About penis problems
What is the penis?
Used for urination and sexual intercourse, the penis is made up of two erectile cylinders (corpora cavernosa) that enlarge with blood during erection. A tough fibrous, partially elastic outer casing surrounds the cavernosa. The corpus spongiosum surrounds the urethra (urinary tube), a tube that runs from the bladder to the end of the penis. The urethra carries urine and semen out of the body.
Cross-section of the penis
The head of the penis (glans penis) is covered by the foreskin in uncircumcised men.
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There are different types of penis lumps and many are harmless. Some common lumps include cysts, ulcers, papules and plaques. Very rarely a penis lump will be cancer.
What are penis cysts?
Sometimes the sebaceous glands (gland that produce oil) on the penis and scrotum can become enlarged and blocked, turning into cysts. Treatment is not usually needed for cysts but sometimes they can become painful and infected if they continue to grow.
What are penis ulcers?
Ulcers appear as craters in the skin and often have a clear liquid or pus in the crater. A single ulcer on the penis can be serious and should be checked by a doctor immediately. Causes of a single ulcer include syphilis, tropical diseases and penis cancer.
Multiple ulcers are more common and less serious, but should still be checked by a doctor. The herpes virus is the most common cause of multiple penis ulcers.
What are penile papules?
Papules are small raised lumps on the skin and most do not have a serious cause. ‘Pearly penile papules’, a common type, appear as one or more rows of small, smooth lumps around the back of the glans penis (head of the penis). These are often mistaken for genital warts; however, these papules are not infectious and do not need to be treated.
Causes of other types of papules on the penis include psoriasis (a skin condition), and sexually transmitted infections such as genital warts.
What are genital warts?
Genital warts are caused by the human papilloma virus (HPV). Warts often happen in clusters and can be very small. Genital warts are spread through skin-to-skin contact, so it is important to use condoms if you or your partner is infected.
Genital warts are treated by either topical antiviral ointment or if that does not work, freezing with topical liquid nitrogen. Although these treatments get rid of the warts, they do not get rid of the HPV virus and warts may come back on the skin or in the eye of the penis. An inspection of the inside of the penis may be needed to fully treat the warts.
There is a National HPV Vaccination Program in Australia where the HPV vaccine is provided free to all males and females aged 12 or 13 years.
What is Peyronie’s disease?
Peyronie’s disease (named after François de la Peyronie, surgeon to King Louis XV of France) is the hardening of tissue (fibrosis) in the penis. A lump or plaque (scar tissue) forms on the lining of the erectile tissue which holds much of the blood in the penis during erection. In most cases, a hard lump can be felt at the point where the penis curves.
The hardened area or plaque prevents normal stretching and can affect the size and shape of the erect penis. In severe cases, the plaque can include the muscle and arteries of the penis leading to erectile problems.
More details about Peyronie’s disease can be found in a separate Andrology Australia fact sheet.
What is penis cancer?
Cancer develops in the penis when cells on the surface divide uncontrollably to form a tumour. Most penis cancers develop from skin cells in the penis; most (95%) of penis cancers are from a particular type of skin cell and these are called “squamous cell cancers”. These cancers usually happen in the foreskin of uncircumcised men but can happen elsewhere in the penis. Most of these cancers grow very slowly and can be cured if found early.
Penis cancer is uncommon. In 2012 there were 108 new cases diagnosed in Australia; up to 1 in 1000 men develop penis cancer during their lifetime.
What causes penis cancer?
It is often not known why a penis cancer develops but there are some factors that are known to make it more likely for a cancer to develop. These risk factors include: chronic (long-lasting) infection with HPV; not being circumcised; phimosis (where the foreskin is too tight and cannot be pulled back); balanitis (inflammation of the glans penis); tobacco smoking; and older age. However, only a small number of men with any of these risk factors will develop penis cancer.
How is penis cancer treated?
There are several treatments for penis cancer and the treatment chosen depends on the type and stage of the cancer, the overall health of the man, and personal preferences for treatment type and associated side effects.
The main treatment is surgery. Other treatments include laser treatments, chemotherapy and radiotherapy; these treatments may be given after surgery or instead of surgery.
What should I do if I find a lump on my penis?
If you are worried about any lumps on your penis you should see your local doctor (GP) straight away. You may be referred to a urologist (a surgeon who specialises in diseases of the urinary tract in men and women, and the genital organs in men) if the lump(s) needs further investigation.
What is priapism?
Priapism is an erection that lasts for more than three hours and is usually very painful. Blood becomes trapped in the penis and does not return to the circulation. It is not always related to sexual stimulation. If priapism is not treated, it can lead to permanent damage to the erectile tissue in the penis and make a man unable to get an erection. Priapism can happen to males at any age.
What causes priapism?
The most common cause of priapism is a side-effect of treatment for erectile dysfunction, in particular, penis injections. About a quarter of other cases of priapism are linked to medical conditions such as advanced cancer, leukaemia and sickle cell anaemia. Other causes include damage to the nervous system, injury to the penis, some medicines and illegal drugs. Sometimes the cause of priapism is unknown.
How is priapism treated?
It is important to see a doctor straight away because the sooner it is treated, the less damage to the erectile tissue. If you seek treatment within four to six hours, the doctor may give a decongestant medicine to help the erection go down. Another option is for the doctor to use a needle and syringe to release the extra blood trapped in the penis. If this does not work, surgery may be needed to try to stop permanent damage to the penis.
What is a fractured penis?
A penis fracture can happen when there is too much force on an erect penis and the fibrous tissue inside the penis ruptures. When the penis fractures a cracking or popping sound may be heard, the erection goes down, and there will be bruising and pain.
What causes a fractured penis?
Fractures of the penis are uncommon. The main cause of a penis fracture is vigorous sexual intercourse or vigorous masturbation.
How is a fractured penis treated?
A fractured penis needs urgent surgery. To get the best outcome from surgery it is best if it happens within six hours of the fracture, if possible. In rare cases, if surgery is not done quickly enough, there may be long-term problems with erectile dysfunction, scarring of the penis, or bent or deformed erections.