis is caused by inflammation and narrowing of the foreskin. This may be the result of infection, poor personal hygiene, or damage to the penis, causing swelling. Top of Page How can I prevent it?It's not always possible to prevent it, but keeping your penis clean and treating any infections quickly will definitely help. Also, make sure you roll your foreskin back after sex. Top of Page Should I see a doctor?Yes. If you can't move the foreskin gently back into position, or if the problem starts to occur regularly, you should get medical advice. If the foreskin remains retracted for too long it can become extremely painful and may even cause permanent damage. Top of Page What are the main treatments?A doctor can manually retract the foreskin under local or general anaesthesia. You may also be shown how to gradually retract the foreskin after a bath, using petroleum jelly (Vaseline) or some other form of lubrication. But if the problem persists, circumcision may be necessary. Top of Page How can I help myself?Keep your penis clean. Top of Page What's the outlook?The probable outcome is excellent if the condition is diagnosed and treated rapidly. But if it is not treated promptly, the penis may – in very rare cases – be permanently damaged or become gangrenous. Top of Page Who else can help?If circumcision is suggested it is not something to be entered into lightly especially when there may be a less invasive alternative treatment. You might like to check out the following website: NORM UK
Web site: www.norm-uk.co.uk
PO Box 71
Stone
Staffordshire ST15 OSF
Tel: 01785 814044 (open Monday to Friday, 9 am–7 pm)
E-mail: info@norm-uk.org
Provides anti-circumcision and foreskin "restoration" information. There is also an International Information Reference Centre website - www.circinfo.com - providing unashamedly pro-circumcision information. Top of Page Peyronie's diseaseWhat is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?A condition in which the penis becomes curved during an erection. Top of Page What are the main symptoms?- Hard lumps, known as plaques, form in the fibrous erectile tissue of the penis.
- A plaque usually forms on the top of the shaft, causing the penis to bend upward.
- A plaque on the underside causes it to bend downward.
- If the plaque develops on both the top and the underside of the penis this can lead to indentation and shortening of the penis.
- The thickened area may be painful when the penis is erect.
- It can be difficult to get an erection (the plaques may obstruct blood flow in the penis). The anxiety caused by Peyronie's disease can also impair sexual performance and be a psychological cause of impotence.
- The pain and the bending of the penis may physically prevent sexual intercourse.
Top of Page What's the risk?About 80,000 men in the UK are thought to have Peyronie's disease. However, one study suggested that as many as 1% of men are affected by the condition. - Men aged 50–60 are most at risk, although the disease occurs in younger and older men.
- There is some evidence of a familial link to Peyronie's disease – a man with relatives affected by the condition is more vulnerable to developing it.
N.B. The lumps in Peyronie's disease are benign and not linked to cancer of the penis. Nor is it caused by sexually transmitted infections, such as gonorrhoea. Top of Page What causes it?Doctors are not entirely certain what causes Peyronie's disease. Many experts believe it is the result of damage to the penis, causing internal bleeding. There is some evidence that the elasticity of the penile tissues is reduced in older men and that minor damage may occur (without any obvious outward signs) during sexual intercourse. Some cases may be caused simply by turning over in bed while asleep with a nocturnal erection. In mild cases the plaque does not advance beyond an initial inflammatory stage, but in severe cases tough fibrous tissue develops and calcium deposits may even build up. While injury may cause some cases of Peyronie's disease, most cases develop slowly and after no apparent trauma. Severe hypospadias, where the opening of the urethra is on the wrong part of the penis, can also cause curvature of the penis. This condition is different from Peyronie's disease, however. Top of Page How can I prevent it?You can't, except perhaps by avoiding sexual acts which might damage or over-stretch the penis. Top of Page Should I see a doctor?If you notice lumps in your penis, you should go straight to your GP. There is no need to worry about having an examination: it may be embarrassing, but doctors are very familiar with Peyronie's disease. They can also rule out any other possible causes. If you have only had the problem for a short time the doctor may ask you to come back in a month or so if the problem persists. But if you are in pain, or if the condition is affecting your sex life and relationship, insist on a referral to a consultant or to another GP with a special interest in sexual problems. There are also special NHS clinics to treat male sexual problems. DiagnosisYou will need to have a physical examination. No medical tests are usually necessary. Top of Page What are the main treatments?Surgery is the only treatment known to be effective. However, many men with Peyronie's disease need no treatment, because in its mild form the condition heals by itself in 6–15 months. Many doctors therefore suggest that men wait one to two years before having surgery. At the end of this period there may be a residual curvature of the penis but, if intercourse is possible without pain, no further treatment is usually required. Prior to surgery some men try other treatments, as listed below, but their effectiveness is unproven. - Your doctor can prescribe vitamin E tablets (800 mg/day) or potassium aminobenzoate, known as Potaba (12 g/day). Some improvement has been reported but their effectiveness remains unproven.
- The affected area may be injected with steroids or other chemical agents to attack the build-up of plaques. This can reduce pain, but steroids such as cortisone have led to unpleasant side-effects, including the wasting or death of healthy tissues.
- Radiation therapy has also been used. This can also reduce pain but appears to have no effect on the plaques and can also cause unpleasant side-effects.
- In the early stages of the disease the drug tamoxifen has been shown to reduce the build-up of plaques. However, the drug is usually given to treat breast cancer and is not licensed for the treatment of Peyronie's disease.
SurgeryAbout 10% of men have surgery. It's not usually considered unless you have been affected for a year and have difficulties performing sexual intercourse. There are three operations available: - Removal of the plaque and grafting with a patch of tissue. This can lead to erection problems, particularly loss of rigidity.
- Removal of tissue from the side of the penis opposite the plaque to cancel out the bend. This is known as the Nesbit procedure. After the operation the erect penis will be straight, but there may be some shortening of the erect penis.
- A device can be implanted in the penis to increase its rigidity. This may be combined with incisions and skin grafts if the penis is still not straight. This procedure is usually only required if there is softness (flaccidity) of the end of the penis (the glans penis) during erection.
Top of Page How can I help myself?If the disease is affecting your sex life this may in turn damage your self-esteem and perhaps cause depression. It could also affect your relationship with a partner. You may find it helpful to talk your feelings through with your partner or with a counsellor experienced in sexual problems. Top of Page What's the outlook?Many men with Peyronie's disease will only be mildly affected and the condition will disappear with time. In severe cases surgery can correct the problem but you may be left with a shorter penis or it may not be as hard when erect. Although this may not prevent you from having sex it may still cause some anxiety. Counselling and discussing the situation with your partner can help. Top of Page Who else can help?Sexual Dysfunction Association
Web site: www.sda.uk.net
Windmill Place Business Centre
2-8 Windmill Lane
Southall
Middlesex UB2 4NJ
Tel: 0870 7743571
For information and advice on all sexual dysfunctions. To read what Dr Ian Banks, malehealth's chief medical adviser, has to say about Peyronie's, click here. Feature article: Peyronie's by Dr Raj Persad. Top of Page PhimosisWhat is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?An unusually tight foreskin that cannot be drawn back from the head of the penis. Top of Page What are the main symptoms?- You cannot retract the foreskin to expose the head of your penis.
- The foreskin is too tight.
- Severe phimosis can make erections painful.
Top of Page What's the risk?Only uncircumcised men are affected. Some have phimosis from childhood but it can develop later in life. The foreskin is stuck to the glans in small children but should begin to separate at around three years of age. As the child gets older the foreskin normally retracts to expose the glans but often the foreskin, although partially retractable, will remain attached to the glans until after puberty If you cannot fully retract your foreskin you won't be able to wash it properly. This may lead to a build-up of smegma, which can become infected. Top of Page What causes it?- Thrush infections, which make the foreskin scarred.
- Balanitis xerotica obliterans, a condition which makes the foreskin stick to the penis.
Top of Page How can I prevent it?The traditional view is that there's not a lot you can do. In fact, there is. Check out our Circumcision FAQs here. Top of Page Should I see a doctor?Yes you should, as trying to force the foreskin back will only cause painful cracks on the inside of the foreskin; these will scar as they heal and make the condition worse. The doctor will carry out a physical examination. Top of Page What are the main treatments?Try the other options first but you may need to be circumcised. This involves an operation to separate the foreskin from the glans. The foreskin is then cut away and the incision stitched up. If the cause is balanitis xerotica obliterans you may first be prescribed steroid creams. This can relieve the condition but circumcision may still be required later. Top of Page How can I help myself?As we said, the traditional view is that there's not a lot you can do. In fact, there is. Check out our Circumcision FAQs here. Top of Page What's the outlook after circumcision?At the very least, the glans will feel sensitive after circumcision as it is not used to being exposed. Wearing loose boxer shorts and using a condom during sex for the first month or two after the operation (even if you have a regular partner) should reduce any irritation. Top of Page Who else can help?If circumcision is suggested it is not something to be entered into lightly. You might like to check out the following website: NORM UK
Web site: www.norm-uk.co.uk
PO Box 71
Stone
Staffordshire ST15 OSF
Tel: 01785 814044 (open Monday to Friday, 9 am–7 pm)
E-mail: Info@norm-uk.org
Provides anti-circumcision and foreskin "restoration" information. There is also an International Information Reference Centre website - www.circinfo.com - providing unashamedly pro-circumcision information. Top of Page PriapismWhat is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?A prolonged erection that, if left untreated, can damage the penis. It's definitely no joke. Top of Page What are the main symptoms?- Persistent erection for more than four hours in the absence of sexual stimulation.
- Penile pain.
Top of Page What's the risk?Priapism can affect men of all ages but the risk is very small, although it's slightly greater for men with an underlying blood disorder (e.g. sickle cell anaemia) or those who are using injection treatments for erectile dysfunction (impotence). Top of Page What causes it?Most cases (60%) are idiopathic (i.e. the cause is unknown). The remaining 40% of cases are usually caused by: - Reactions to drugs, especially those prescribed to treat erectile dysfunction (impotence), but also including antidepressants such as chlorpromazine.
- In childhood leukemia the white blood cells can block the outflow of blood from the penis.
- In sickle-cell anaemia the blood receives low levels of oxygen, causing it to thicken. This makes the outflow of blood from the penis sluggish.
- Injury to the penis or to the area underneath the penis between the genitals and the anus known as the perineum.
- Spinal cord injuries.
- In rare cases cancers may affect the penis and prevent the outflow of blood.
- A blocked or ruptured blood vessel can also affect blood flow in the penis.
Top of Page How can I prevent it?You can't. Top of Page Should I see a doctor?You need to see a doctor as soon as you think there is a problem (i.e. if your erection hasn't disappeared after four hours). The visit will involve a physical examination and questions about any drugs you have been taking. The doctor may also take a blood gas measurement of the blood from the penis. This provides a clue as to how long the condition has been present and how much damage has occurred. A small needle is placed in the penis and blood is collected. Top of Page What are the main treatments?If a patient gets treatment within four to six hours, the erection can almost always be reduced with medication. Decongestants can reduce the flow of blood to the penis. If this fails, the old blood can be released from the penis through a small needle. The area will be cleaned first and numbed with a local anaesthetic. If this treatment is performed in the first few hours, it may be all that is needed to correct the problem. However, if the erection persists or recurs, you will be given drugs that cause the blood vessels to constrict to prevent priapism. If this is unsuccessful a minor surgical operation called shunting can be performed. This allows blood to drain from the erectile tissue into the glans and other tissues. As this procedure can result in permanent and irreversible impotence, it is essential that you go to your doctor as soon as you think you may have a problem. If necessary, go to the nearest accident and emergency department. Top of Page How can I help myself?The most important thing to do is to seek medical help quickly. However, putting ice-packs on your penis can ease the pain of priapism. Running up and down stairs or using an exercise bicycle might also be worth a try. Top of Page What's the outlook?Providing that the priapism is dealt with quickly the outlook is very good. After prolonged priapism there is a very real risk of permanent impotence. Top of Page Who else can help?Don't waste time contacting organisations or surfing the web: see a doctor as soon as possible. Top of Page Back to A-Z of Health  By David Batty, a freelance journalist and editor specialising in men's and mental health and a reporter for GP magazine. He has contributed to NetDoctor, The Guardian, BBC Online, The Big Issue and Nursing Standard. Have your say about penis problemsHave you been affected by a penis problem? If so, we'd like to hear about your experience and to post it on the malehealth.co.uk site. This could be useful to other men who are also affected by this problem. Please note, we cannot answer any queries posted here. If you would like to ask a question about penis problems that will be answered by our panel of experts, please go to Ask the Doctor. Read about other men's experiences of tackling penis problems
Page last updated: 01/12/2004
|
