Everything you were afraid to ask about penis diseases


WHEN IT comes to diseases of the penis what you don't know may harm you. Knowing what to look out for and what you should do could prevent discomfort, pain, impotence, penile amputation or an untimely death.

The word penis is somehow embarrassing. Just as we refer to dying as passing away going to heaven - or any other comforting euphemism that comes to mind, the word penis even in today's unshockable world still has shocks' value: it's still a word not to be said in front of your aunt. Willy, mickey, dick, prick ... the list is endless. Joke about it boast about it - anything but acknowledge that it's a bodily part like any other which does at times need looking after.

In medic speak, the helmet shape at the tip of the penis is called the glans. Stuck to the foreskin at birth, it gradually separates. Sometime between four and seven - though it can happen as late as 17 - full "retraction" becomes possible: the foreskin can be fully drawn back to reveal the glans' - but it shouldn't be forced prematurely as that can lead to problems.

Smeghead is not a term of endearment. Smegma is a white, foul smelling, cheesy mix of bacteria, yeasts and urine that accumulates between glans and foreskin if males don't retract the foreskin daily and wash underneath.

Parents need to make sure their sons with partially retracted foreskins don't tear remaining adhesions while washing. Nasty things can happen people who forget to put their foreskins back in the normal position. Such as paraphimosis. That's the unenviable condition where the foreskin can't be replaced to its normal position after retraction. The tight foreskin acts like a tourniquet, constricting the glans's blood supply. Unless a doctor is seen quickly, gangrene of the penis could develop.

This particular nightmare city is caused by failure to replace the foreskin to the normal position after washing, sexual activity or even after a doctor has inserted a catheter to drain the bladder. A doctor - hopefully not the same one - can usually reduce it probably using an anaesthetic.

"Most people," says Eamonn Kiely, Consultant Urologist at Cork University Hospital, "are advised to have a circumcision after a paraphimosis."

In contrast a phimosis is a tightness at the opening of the foreskin. It can be so tight that the opening is almost shut. The phimosis can develop at any age due to a healed foreskin tear, sometimes caused by misguidedly trying to hurry along full retraction as a youth.

The foreskins of some men with a phimosis swell up while passing water, retaining urine which may later leak. Sufferers may also experience pain during masturbation or intercourse. According to Eamonn Kiely, "a phimosis is a definite indication for circumcision".

Another condition of the penis is balanitis: an inflammation of the glans that's sore and itchy. Parents will notice their baby son's red foreskin. Youths and adults who suffer it may need to review their personal hygiene. If caused due to a soap allergy, washing with water only is the answer. Men may also get it if their partner has vaginal thrush, caused by the yeast Candida albicans. Small reddened areas appear on the glans but can be cleared up by an antifungal cream. If balanitis is severe circumcision may be necessary.

Balanitis xerotica obliterans is another charmer. Although a disease of the older man, it can also affect boys.

The area around the opening for urine, the urethral meatus, becomes white while the glans and foreskin harden and scar. It can lead to a narrowing of the water passage and difficulty urinating. Once again, it is often caused by poor hygiene and the brandished knife may be required. A procedure to widen the urethra, the tube that drains the bladder, is sometimes performed at the same time.

Those with Peyronie's disease have an abnormal curvature of the erect penis which can be painful and make intercourse difficult or impossible. Eamonn Kiely explains that it is caused by fibrous changes in the erectile bodies of the penis. Elastic fibrous tissue is replaced by less elastic tissue. During an erection, the penis curves towards these plaques. When erections are painful or intercourse problematic, surgery is required. The surgeon cuts out the plaques themselves or compensates for them by removing tissue from the other side of the penis.

PRIAPISM isn't a desirable bedfellow either. It's a prolonged and painful erection unsolicited by sexual desire. Associated with blood disorders such as leukaemia and sickle cell disease, it can also be caused by incorrect use of penile injections for impotence. The condition requires treatment within four hours of onset - failure to act immediately may result in impotence. The doctor may use a syringe to render the penis flaccid. Occasionally surgery may be required.

Leukoplakia is a rare condition in older men whereby large white patches appear on an inflamed glans. Although painless it can be pre malignant and must be treated to prevent development of a cancer.

Cancer of the penis is also rare. Though unproven, it too has been linked to poor personal hygiene. Elderly men who notice a raised ulcer or discharge under the foreskin should have it checked out without delay. Treatment can include radiotherapy or, if the cancer is advanced, radical surgery involving the amputation of all or part of the penis.