There are many diseases that can affect the penis, most of which are mild. Zoom on the main diseases of the penis.

The penis, also called the penis in France, is an organ of the male reproductive and urinary system. It is composed of one of the erectile bodies, in number of two, called the corpora cavernosa, and the spongy body, placed below the corpora cavernosa. The two spongy bodies are surrounded by a membrane, the albuginea which is not very extensible and which has an essential role in the erection.

The spongy body surrounds the urinary tract called the urethra. It is surrounded by a muscle whose rhythmic contractions ensure the expulsion of sperm. It ends with the glans which covers the end of the two corpora cavernosa. The skin of the penis is called the sheath of the penis and at its end is the foreskin which covers the glans. The small skin bridge that connects the foreskin to the lower base of the glans is called the frenulum of the foreskin.

We distinguish:

• dermatological and subcutaneous tissue diseases,
• pathologies of the urethra,
• diseases of the erect penis.

The penis can be the subject of inflammatory dermatoses localized at the level of the sheath of the penis or of the foreskin and the preputial sac and the glans of the penis. Penile cancer is rare. Sometimes lesions are found in the subcutaneous layer and the veins located in this space.

If we consider the erect penis, we find phimosis and its formidable complication paraphimosis and erectile dysfunction. In case of phimosis, the ring of the foreskin is too narrow and it is not possible to uncover the glans – one cannot retract – whereas paraphimosis is a complication – the glans is visible but it is strangled by the foreskin which slipped behind the groove of the glans, most often by a forced cracking and inability to recalloter–. It is particularly painful and it is necessary to consult urgently because there is a risk of ischemia of the glans.

We must distinguish erectile dysfunction, Peyronie’s disease, congenital deviation of the penis. All diseases of the penis can interfere with sexuality.

Balanoposthites

These are balanitis (inflammation of the glans) which are often balano-posthitis (inflammation of the glans and foreskin). These pathologies are exceptional in circumcised men.

Acute forms

There are acute forms, most often infectious but can be allergic or irritative causes. The microorganisms responsible for infectious balanoposthitis most often identified are fungi (Candida Albicans), streptococci or staphylococcus, Gardenella vaginalis. Candidiasis caused by candida albicans are the most common forms.

Irritative or allergic causes

Apart from infectious causes, there are irritative or allergic causes:

• latex allergy,
• contact eczema (laundry, laundry, spermicides, lipstick, soaps, etc.).

Traumatic causes

More rarely traumatic causes with bite, zipper, erosion or rupture of the frenulum of the foreskin, foreign bodies. In more than a third of cases there is no infectious agent

Genital herpes

Genital herpes is the number one cause of ulcerative balanoposthitis. Genital herpes is a sexually transmitted infection caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) predominantly on genital lesions. It manifests itself in men by painful small vesicles (buttons filled with a clear liquid) on the penis.

Sexually transmitted infections

Sexually transmitted infections are also manifested by balanoposthitis but sometimes they also affect the rest of the sheath of the penis, the pubis or the scrotum and not only the foreskin and / or glans. Among the pathogens responsible for infectious balanoposthitis are syphilis, genital herpes (herpes simplex type 1: HSV-1 or type 2: HSV-2) and papillomavirus (HPV virus). 

Syphilis

Syphilis is a growing STI. It is a diffuse, superficial and erosive balanitis with cardboard induration: ulceration or erosion of the groove, the sheath, the penis, called syphilitic chancre, painless, accompanied by a ganglion (inflammatory lymphadenopathy) in the groin.

Condylomas or genital warts 

The condylomas or genital warts on the penis (they can be present at the level of the glans, the furrow, the sheath) are due to the Papillomavirus (HPV virus). These are growths that look like warts or have a “cauliflower” or “rooster’s crest” appearance.

Chronic dermatoses

Chronic balanoposthitis is primarily inflammatory. The most common chronic inflammatory disease is genital lichen sclerosus, but there are also other forms of eczema, psoriasis, lichen planus or Zoon’s balanitis. The common point is the clinical form with a glans and a swollen and red foreskin, itching, pain and difficulty in retracting the foreskin.

Lichen sclerosus

Lichen sclerosus is characterized by a whitish porcelain-like skin and thicker with evolution towards a white sclera ring at the level of the foreskin (secondary phimosis) and extension towards the frenum and especially on the level of the glans with loss of sensitivity and stenosis of the meatus of the urethra. Due to phimosis, initially visible only when erect, there are cracks and erosions that have difficulty in healing. The functional signs are absent at the beginning and then itching, pain, urinary difficulties and erectile dysfunction.

Lichen planus 

Lichen planus of the penis is a chronic, recurring inflammation. Lichen planus can affect both men and women (vulvar involvement) with predominant oral involvement. The oral form is more common but the genital form. Characterized by a more fragile and paler, thicker and indurated skin and progression to atrophy and sclerosis.

Genital eczema

Genital eczema causes red, itchy patches on the penis.

Psoriasis

Psoriasis located on the penis is very common in men who have psoriasis. It results in red patches on the glans, the skin of the penis, itching, burning, pain.

Zoon’s balanitis

Zoon’s balanitis is a smooth, moist, shiny, benign redness of the glans of unknown origin occurring in uncircumcised humans.

Namely 

The biopsy of any fixed, chronic, suspicious lesion must be systematic in order to rule out a cancerous lesion.

The space between the skin of the penis sheath and the corpora cavernous albuginea contains fatty tissue as well as the veins of the penis. The pathologies are represented by sclerosing lymphangitis of the penis which appears within 48 hours after prolonged intercourse or repeated over a short period of time. Another pathology is thrombophlebitis of the superficial dorsal vein of the penis. 

Rupture of the frenulum of the penis and fracture of the corpora cavernosa usually occur during intercourse or masturbation. The breaking of the brake is favored by the short brake. Cavernous body fractures are the consequence of significant mechanical stress on the erect cavernous body facilitated by more or less acrobatic positions.

The penis is an organ that belongs to the urinary tract. Also diseases affecting the penis can be of urinary origin.

Urethritis 

Urethritis is an inflammation of the urethra that is most often infectious and sexually transmitted. The bacteria most frequently involved are Chlamydia trachomatis, Neisseria gonorrhoea (gonococcal urethritis, also called gonorrhea or “hot-piss”), mycoplasma or ureaplasm. It is not uncommon even streptococcal urethritis or other bacteria of oral flora. Signs of urethritis are pain in urination, difficulty urinating, and urethral discharge that varies in appearance depending on the bacteria involved (clear or yellowish discharge). Urethritis can lead to erosions of the urethral meatus (posthitis).

Urethral stricture

Another pathology that affects the urethra is the narrowing of the urethra: urethral stenosis or the narrowing of the urethra. It is a stricture which is always secondary to a urethral infection but most often goes unnoticed. The narrowing of the urinary canal is signaled by a slowdown in the flow of the urine stream and incomplete urination, frequent urination, urgent urination, urinary burns. What is classic is a slow ejaculation (“slobbery”).

HPV

HPV can also cause urethral condylomas in the distal part of the urethra and therefore visible to the naked eye by spreading the edges of the meatus of the urethra.

Penile cancer is uncommon in Western countries. It mainly occurs in uncircumcised 60-year-old men, mainly in the form of squamous cell carcinoma. It is often caused by a lack of hygiene aggravated by the existence of a phimosis. Other causes of penile cancer are dermatologic disease of the glans head or foreskin, sometimes associated with papillomavirus (HPV) infection, which can progress to cancer.

The signs of penile cancer are a persistent red lesion in the glans area that does not cause pain at first, then when the tumor progresses burns, itching, bleeding on contact, and especially an enlargement of the glans penis.

Note: a red spot on the acorn that persists should alert you

Phimosis

When the ring at the top of the foreskin is too narrow and prevents the glans from being exposed, it is called phimosis. Until the age of 4 or 5 years, phimosis is physiological. At birth the majority of newborns have phimosis which will disappear in 90% of cases at 3 years and it is rare after 5 or 6 years.

Phimosis can cause complications such as infection (balanoposthitis), difficulty urinating, or even retention of urine under the foreskin or paraphimosis, strangulation of the glans by the preputial ring which prevents recalotation. For the treatment of phimosis in children, drug treatment is recommended as a first-line treatment. For the surgical treatment it is generally necessary to wait until the age of 5 or 6 years.

Erectile dysfunction

Strictly speaking, erectile dysfunction is defined as the inability to obtain and / or maintain an erection sufficient to allow satisfactory sexual activity and for at least 3 months.

The frequency described is that one in 3 men after 40 years has erectile dysfunction, but this figure varies according to the studies which do not always take into account the duration of 3 months. If the classic distinction between a “psychological” form and an “organic” form has been abandoned, we can distinguish a multifactorial origin. Age is an independent risk factor for erectile dysfunction. The physiological mechanism of erection is based on the filling of the cavernous bodies, real active vascular sponges and the veino-occlusive system. Any alteration in one or more of the factors involved in this complex mechanism can lead to erectile dysfunction.

Cardiovascular disease, diabetes, hypercholesterolemia, smoking, stress and sedentary lifestyle through atherosclerosis and arteriosclerosis are responsible for an erectile disorder by vascular mechanism. The testosterone deficiency as other endocrinological diseases are also responsible. Prostate surgery and in particular the treatment of prostate cancer and surgery of the small pelvis are responsible for iatrogenic erectile dysfunction. Depression and psychiatric illnesses, burnout and unfavorable psychological disorders are risk factors for erectile dysfunction. Whatever the cause, there is always a so-called psychological component through performance anxiety.

Peyronie’s disease

Peyronie’s disease is a pathology of the erect penis. It is a psychologically devastating disease. It is a fibrosis of the albuginea of ​​the cavernous bodies, probably consecutive to microtrauma of the penis occurring during sexual intercourse, or during other activities. Albuginea fibrosis presents as a plaque of the cavernous bodies and develops in two phases. The acute phase during the onset of the disease with pain, which disappears but especially an erectile deformity, loss of length and erectile dysfunction. In the chronic phase, the pain always disappears and the deformity stabilizes.

Inflammatory pathologies of the penis

Inflammatory pathologies of the penis such as lichen sclerosus, lichen planus, eczema, psoriasis are treated by the application of topical corticosteroid ointments (local corticosteroids). Zoon’s balanitis is treated with circumcision.

Mycosis of the penis

Mycosis of the penis is treated with the application of an antifungal cream.

Genital herpes 

Genital herpes is a chronic disease that cannot be cured. Antiviral treatments relieve symptoms during flare-ups and reduce the risk of recurrence.

Anogenital condylomas 

Anogenital warts are treated locally with chemical treatments, physical and surgical treatments or immunomodulatory treatments.

Treatment of syphilis

The treatment of syphilis is based on injectable antibiotics.

Urethritis 

Urethritis is treated with antibiotics.

Treatment of urethral stricture

The treatment of urethral stenosis is a surgical treatment which depends on the location, the extent and the severity: either a urethrotomy by more or less complex plasties.

Penis cancer

In case of penile cancer, treatments consist of partial or total amputation of the penis, depending on the extent of the tumor in the glans, or conservative treatment of the glans with brachytherapy for limited lesions.

Tumors of the foreskin

Circumcision may be sufficient for tumors of the foreskin.

Treatment of phimosis

The treatment of primary phimosis is first-line medical (application of corticosteroid creams to soften the ring of the foreskin). In case of failure of local treatment, the treatment of phimosis is surgical for circumcision or plasty of the foreskin (posthoplasty). For the surgical treatment of primary phimosis in children, it is advisable to wait until the age of 5-6 years.

The frenulum of the foreskin short

For the frenulum of the short foreskin having been injured during sexual intercourse, a plasty of the frenum of the foreskin should be performed.

Erectile dysfunction

Erectile dysfunction is treated first-line orally: phosphodiesterase type 5 (IPDE5) inhibitors: sildenafil (Viagra®, Xybilun®), vardenafil (Levitra®), tadalafil (Cialis®) and avanafil (Spedra®). In case of failure of oral treatments or uses alprostadil, intra-urethral gel (Vitaros®) or intracavernous injection (Edex®). We can fear to appeal to vacuum treatment or the installation of an erection prosthesis (penile implant).

Peyronie’s disease

For the treatment of Peyronie’s disease, the only treatment approved, Xiapex® was withdrawn from the market. In the absence of a treatment with a marketing authorization, multimodal treatments with mechanotherapy, infiltration of albuginea with PRP or Verapamil (Isoptine®), shock waves and in more complex situations by surgery are proposed.