A number of problems can affect the penis. This leaflet will give you some idea of the conditions to be aware of and the sort of symptoms to watch out for.
Itching of the penis
Itching can sometimes be a symptom of a condition called balanitis. This is the term used to describe inflammation at the end of the penis. The tip of the penis may also be red or sore. It can be caused by poor hygiene and infections picked up during sexual activity, such as genital herpes, genital warts and crabs (public lice). It can also be caused by infections not linked to sexual activity, such as thrush.
Infections that can affect the shaft of the penis include thrush, allergies or irritants, or as part of a more generalised skin problem such as psoriasis.
A doctor can often diagnose the condition just by its appearance, but sometimes tests are needed. The treatment depends on the cause.
In this condition, thickened areas of scar tissue (fibrous plaques) appear along the shaft of the penis. As a result the penis can develop a bend or assume a deformed shape. The exact cause is unknown but there are several theories. Erections can become quite painful and men can have problems with penetration during sex. In most cases tests are not needed, but occasionally a scan is suggested if a circulatory problem affecting the penis is suspected. The treatment includes medication that can be swallowed, medicines applied directly to the surface of the penis, or injections into the areas of scarring. Other options are available. In most cases, the condition stays the same or becomes worse but occasionally it gets better with time.
This is a malformation of the urethra and penis that some babies are born with. It can cause difficulties with the urine flow. In later life, there may be erection problems. There are a number of different forms. In mild cases, the urethra may just open lower down than its usual position. In severe forms, it can open right down at the base of the penis, by the scrotum. Other abnormalities of the foreskin or the underside of the penis may also occur. Tests are not usually needed unless it is suspected that the abnormalities of the penis are part of a wider disorder (such as 'intersex syndrome'). Treatment may not be needed for milder cases, but many patients require some form of corrective surgery. This is particularly true if there are problems with the direction of urine flow or erection difficulties.
Discharge from the penis
Discharge from the penis is usually caused by inflammation of the tube between the bladder and the end of the penis (the urethra). The medical term is urethritis. You may notice a burning pain or urge to pass urine, but this doesn't always happen. Some men don't get any symptoms.
Usually, the cause is a sexually transmitted infection. The common causes are gonorrhoea and non-gonococcal urethritis (NGU). It's at its most common in younger men, especially men who have sex with men.
As the name suggests, infections other than gonorrhoea can be a cause of NGU. Chlamydia, a germ (bacterium) is a common cause. Irritants to the urethra, such as putting a tube (catheter) in to drain the bladder, soap or spermicides can also be to blame. A cause can't always be identified.
If an infection is the cause, it may go away without treatment, but this can take months. You may still be infectious, even if the symptoms have gone.
If you have a discharge from the penis, get checked out by your GP or genitourinary medicine (GUM) clinic. Don't have sex until you and your partner(s) have been tested and it's shown that any infection has been cleared by treatment.
Lumps on the penis
These are also called anogenital warts or simply genital warts. They look like little lumps on the outer skin of the penis. They also sometimes occur around the anus. They are caused by infection with the human papillomavirus (HPV). They are passed on by skin-to-skin contact. This is mainly during sexual contact, but can occur in other circumstances (eg, from mother to baby during birth). Warts on the penis usually don't cause any symptoms but people seek treatment because of their appearance. It's best to visit a GUM clinic to get checked out for other infections.
Genital warts are not cancers, but the risk of some cancers (genital cancers, cancer of the mouth, throat and neck). HPV infection is linked to cervical cancer in women.
The warts can be left alone, or removed by a variety of methods such as chemicals, freezing, burning, lasers or surgery. New warts develop after treatment in 1 in 4 cases, due to reactivation of the infection.
Condoms - both male and female - help reduce the risk of acquiring genital warts but don't abolish it because of contact with uncovered skin. Sex toys can pass on the virus and should not be shared. A vaccine is now available against HPV infection which is offered to teenage girls. There's talk of it being offered to boys and some men.
This is an operation in which the foreskin is cut off and the remaining skin stitched back. It is usually performed for a condition called phimosis. Phimosis means tightening of the foreskin. This can result in difficulties in pulling the foreskin over the head of the penis.
If the foreskin is pulled back for cleaning or insertion of a tube (catheter) to drain the bladder, and it is not pulled forwards again, the head of the penis (glans) can swell. The foreskin can become trapped under the swollen glans: this is called a paraphimosis.
Steroid cream or an operation to loosen the foreskin can sometimes be used if it is not too tight. Otherwise, a circumcision is required
Sometimes a circumcision is done for religious or hygienic reasons. Other reasons include:
- An infection of the glans, called balanitis.
- An infection of the foreskin, called posthitis.
- A skin condition called balanitis xerotica obliterans.
This is also called impotence. In this condition, you are unable to maintain an erection long enough to complete sexual intercourse, or you are unable to get an erection at all. It happens to a lot of men on a temporary basis, often as a result of stress or tiredness. It can, however, become a more persistent problem. Long-term ED is more likely to happen as you become older.
There can be many causes of persistent ED, including circulation problems to the penis, diseases of, or injury to, the nerve supply, diabetes, and lack of the male hormone (testosterone). Other causes include alcohol and recreational drugs, cycling, leakage of blood through the veins of the penis, and psychological causes.
If your ED is due to a circulatory cause (as many cases are) you will need checks to make sure you don't have a more general problem with the state of your circulatory system, including your heart. These may include blood tests to rule out raised cholesterol and diabetes, a blood pressure check, and a heart tracing (electrocardiogram, or ECG). Your lifestyle will also be reviewed (eg, weight, exercise, smoking and alcohol intake).
Treatment options will include removing any of the aggravating factors (such as excessive alcohol or stress); medication in the form of cream, or tablets that you swallow; and injections, or pellets put in the urethra. Other options include vacuum devices or a rod inserted into the penis (a prosthesis).
Cancer of the penis
This is also known as penile cancer. It is very rare (1 in 100,000 men in Europe. A cancerous (malignant) tumour grows from one abnormal cell. It is not known why this happens but certain factors are known to increase the risk. These include age (it is more common over the age of 50), becoming infected with the human papillomavirus (HPV), and certain rare skin conditions (eg, erythroplasia of Queyrat and balanitis xerotica obliterans).
Poor hygiene in adults and having a phimosis can increase the risk. Having a circumcision as a baby seems to have a protective effect.
The first sign of penile cancer is an alteration in the colour of the skin either on the head of the penis (the glans) or the underside of the foreskin if you have not been circumcised. It never occurs on the shaft. Eventually, the whole of the glans and/or foreskin can become involved.
You will probably need removal of some tissue for analysis (a biopsy) and some scans to confirm the size and spread of the cancer.
Treatment options include surgery, radiotherapy and chemotherapy.
Further reading and references
Edwards S, Bunker C, Ziller F, et al; 2013 European guideline for the management of balanoposthitis. Int J STD AIDS. 2014 May 1425(9):615-626.
Guidelines on Penile Curvature; European Association of Urology (2015)
Snodgrass W, Bush N; Recent advances in understanding/management of hypospadias. F1000Prime Rep. 2014 Nov 46:101. doi: 10.12703/P6-101. eCollection 2014.
Earp BD; Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed CDC Guidelines. Front Pediatr. 2015 Mar 183:18. doi: 10.3389/fped.2015.00018. eCollection 2015.
Lau WD, Ong CH, Lim TP, et al; Penile cancer: a local case series and literature review. Singapore Med J. 2015 Nov56(11):637-40. doi: 10.11622/smedj.2015174.
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