penile_conditions
Table of Contents
diseases and injuries of the penis
see also:
Introduction
- acute penile conditions are fairly common presentations to the ED and the initial triage may be quite inaccurate due to patient embarrassment
Penile trauma including fractured penis
- other sexual misadventures:
- injuries from penile piercings
- severe oedema due to stuck cock ring
- urethral trauma from urethral sounding
- penile necrosis from subcutaneous injection of non-approved “fillers” such as lard
- contact dermatitis or acute allergic swelling (eg. to latex rubber)
Foreskin and glans conditions
- paraphimosis - very swollen, oedematous un-retractable foreskin due to prolonged retraction
- phimosis
- narrowed foreskin orifice causing urination and hygiene difficulties
- balanitis (inflamed glans penis)
- Candida
- circinate balanitis
- associated with reactive arthritis (Reiter's syndrome) and thus there may also be non-gonococcal urethritis
- pinhead-sized lesions covered by white plaque, which grow into a flat, red region with a white margin
- not itchy or burning
- usually Rx with topical steroids or topical calcineurin inhibitors
- https://dermnetnz.org/topics/balanitis for more causes
- sexually transmitted infections
- syphilis chancre
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- warts on penis +/- anus
- Bowenoid papulosis
- small red, brown, or purple spots on the penis or anus
- may resolve, but in rare cases may result in Bowen disease, an early form of penile cancer
- molluscum contagiosum
- dermatological conditions
- dermatitis
- lichen planus
- rare; raised, flat, violet-colored bumps on the glans of the penis; sometimes have fine white streaks and a smooth surface; lesions often appear in a ring or a line; may also occur on wrists, shins, buccal mucosa;
- 5x more common in those with hepatitis C virus
- Rx with topical steroids
- lichen sclerosus
- 1 in 300 males;
- crinkled, whitish lesion, usually around or under the glans
- psoriasis
- pearly penile papules - more common on uncircumcised penises; angiofibromas;
- angiokeratomas - small red or blue spots; may extend to the scrotum, groin, and thighs; may warrant laser Rx if bleeding or painful;
- Fournier's gangrene
- rapidly progressive life threatening necrotizing fasciitis of the genitals and perineum
- 20-70% have diabetes (higher risk if on sodium-glucose cotransporter-2 (SGLT2) inhibitors); 25-50% have alcohol abuse;
- other risk factors:
- age > 50yrs; cardiovascular disease, cirrhosis, HIV, hypertension, chronic renal failure, obesity, smoker, immunocompromised
- usually has a source for infection:
- local trauma/sexual activity/shaving cuts/burn/ulcer/abscess; insect bite, anal fistula, diverticulitis, genital piercing, UTI, rectal cancer;
- Ix in addition to bloods, blood cultures, etc may include:
- XR to visualize extent of subcutaneous air
- US
- CT scan
- emergent IV antibiotics and surgery
Penile Mondor's disease (PMD) - thrombus of dorsal vein
- a rare genetic condition which causes thrombophlebitis of the dorsal vein of the penis (as well as potentially other body regions such as chest, abdominal wall, upper arm)
- may affect any age who are sexually active
- thrombophlebitis usually occurs following either:
- very frequent or rough sex
- trauma to the penis
- use of a penile vacuum
- clinical features:
- swollen dorsum of penis with a tender, rope-like vein on the dorsum
- often have difficulty passing urine
- diagnosis
- ultrasound
- Mx
- abstinence from sex for 2-4 weeks or until symptoms fully resolve
- warm compresses may help
- antibiotics if secondary cellulitis evident
- d/w urology
- ? anticoagulants / anti-inflammatory medications
- Prognosis:
- most patients fully recover in 4-8 weeks
Other conditions of the penis and/or scrotum
- folliculitis
- inflamed / infected hair follicles
- cellulitis
- scabies
- pubic lice
- tinea cruris - fungal groin condition “jock itch”
- dermatological conditions
- psoriasis
- contact dermatitis or acute allergic swelling (eg. to latex rubber)
- drug reactions
- neoplastic
- 95% are SCC, others include verrucous carcinoma and melanoma
- scrotal pain or swelling
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- varicocele
- usually affects left scrotum, worse on standing, may be precipitated by faecal loading increasing pressure on left testicular vein
- cellulitis
- folliculitis / abscess
- scrotal trauma
- sebaceous cyst
- neoplasia
- scrotal
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penile_conditions.txt · Last modified: 2025/08/03 09:34 by wh