During the pandemic I saw more penises than normal. And, as a GP, that was a good thing.
Men who suddenly found they had more free time were able to devote a little more attention to their genitals, it seemed. Or that was my theory, at least.
They’d come into my busy north London practice, clearly fairly embarrassed – although they needn’t be.
Some said they’d put off seeking help until their condition became intolerable, because they thought an examination might be mortifying or even painful.
I understand their reluctance. After all, society – and often these days, I’m afraid, pornography – tells men the ideal penis is big, long, smooth and straight.
Men who deviate from this – which, let me assure you, is the majority – often, mistakenly, believe they’re not normal. And as soon as something goes wrong in this area, it can feel terrifying.
The truth is, having seen thousands of penises over the years, they come in all shapes and sizes. There is no correlation between its size when flaccid and when erect, and the average length when fully erect is a relatively modest five-and-a-half inches.
As an aside, research has confirmed that shoe size bears no relation to penis size. But there is a lot a penis can tell a man about his overall wellbeing.
Erectile dysfunction, for example, which affects around half of all men aged 40 to 70 in the UK, is often described as the canary in the coal mine for men’s health – an early signal that there might be a risk of other problems, such as heart disease.
Don’t be tempted to just buy some Viagra – see your GP so we can figure out what’s causing it. And while it’s the most talked about issue, it’s not the only thing that can go wrong.
While some ailments that affect the penis are relatively minor and don’t require treatment, others can be fatal if ignored. Here, then, is everything that can go wrong with the penis and testicles – and what you need to do about it…
Erectile dysfunction, which affects around half of all men aged 40 to 70, can often be a sign of other conditions, such as heart disease
When a tight foreskin becomes an emergency
It’s the fold of skin covering the head of the penis, the glans, and it has important functions.
It provides sensation and lubricates the penis, which aids sexual activity. It also protects the glans, which is extremely sensitive, when flaccid – and naturally retracts during an erection. Or at least, it should.
In some cases, the foreskin becomes trapped in the retracted position and can’t be rolled back down. Known as paraphimosis, it’s considered an emergency and can impact sexual function if it isn’t treated promptly.
The foreskin can effectively strangle the glans, cutting off the blood supply and causing it to become swollen and painful.
In a worst-case scenario it can lead to infection, gangrene or tissue death. So don’t hesitate to seek help if this happens – most often it happens during washing.
Retracted foreskin tends to occurs in men whose foreskin doesn’t retract easily – a condition known as phimosis, thought to affect roughly one in 100 males. Treatment might include ice packs to reduce the swelling, or surgery to release or totally remove the foreskin, known as circumcision.
Another condition which can cause the foreskin to tighten is the chronic inflammatory skin condition lichen sclerosus. More common in women’s genitals, it causes an itching, burning sensation to the tip and foreskin of the penis. The skin of the penis may have tell-tale white patches and could bleed and tear during sex. Again, circumcision is the definitive treatment, if anti-inflammatory steroid ointments don’t help.
Patients with lichen sclerosus are advised to wash the area with an emollient rather than soap, so as not to irritate the skin, and put a barrier cream around the head so it isn’t irritated by urine.
The small marks that could become cancer
Small white, yellow or pink bumps around the head of the penis are generally nothing to worry about. Known as pearly penile papules, they’re totally benign and very common.
But it’s important to keep a note of what’s normal for you – if anything changes or spreads, starts looking like an ulcer or pustule that won’t heal, or develops redness, itchiness or swelling, please don’t be embarrassed to get it checked out by your GP.
It could be warts or another sexually transmitted disease. A painless open sore can be a sign of syphilis, while painful small blisters that burst and leave red sores can indicate genital herpes.
These kind of skin changes can also, rarely, be a sign of penile cancer. The disease, which causes small lesions or red patches at the top of the penis, affects around 700 men a year in the UK and can be cured if spotted early. But half of cases are detected at a late stage – when it may not be possible to save the organ.
Other treatment includes chemotherapy creams, laser therapy, surgery and radiotherapy.
Around 63 per cent of cases are linked to the human papillomavirus (HPV), a common, symptomless sexually transmitted infection (STI) that can trigger changes in cells that become cancerous. HPV also causes cervical cancer.
Doctors believe other cases are linked to damage to the skin of the penis from conditions such as lichen sclerosus. The longer left untreated, the more invasive the surgery – so get any unusual changes checked out promptly.
Don’t ignore discharge – whatever the colour
Generally, discharge that isn’t urine or semen isn’t normal.
In many cases it’s linked to a sexually transmitted infection – if it’s chlamydia it tends to be white-ish, gonorrhoea can be white, yellow or even green, and trichomoniasis tends to be a thin white or frothy liquid.
But don’t diagnose yourself on the colour – go to a sexual health clinic. There are other causes. A urinary tract infection (UTI) can also cause blood in the urine and pain when trying to pee as well as a discharge. An infection of the prostate, known as prostatitis, can also cause discharge.
Balanitis – which affects 3 to 11 per cent of men at some point in their lifetime, and is more common if you have type 2 diabetes, is generally caused by a fungal infection which causes inflammation in the head of the penis. Along with itching and swelling you may find discharge under the foreskin or on the head of the penis.
Some men also find what’s known as smegma building up underneath the foreskin.
This isn’t discharge, but a build-up of oils, skin cells and sweat which will smell like off-milk and look like crumbled feta. It can make everything irritated and sore but it’s easily fixed by good hygiene.
The NHS recommends washing the genital area with water or an emollient, such as aqueous cream, Epaderm ointment, Diprobase or Doublebase.
Men are also recommended to wear loose-ish cotton underwear, which allows the area to breathe – encouraging air circulation and preventing overheating, sweating and discomfort.
Any blood in urine or semen should also checked out promptly – it might be kidney stones or an STI or UTI, but can be a sign of prostate, kidney or bladder cancer, especially in men over 40.
Help! My erection won’t go down
Don’t see this as a demonstration of your virility – if you have an erection that lasts more than four hours it’s a medical emergency.
Known as priapism, it can be caused by medications such as antidepressants or blood pressure pills, and also by alcohol and drug abuse, particularly cocaine and cannabis.
It’s also associated with sickle cell disease, which can interrupt the normal flow of blood within the penis.
Without prompt treatment the blood in the penis is starved of oxygen, which can cause pain and tissue damage.
You can try having a warm bath or going for a walk to see if that helps – but don’t masturbate as it won’t help.
The treatment usually involves draining blood from the penis – under an anaesthetic – and, rarely, surgery to prevent permanent damage.
How bendy is too bendy?
A slight curve to the penis during an erection is normal, but if it bends significantly it might be a sign of Peyronie’s disease.
Former US President Bill Clinton reportedly suffered from a pronounced ‘kink’ – according to claims made in connection with a sexual harassment lawsuit filed in 1994 by civil servant Paula Jones.
The condition is caused by scar tissue forming inside the penis, which might be as a result of injury, or by other problems such as diabetes, high cholesterol or high blood pressure.
It leads to the development of a hard area of tissue on one side, which means when the penis fills with blood and becomes erect it is forced to bend.
In extreme cases, Peyronie’s can cause almost a right-angle bend, mid-shaft. And the bend can be in just about any direction – to the left, right, upward or down. It doesn’t always need treatment, but if it’s painful to have sex, or is causing low self-esteem or affecting your mental health, there are options, including medication to slow down the hard growth, surgery, or treatment using sound waves to break down the scar tissue.
Former US President Bill Clinton reportedly suffered from a pronounced ‘kink’ – according to claims made in connection with a sexual harassment lawsuit filed in 1994
Not all lumps are testicular cancer
It would feel like something was amiss if, while discussing the penis, we didn’t pay at least some attention to its close relative, the testicles.
These two sperm-producing, egg-shaped glands sit inside the scrotum, a sac of soft skin that hang beneath the penis.
It’s normal for one testicle to hang lower than the other, or for one to be slightly bigger. But any changes, such as a lump or any feeling of discomfort like a dragging sensation, should be flagged to a doctor.
Lumps can be benign problems. Epidydimal cysts, for example, are fluid-filled pocket which grow from the epididymis, the tube that transports sperm. They are usually harmless and disappear by themselves.
Doctors can normally tell what they are just by feeling them or with an ultrasound scan, and they won’t need treatment unless they cause pain or become twisted, which is called torsion and usually needs surgery to fix.
Other lumps you might experience are hydroceles, which affect one in 100 men and might feel like a fluid-filled balloon. They can be diagnosed by shining a light through the scrotum – if it’s full of fluid, it will illuminate.
Swelling might also indicate orchitis – an infection of the testicle – or a varicocele, which is essentially varicose veins that can feel like a bunch of worms at the back of the testes.
If you get checked out by your doctor, who is likely to offer an ultrasound scan, and no concerning cause is found but you still have some discomfort, wear more supportive underwear which cup the genitals rather than letting it all hang out in baggy boxers.
Rarely these lumps and discomfort might be a sign of testicular cancer. About 2,400 cases are diagnosed every year in the UK, most commonly in those aged 30 to 34. Nearly three quarters of cases are diagnosed at the earliest stage, which means more than nine in ten men survive longer than ten years.
All the more reason to see your GP promptly.
While the penis doesn’t contain any bones, it is possible to have a penile fracture.
It’s rare, and tends to happen as a result of an injury – which might include falling with an erection, rough masturbation, or switching suddenly between energetic sexual positions.
A penile fracture is a medical emergency – but it can be repaired surgically
The shaft of the penis contains spongy areas called the corpora cavernosa and the corpus spongiosum, which fill with blood during an erection. These areas are surrounded by thick fibrous tissue – and rupturing this is what causes the ‘break’.
There’ll be no mistaking what you’ve done. It generally causes immediate, often severe pain and you may also hear a popping or snapping sound, followed by swelling, bruising and blood in the urine. Indeed, it becomes so distended and bruised, medics liken the appearance of a fractured penis to an aubergine – using the American name for the vegetable, it’s called ‘eggplant deformity’.
It’s definitely a medical emergency – but it can be repaired surgically.
The aim is to keep the penis functioning and prevent issues with urinating, erections and scar tissue developing.
NHS figures suggest around 150 men have to undergo surgery every year to fix a snapped penis. A 2015 study concluded that the cowgirl position – where the woman is on top – is most likely to cause the injury.
