Male Genital Disorders: The Penis
Basic Information
The penis belongs to the genitourinary system and is a body organ just as the liver is. The two main functions of the penis are:
- to transport semen for sexual gratification and/or procreation
- to transport urine from the body
The size of the individual penis varies -- it is estimated that the average size of the penis when erect is 6 inches in length by 1.5 inches in diameter -- but the functions remain the same.
To better understand disorders that can affect the penis, it is important to understand how the penis works and how an erection is achieved. When your penis is flaccid your blood is flowing straight into your veins, but when you become aroused and achieve an erection the blood swells your penis by filling your three tubes of pulpy erectile tissue. When blood rushes into the penis the nerves relax while the veins constrict, not allowing the blood to escape. The exciting sensations that are felt are caused by nerves, usually concentrated in the upper half of the penis. Besides transporting semen, the penis transports urine which is removed from your bladder by the urethra which runs along the lower surface area of your penis.
Most disorders of the penis are the result of:
- congenital birth defects
- skin disorders (usually caused by allergies)
- lesions
- Peyronie's disease
- priapism
- self-inflicted injuries, usually unintentional
- injuries inflicted by others, usually unintentional
Congenital birth defects
Abnormalities at birth, as rare fortunately as they are, have included:
- the penis and urethra congenitally absent
- double penis
- hypospadias -- displaced urethral opening
- chordee -- ventral curvature of the penis, most often linked to hypospadias which can cause stenosis or an inability to direct the urinary stream and may cause sexual dysfunction in later years. Fortunately early surgery in which the shaft is straightened and the chordee is released and the urethra undergoes a plastic reconstruction usually results in normal functioning and cosmetic acceptability.
- stenosis -- meatal stricture in which the patient cannot direct his stream of urine and if left uncorrected leads to sexual dysfunction later but can usually be successfully corrected by a urethral meatotomy
- phimosis (in which the foreskin of uncircumcised males cannot be retracted) and paraphimosis (in which the retracted foreskin of uncircumcised males cannot be pulled back over the head) have generally good prognoses. (See article on Circumcision.)
Skin disorders
Skin disorders of the penis can be caused by:
- rubbing a skin infection from another part of your body onto your penis -- many disorders from psoriasis to poison ivy can be transmitted to your penis from almost any part of your body that is affected
- hives, usually because of an allergic reaction, can appear on your penis
What items or substances are most likely to cause allergic reactions or hives on your penis?
- condoms
- spermacides
- lubricants
- antibiotics
- various medications besides antibiotics
- oily hand creams
Fortunately most skin disorders that appear on the penis are eradicated, even if they seem most persistent. But it is important to remember that fissures or breaks on the skin of the penis can make transmission of STDs (sexually transmitted diseases) more likely, including HIV.
Balanitis, an infection and inflammation of the foreskin in the uncircumcised male, is not uncommon but usually treatable. (See article on Balanitis.)
Lesions
It is thought that cancer of the penis may be caused by poor hygiene in uncircumcised men, but this is an extremely rare condition. (See article on Circumcision.)
However, rare skin cancers that appear on the penis can result from Bowen's and Paget's diseases.
Penile lesions can also be caused by:
- TB
- herpes zoster
- herpes simplex
- chancre (from syphilis)
- genital warts (condylomata acuminata)
- mycotic penile disease
Additionally a premalignant lesion that usually appears on the penile head called Erythroplasia of Queyrat can be treated after diagnosis through biopsy by fluorouracil cream but follow-up is indicated to be certain that the lesion does not reappear.
Peyronie's Disease
Named for the French doctor who discovered it, Peyronie's disease refers to a severe curve in the penis, contracting or bending the penis to one side when erect (scarring beneath the skin stops the expansion of erectile tissue) causing painful erections and sometimes even preventing ejaculation. The cause is unknown (it may come from the twisting or snapping of the penis when it is erect) but it affects adult males.
Treatment is varied. The disease may resolve spontaneously over a period of months or even years which is an acceptable resolution if the curvature is not too severe and there is no sexual dysfunction. However, treatments for more serious cases include:
- local injections of high-potency corticosteroids directly into the scar
- use vitamin E to soften the scar
- Potaba
- ultrasonic treatment to relieve symptoms
- surgery -- the scar is removed and replaced with a patch graft. This is usually successful although sometimes further scarring occurs.
If your penis has an uncomfortable curvature or is beginning to curve, please see your health care provider and/or urologist to see what kind of treatment, if any, is appropriate for you.
Priapism
Priapism is an abnormal erection of the penis that is painful and persistent and occurs when blood cannot escape from the erectile tissue and when new blood tries to get into the penis that is already bloated a violent pain occurs.
This condition is not accompanied by sexual desire or excitement and does not resolve on its own, meaning that the erection does not go down following ejaculation.
Causes of this disorder are not particularly well understood but they are believed to be related to vascular neurologic problems. Priapism is thought to result from, among others, the following:
- leukemia
- sickle cell disease
- pelvic neoplasm
- pelvic hematoma
- prostatitis infection
- urethritis infection
- cystitis infection
- injections used to treat erectile dysfunction
- certain drugs or medications, especially for blood pressure control
- the use of antidepressants
Priapism can become an emergency situation that requires prompt medical attention, otherwise the risk exists that injury due to pressure and lack of oxygen could injure erectile tissue.
In worse case scenarios, scarring takes place and the erectile tissue becomes incapable of expansion, causing impotence. In worse than worst case scenarios, gangrene results. The end result could be as extreme as the initial erection disorder only at the very opposite end of the spectrum -- impotence.
Treatment must be prompt to be effective, otherwise permanent sexual dysfunction usually results. This is a very serious condition and treatment is not always successful.
Treatment modalities include:
- the use of anticoagulants, successful only in the early stages
- spinal anesthesia (for neurogenic priapism)
- large bore needles are put into the swollen penis for evacuation and irrigation -- washing out the now languid blood.
- Medications to constrict arteries are used to stop new blood from rushing in immediately to fill the empty spots during large bore needle irrigation.
- Creating a fistula between the penis head and corpora with a biopsy needle is mostly met with success.
Naturally, besides treating priapism in an emergency situation underlying causes must be addressed and treated as well.
Self-inflicted penile injury
Although the penis can suffer trauma that is not self-inflicted or inflicted by others (usually in a sexual situation) it can occur albeit very rarely. Examples include:
- urethral injury due to pelvic fracture which if traumatic enough can cause impotence
- crushing blows to the penis during traumatic accidents such as during automobile, train or plane wrecks
- penile injuries among industrial or farm workers when clothing becomes caught in machinery
- pulling up the pants zipper with such force that the penis, caught outside the pants, is cut or bruised, sometimes very seriously
Most injuries to the penis, however, are self-inflicted, albeit unintentionally, and most often out of illness or neglect. These injuries include:
- self-inflicted priapism
Many men cause the serious condition of priapism themselves, usually by one or more of the following four methods:
-
Using leather straps or cockrings to
heighten sexual excitement and to
lengthen the period of erections,
causing the blood to be unable to leave
the penis can turn a pleasurable
experience into a nightmare.
If you use a cockring for sexual stimulation or for a firmer erection, be sure that you select one that you can get on and off easily. A cockring fits tightly around the base of the penis and scrotum. You should select a leather cockring with metal snaps that has been fitted not only for pleasure but for easy removal as well. Men wearing metal cockrings which they put on when their penis is flaccid have had their erections swell and become very painful after elongated sex and have had to wait for hours while their cock turns purple before it becomes flaccid enough to remove from the metal cockring.
- Consumption of alcohol and cocaine use have been linked to this disorder, especially when cocaine is injected directly into the penis.
- prolonged sexual activity
- the use of the new medication Viagra which promotes the filling of the erectile tissue
The urethra is delicate and can be bruised or torn by the introduction of foreign objects into it, even if they are inserted as gently as possible. Though you may perceive that there is no current damage being done at the time, a scar may slowly begin to develop, causing urethral stricture over time, preventing urination from occurring and necessitating surgical intervention. And surgery may not necessarily be years down the road -- should the foreign object slip from urethra into your bladder immediate surgery would be required.
You must understand the very serious risks and consequences involved before you begin to attempt to heighten your sexual pleasure by putting objects, however gently, into your urethra. It will be rare if you do not sustain some kind of damage, whether mild to severe, in the long or short run.
- injury due to penile enlargement
A number of men want to enlarge their penises. Some are very concerned about penis size and feel inadequate and elect to have surgical procedures to lengthen or widen their penises, even though most health care providers only consider penises under four inches in length to be abnormal in size. Other men like to use a suction/vacuum pump, not only to increase penis size but because of the pleasurable sensation occurring using the pump. Gay males have formed clubs in which they vacuum pump together for fun and sexual excitement as well as to enlarge their penises, which may occur but usually is only of temporary duration. Increasing the size of the penis through vacuum pump use can occur but it does so very slowly over years and years.
Surgery to either lengthen or widen the penis is in reality two distinct and different surgical procedures.
Lengthening the penis is actually a misnomer because the penis is not really lengthened by surgery. By cutting ligaments that support the penis, the penis is able to pull away from the pubic bone and you can see more of it, that's all.
By adding bands of fat from other parts of the body, surgeons can add width to your penis, but your penis can become disfigured or at least you or your partner may perceive it as such because while becoming wider the penis will still have a normal or natural head or glans that does not match the newly-widened penis and there will be deep pockets between the areas of fat which will probably look unattractive.
If you decide to have surgery to either lengthen or widen your penis, you must select your surgeon carefully and become comfortable with him beforehand. There is an element of danger in ligament-cutting operations because ligaments can sustain damage if cut improperly and damage can occur as well to nerves at the top of the penis, lessening pleasurable feelings.
The suction or vacuum pump works by pulling more blood into the penis. Vacuuming or pumping the penis for long durations of time while using a cockring simultaneously or putting it on after pumping (which does not allow blood to escape) may cause priapism.
Injuries to the penis inflicted by others
These injuries can include:
- intentional or unintentional bites, beatings, cuts or abrasions to the penis during rough sex or attempted mutilation
- phlebitis -- this condition occurs during energetic oral sex. A cord, hard yet tender, appears along the top of the penis as blood clots in the vein. Swelling of the penis usually accompanies the formation of the blood clots. It may take several months for the penis to be restored to normal but healing will occur during this period with the help of aspirin and warm baths.
If you have one of the penile disorders discussed above or would like more information about sexual practices that may be injurious to your penis, please seek treatments or information from an experienced, nonjudgmental health care provider.