About penis problems
What kinds of penis problems are there?
Lumps, foreskin problems and inflammation of the penis are common problems men can experience. Men who are not circumcised can experience problems with their foreskin.
Most inflammations and lumps are not too serious and can easily be treated; however, some penis problems can increase the risk of penis cancer.
Priapism is an erection that lasts more than three hours, and can cause damage to the penis so must be treated promptly.
If you have any changes in the skin or foreskin of your penis, see your local doctor.
At birth, the foreskin and the glans penis are joined. As boys start growing, an increase in hormones contributes to the foreskin and glans separating and the foreskin is then able to be pulled back. This happens in most boys at around three years of age.
The foreskin of an uncircumcised child should not be forcibly pulled back as this can cause bleeding and injury. By forcefully pulling back the foreskin, scarring can happen. In the future, scarring can cause problems with retracting the foreskin, which is called phimosis.
All uncircumcised adult men should have a genital examination by their doctor and have their foreskin retracted to check for signs of penis cancer.
Penis lumps and priapism
There are different types of penis lumps and many are harmless. Some common lumps include cysts, ulcers, papules and plaques.
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. Herpes 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, 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 resistant, freezing with topical liquid nitrogen. Although these treatments get rid of the warts, they do not get rid of the 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.
A school-based HPV vaccination program for boys started in Australia in early 2013. Boys aged 12 or 13 years are eligible for the ongoing program and 14 to 15 year-old boys are eligible in 2013 to 2014 only (catch-up program).
What are plaques?
Plaques are raised lumps that are bigger than one centimetre in diameter. They do not usually have a serious cause, but some are infectious and can develop into more serious conditions such as penis cancer.
Plaques can be caused by balanitis or eczema.
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 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 the inability to get an erection. Priapism can happen to males at any age.
What causes priapism?
The most common cause of priapism is 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 the treatment, 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.
If priapism is caused by an erectile dysfunction treatment or other medicines, trying a different treatment may help.
What is balanitis?
Balanitis is a very common inflammation of the glans penis (head of the penis) that can affect males at any age. Balanitis can affect circumcised males but is more common in men who have not been circumcised.
What are the symptoms of balanitis?
Men with balanitis may have the following symptoms:
- not able to pull back the foreskin
- itchiness or rash
- sore or tender glans penis
- redness or swelling
- discharge from the penis.
What causes balanitis?
Balanitis often happens when the foreskin is not pulled back, or is unable to be pulled back due to scarring, and the inside of the foreskin is not kept clean. Inflammation caused by a bacteria or fungus is common. Balanitis can also be caused by irritation from chemicals in soap, clothing, washing powder and latex in condoms. Allergies to certain medicines, viruses such as HPV, and diabetes can also cause balanitis.
In adults balanitis can be a sign of diabetes. After urinating, some urine can get trapped under the foreskin. The moist area and the glucose in the urine can lead to bacteria growing. If you have balanitis and it keeps happening, ask your doctor about a test for diabetes.
How is balanitis treated?
Treatment for balanitis depends on the cause. Usually, washing the penis and the inside of the foreskin with soap and warm water will help. Topical antibiotic or antifungal ointment/cream can be very effective for treating balanitis caused by infection.
What is Balanitis Xerotica Obliterans (BXO)?
Balanitis Xerotica Obliterans (BXO) is not the same as balanitis (inflammation of the glans penis). BXO is a rare condition where scar tissue forms in the foreskin. A ring of white tissue develops at the tip of the foreskin making the foreskin tight so that it is difficult to pull it back (phimosis). BXO may spread to the glans penis, but this is not common.
Speak to your doctor if you are concerned about white scarring of your foreskin to see if it is BXO and not early penis cancer. BXO gets worse over time and is usually treated by circumcision.
Phimosis and paraphimosis
What is phimosis?
Phimosis is when the foreskin is too tight, or the tip of the foreskin narrows and is unable to be pulled back to expose the head of the penis.
What are the symptoms of phimosis?
Severe phimosis can cause pain when urinating, urinary retention, urinary tract infections and the skin on the penis can become infected. In older men with severe phimosis the foreskin can look swollen.
What causes phimosis?
Phimosis is often seen in children or young adults (called primary or congenital phimosis), most commonly happening before puberty. Phimosis can also happen after injury that causes the foreskin to tear (called secondary or acquired phimosis). As the tear heals, scar tissue forms which makes the foreskin less able to stretch far enough to pull back. The scarring from BXO can also cause phimosis. Phimosis can happen after infection or inflammation such as balanitis.
How is phimosis treated?
Phimosis can be treated with steroid creams applied once or twice daily for a couple of weeks. Studies have shown that the creams have a success rate of more than 85 per cent, and this can increase if the foreskin is gently stretched at the same time as applying the cream. If steroid creams do not work and phimosis is severe, circumcision is an option. Adult men with phimosis should be checked for balanitis, diabetes and penis cancer.
What is paraphimosis?
Paraphimosis happens when the foreskin has been retracted behind the head of the penis and cannot go back to its original position. If the foreskin stays in this position, it can cause pain and swelling and can stop blood flow to the penis. This is a serious medical problem and must be treated immediately or the penis can have long-term damage.
What causes paraphimosis?
Paraphimosis can happen at any age, and can be caused by injury to the head of the penis. It can also happen to infants if parents pull back their foreskin and do not pull it forward again.
How is paraphimosis treated?
It is important to apply ice to reduce any swelling and then try to move the foreskin forward to the usual position. Other ways to reduce swelling include injecting medicine that lessens swelling or inserting a needle and releasing some blood. If the foreskin does not return to its normal position, a surgeon may have to cut the foreskin to release it, or circumcision may be necessary.