The penis (from Latin penis) is an organ of the male reproductive and urinary system.

The penis, also known as the “penis”, is one of the male’s external genitalia. It hangs between the legs, in front of the scrotum which contains the testicles.

The penis is made up of three distinct parts:

• The glans: it is the swollen end of the penis on which the urethral meatus is located which corresponds to the opening of the urethra, the urinary tract. This duct runs along the entire length of the penis from the base of the bladder. The skin that covers the glans forms a fold called the foreskin. It is possible to remove this small piece of skin by surgery, it is circumcision. The skin of the glans is also very thin and very innervated which makes it an essential area for sexual stimulation.

  On the underside of the glans is a fold of skin connecting the foreskin to the base of the glans, it is the frenulum of the foreskin (or thread of the penis). At the base of the glans, a circular relief emerges, it is the crown of the glans which delimits the balano-preputial groove below.

• The body: it is made up of erectile tissue which contains many blood vessels. There are three regions: the spongy body that surrounds the urethra, and the two cavernous bodies on the top of the penis. These cavernous bodies are surrounded by the albuginea, an elastic envelope that allows them to lengthen and increase in volume during erection.
• The root: it constitutes the base of the penis which is located inside the pelvis.

The penis is involved in urinary and sexual function.

As described previously in the Anatomy section, the penis contains the urethra which allows urine to pass out of the body.

The penis is involved in sexual and reproductive functions. During arousal, the erectile tissue of the penis becomes filled with blood. As the blood supply increases, the penis increases in size and hardens. This erection phenomenon allows the penis to enter the vagina during sexual intercourse. At the time of ejaculation, the semen is evacuated through the urethra.

Erectile dysfunction (impotence) : Repeated inability to get or keep an erection sufficiently during intercourse. It can have a physiological or psychological cause. Erectile dysfunction affects about 20% of men aged 50 to 59, a proportion increasing with age and the onset of disease.

• Premature ejaculation: the man ejaculates very quickly in a systematic and uncontrolled manner, sometimes even before having penetrated his or her partner. The phenomenon may or may not also be present during masturbation.
• Delayed ejaculation (or anejaculation): the man has difficulty ejaculating, only succeeds if the coitus is very long or even, he never manages to ejaculate. The causes are varied (health problems, taking certain medications, psychological restraint or even overconsumption of pornographic images).

Decreased desire: The breakdown of sexual desire affects both men and women. A multiplicity of factors can interfere with desire. True desire disorder is diagnosed when the drop in libido occurs for no apparent reason and persists over time.

Penile cancer Cancer of the penis is a rare condition, accounting for approximately 0,7% to 0,8% of cancers in adult men (4). It is characterized by the development of a malignant tumor in the cells of the penis, the proliferation and behavior of which becomes abnormal and uncontrolled. It preferentially affects the glans and the foreskin (for uncircumcised men). Different signs and symptoms alert to the appearance of such a pathology: a mass or lesion that does not heal, a change in color of the penis, redness or irritation or even a smelly discharge from the penis. This list is not exhaustive. Do not hesitate to contact your healthcare professional in case of doubt or changes detected.

Penile fracture : it is a rare pathology occurring most often in young adults during sexual intercourse. The most frequent cause (30 to 50% of cases) (6) is the “misstep of coitus”: during vigorous vaginal intercourse, the erect penis strikes the perineum (between the vagina and the anus. ) of the partner during a movement outside the vagina. The fracture of the penis therefore corresponds to a rupture of the cavernous bodies and sometimes of the albuginea (envelope of rigid skin which surrounds the penis). The rupture can also affect the urethra. The accident is accompanied by a sudden cracking sound usually followed by severe pain. Subsequently, the blood spreads under the skin and a hematoma appears. In more severe cases, surgery is needed to suture the tear wound.

Condylomas (genital warts) : These are quite common sexually transmitted infections (STIs). They are caused by human papillomaviruses (HPV). Condylomas appear as small warts on the genitals or anus. These are benign, contagious and recurrent lesions.

Genital herpes : sexually transmitted infection (STI) caused by a herpes simplex virus. It is characterized by the appearance of small painful blisters on the sexual organs. These vesicles are transparent and filled with fluid. It is a chronic infection, it is impossible to get rid of the virus.

Balanitis: inflammation of the glans and the groove between the glans and the foreskin. If the inflammation also affects the foreskin, it is called balanoposthitis. The causes are multiple: bacteria, fungi, viruses (candida albicans), viruses (herpes), skin diseases (psoriasis or eczema for example) or poor hygiene. It manifests itself differently depending on the cause: redness or white spots, erythema, unusual odors, etc.

Priapisme : involuntary and prolonged erection of the penis, without any sexual stimulation. It is due to an abnormality in the drainage of blood from the cavernous bodies. If it is an anomaly of the venous return, it is called low flow priapism. If it is an increase in arterial blood, it is called high-flow priapism. The causes at the origin of priapism are varied: taking certain drugs (eg antidepressants, corticosteroids, certain antihypertensives), intracavernous injection of substances for the treatment of impotence, diseases (leukemia, sickle cell anemia, etc.). Priapism is a medical emergency because it can lead to permanent impotence.

Peyronie’s disease : pathology of the penis characterized by pain and curvature of the erect penis. This curvature is due to the appearance of fibrous plaques in the cavernous bodies. This phenomenon causes a loss of elasticity of the cavernous bodies which results in the angulation of the penis making it difficult or even impossible to penetrate during sexual intercourse. This disease generally affects men in their fifties with an incidence of 7%. There is no specific cause for the origin of this disease; in 37% of cases it is a trauma and in 10% a genetic predisposition (9).

Phimosis : it is a narrowing of the foreskin that prevents the glans from being discovered. Phimosis almost always occurs from scalping maneuvers performed in a newborn or young child. These forced retractions lead to adhesions and retractions of the tissues of the foreskin.

Hypospadias : the most frequent congenital malformation of the penis (1 in 250 boys) (10), it corresponds to an anomaly in the position of the urinary meatus which is accompanied in particular by a curvature of the penis. The cause is unknown and the number of cases has doubled in 30 years. Several hypotheses have been put forward, in particular that of the exposure of the fetus to endocrine disruptors of the estrogen type used in the food industry. There are different forms:

• Penoscrotales: the meatus is located on the underside of the penis, at the level of the scrotum.
• Perineal: the meatus is located at the level of the perineum (between the scrotum and the anus).
• Penile: the meatus is located in the middle of the penis.
• Balanic: the meatus is located under the glans.

Hypospadias is treated with surgery.

Sclerosing lymphangitis : benign affection which is characterized by the sudden appearance of a thick and hard cord around the balano-preputial groove of the penis indicating the obstruction of a lymphatic vessel. This cord is the consequence of microtrauma following vigorous intercourse or masturbation. It generally affects young men (20-30 years) 11. Recovery is spontaneous after 4-6 weeks and abstinence is required during this period.

Many factors, whether physical or mental, can influence sexual function. There are several causes that can cause erectile dysfunction and sometimes a lower libido.

Health problems such as diabetes, atherosclerosis, high blood pressure, or even obesity are examples. Erectile dysfunction can also appear in the case of prostate removal due to cancer; during the operation, the nerves of the erection are sometimes difficult to preserve.

Medicines or treatments. Certain treatments (for benign prostatic hyperplasia, for example) or medications (certain antidepressants, antipsychotics, and high blood pressure medications, in particular) affect the ability to have an erection or the desire for sex.

Smoking, alcohol or drug abuse. They can contribute to erectile dysfunction or difficulty ejaculation.

Stress, depression, anxiety. Nervous tension generated by concerns (worries related to work, family, financial difficulties, personal history, etc.), anxiety and depression often reduce energy and sexual desire. There may also be apprehension about having sex, due to past bad experiences or fear of failure, called performance anxiety.

All men are likely to experience a decline in their sexual satisfaction during their lifetime. Certain preventive measures make it possible to put all the chances on your side to have satisfactory sexual relations, such as maintaining good health for example.

Hygiene. Observing good daily hygiene of the penis keeps away bad odors and maceration conducive to infections, such as balanitis.

The use of condoms is a basic measure to reduce the transmission of genital warts. However, they are not 100% effective, as the virus is also transmitted from skin to skin.

Examination of the patient: carried out by the doctor, it takes place first by questioning (pain, appearance of a lump, erection problems, search for pathologies influencing or aggravating this dysfunction, ejaculation disorders, etc.) . It is followed by a clinical examination of the penis (glans, foreskin, cavernous body, urethra), testes and neighboring structures in order to detect any inflammation, lesion, ulceration, tumor or morphological anomaly (eg: curvature or hypospadias). ).

biopsy : if cancer is suspected, the diagnosis must be confirmed histologically. A biopsy is then carried out which consists in surgically removing a fragment of tissue from the penis, generally carried out at the healthy skin / pathological skin junction. The removed piece is subjected to microscopic examination and / or biochemical analysis for various abnormalities or diseases.

Ultrasound : imaging technique based on the use of ultrasound to visualize the internal structure of an organ. In the case of the examination of the penis, it is used in the management of trauma (makes it possible to search for the site of a fracture, Peyronie’s disease or priapism for example) or the evaluation of tumors.

IRM (magnetic resonance imaging): medical examination for diagnostic purposes carried out using a large cylindrical device in which a magnetic field and radio waves are produced. It allows very precise images to be obtained. It is recommended in the study of traumatic lesions of the penis and in the event of difficulty in the clinical evaluation of tumors of the penis. It allows visualization of a potential extent of the tumor to the corpora cavernosa or the urethra.

Echo-doppler : examination which aims to observe the circulation of blood in certain vessels of the body. It combines an ultrasound, which makes it possible to visualize the vessels, with a “Doppler” function, which makes it possible to observe the conditions of blood flow in these vessels. In the case of the penis, the healthcare professional uses it for a diagnosis of erectile dysfunction of vascular origin.

Laboratory examinations : in the event of erectile dysfunction, the patient may be asked to perform tests to measure glycemia (blood sugar level), creatinemia (to assess renal function) or even testosterone dosage .

The penis can be designated by the term “phallus”: it designates the erect male organ. Since Antiquity, it has been the symbol of virility and fertility.

In Greek mythology, Priapus, god of fertility, protector of gardens and herds, is represented with a giant erect penis. The medical term priapism therefore comes from this physical characteristic (13).