Penis problems, itchy penis, and penis pain

What causes an itchy penis?

An itchy penis is often due to a fungal infection such as thrush. This is also known as candidiasis. It can be a sign of diabetes mellitus but this most often has other symptoms too such as tiredness, excessive thirst and needing to pee a lot.

Alternatively, penis itching can sometimes be a symptom of a condition called balanitis. This is the term used to describe inflammation at the head of the penis, which can also cause penis pain. The tip of the penis may also be red or sore. In addition, you may notice pain when you pass water or make love and sometimes bleeding or a smell coming from your foreskin, which usually develops over a few days.

Balanitis can be caused by poor hygiene and infections picked up during sexual activity or sexual intercourse, 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.

Our separate leaflet on Balanitis has more information.

Infections that can result in an itchy penis and affect the shaft of the penis include thrush, allergies or irritants, or as part of a more generalised skin problem such as psoriasis. Other skin conditions that can make your penis itch include contact dermatitis (where you come into contact with something you are allergic to, such as soaps or shampoo) and eczema.

An itchy penis can also sometimes be a cause of a lower urinary tract infection in men (UTI), which can again be a source of penile discomfort and penis pain.

A doctor can often diagnose the condition just by its appearance, but sometimes tests are needed. The treatment depends on the cause.

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Phimosis and paraphimosis

What causes penis pain?

There are several causes of penis pain which we discuss in more detail below. Causes of penis pain include:

• An injury due to a fall or during sports.

• Strenuous sexual activity.

• Penile fracture - force applied to an erect penis that damages the fibrous part of the shaft. There is no bone in the penis.

• Sexually transmitted infections.

• Non-sexually transmitted infections, such as yeast infections leading to balanitis.

• A paraphimosis, where the foreskin has been pulled back and gets stuck (this is a medical emergency).

• Peyronie's disease.

Peyronie's disease

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. With Peyronie's disease, painful erections and problems with penetration during sex are common.

In most cases tests are not needed, but occasionally a scan is suggested if a blood circulation problem affecting the penis is suspected. The medical treatment includes:

• Medication that can be swallowed; or

• Medicines applied directly to the surface of the penis; or

• Injections into the areas of scarring.

Other treatment options are available. In most cases, the condition stays the same or becomes worse, but occasionally it gets better with time.

See the separate leaflet called Peyronie's Disease for additional information.

Hypospadias

Your urethra is the tube running from your bladder down the length of your penis, which your urine comes out of. Hypospadias 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 from 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.

See the separate leaflet called Hypospadias for additional information.

Discharge from the penis

Discharge from the penis is usually caused by inflammation of 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 disease or 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 soap, spermicides or putting a tube (catheter) in to drain the bladder can also be to blame. A cause can't always be identified.

If an infection is the cause, it may go away without medical treatment, but this can take several 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, a sexual health clinic, or a genitourinary medicine (GUM) clinic. Don't have sex until you and your sexual partner(s) have been tested. Even after treatment, you must avoid sex until it's shown that any infection has been cleared by treatment.

See the separate leaflets called Gonorrhoea, Non-gonococcal Urethritis and Urethritis and Urethral Discharge in Men for additional information.

Lumps on the penis

A common cause for these is warts, 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 penis pain or 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 and penile cancer, 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 boys and girls aged 12 to 13 years.

See the separate leaflet called Anogenital Warts for additional information.

Circumcision

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 and sometimes penis pain.

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. It's not uncommon for this to result in penis pain.

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 (see above).

• An infection of the foreskin, called posthitis.

• A skin condition called balanitis xerotica obliterans.

See the separate leaflet called Circumcision for additional information.

Erection dysfunction

This is also called erectile dysfunction or impotence. There are 2 types of ED:

• You can't maintain an erection long enough to complete sexual intercourse; or

• You're unable to get an erection at all.

A lot of men have ED now and again, 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 are 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).

See the separate leaflet called Erectile Dysfunction (Impotence) for additional information.

Penile cancer

This is also known as penile cancer. It is very rare, affecting 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 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.

See the separate leaflet called Penile Cancer for additional information.