Penis problems you shouldn't ignore

When it comes to noticeable changes in the penis, testicles or scrotum, it is important for men to be vigilant and, if concerned, swallow their pride and seek advice from a medical expert.

Penile problems, like the sexual organ itself, come in all shapes and sizes. The good news is that, as embarrassing and unsightly as some of them may be, most are treatable and ultimately harmless.

Peyronie's disease

One of the more common is Peyronie's disease, characterised by a significant bend in the penis, or a misshapen phallus (like an hourglass). Peyronie's disease occurs in approximately 3-5% of men, the majority of them in middle age.

Other indicators include a thickened area or hard lump called a plaque in the shaft of the penis, and a loss of penile length or girth. These may cause the sufferer pain or difficulty having sex and in some cases can be associated with erectile dysfunction.

The cause of Peyronie's disease remains elusive. One theory is that it can result from a microvascular injury to the erect penis, which causes abnormal deposition of scar tissue.

The pain and curvature settles after about 12 months. Experts may therefore suggest waiting 12-18 months before attempting to correct the deformity surgically, and only if it is preventing the patient from being sexually active.

Changes in your testes

Testicular cancer is relatively rare, accounting for just 1% of all cancers in men in the UK, around 2,400 cases each year. Men in their early 30s are most at risk. It becomes less common with age.

The most common symptom of cancer is a painless lump or swelling the size of a pea (or larger) in one of the testicles. Other symptoms can include a dull ache or feeling of heaviness in the scrotum.

Be sensible and check yourself regularly for abnormalities. Don't hesitate to visit your GP if in any doubt. Remember, testicular cancer has a successful cure rate of 99% if captured early.

A good time to self-examine is after a warm bath or shower, when the scrotal skin is relaxed. Hold your scrotum in the palms of your hands, and use the fingers and thumbs to examine your testicles.

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Phimosis and paraphimosis

Phimosis means that the foreskin of the penis is too tight and so cannot be pulled back off the rounded head of the penis (glans). In paraphimosis, the foreskin has been pulled back (retracted) but cannot be returned to the original position. Paraphimosis needs emergency medical treatment to prevent complications.

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The issue of penile hygiene

Penile pain, swelling and itching, a rash on the penis and strong-smelling discharge may all by symptoms of balanitis, a condition whereby the glans (head) of the penis becomes inflamed.

Men who are uncircumcised and those whose foreskin is difficult to retract (known as phimosis if the foreskin is so tight it's impossible to retract) are especially vulnerable. However, recent research challenges the widely held view that poor personal hygiene is solely to blame.

"Interestingly, washing too much and using unnecessary antibacterials can reduce the healthy, protective microbes normally found on our skin," says Dr Anna Pallecaros, a consultant physician at the Princess Grace Hospital in London. "Understanding how to look after our skin microbiome is as important on the penis as it is on the rest of our skin.

"Good general health is vital for a healthy penis," she continues. "Not smoking, regular exercise and eating a diet with lots of fresh foods, fruit and vegetables are all important.

"Changes in erectile function resulting from reduced blood flow in the penile artery, for instance, can take place long before heart disease may become obvious."

Sexually transmitted infections

Sexually transmitted infections (STIs) that can affect the penis include herpes simplex, human papillomavirus, syphilis, chlamydia, gonorrhoea and trichomonas vaginalis.

However, many people wrongly assume that penile problems must be caused by an infection and also that men will notice a change if they have an STI. In reality, many penile symptoms are not related to STIs and only a minority of people display symptoms when they have one.

"A case in point is chlamydia," says Pallecaros. "Research shows that most young men think that you would know if you had it, when it is usually asymptomatic in 70% of young men."

So, use a condom and if you are worried by unfamiliar symptoms, don't be afraid to ask for help.

"GPs and genitourinary medical (sexual health) clinics are very good at advising if, and how quickly, further assessment is needed," Pallecaros concludes. "So, overcoming fear or embarrassment to promptly let a doctor know when you notice a change from normal is important."

When should I visit my GP?

In addition to abnormalities in the penis, testicles or scrotum, changes in urinary habits, blood where there shouldn't be, pain and itching are all worth getting checked out.

"Any red area on the penis persisting for more than four weeks, despite topical treatment, needs assessment," advises Mr Asif Muneer, a consultant urological surgeon and andrologist, and spokesperson for The Urology Foundation.

"Often there are red areas on the head of the penis that are likely to be inflammatory but can also indicate pre-malignant (pre-cancerous) disease; therefore medical advice should be obtained."

If the pre-cancerous disease is allowed to progress, invasive penile cancer can develop. However, rest assured that this is rare, with just 600 cases recorded annually in the UK.

"Cancer of the penis can give a variety of appearances - some start as thicker areas of skin, others as ulcers that don't heal," adds Pallecaros.

"Men should therefore seek medical advice if they notice any change from the usual appearance including, but not limited to, a rash, ulcer, fissure, change in skin colour or texture, lumps or bumps."

"Similarly, any blood in the urine or bloody discharge from under the foreskin requires investigation. Painful urination may indicate an infection, although it can also indicate an underlying problem with the bladder itself," adds Mr Muneer.