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Pearly papules and other penis problems

Diane Mapes writes:

Until a 22-year-old Lakeville, Minn., man filed a recent lawsuit against the producers of the daytime television show "The Doctors," claiming he'd been "tricked" into appearing on the show to discuss blemishes on his penis not many people had heard of pearly penile papules (PPP).

Even more surprising than the name of the condition (or the fact that someone would file a very public lawsuit about their penis predicament) is that the young man opted for a potentially risky laser procedure on such a delicate area.  PPPs are typically harmless.

"The papules are pinhead-sized cyst-like growths around the head of the penis," says Dr. Christopher Saigal, associate professor in the UCLA department of urology, adding that they're totally benign and not painful.

The papules, which occur in about 5 percent to 10 percent of the male population, are neither contagious, nor associated with an STD (although they're often mistaken for one). All in all, Saigal says they're as harmless as a freckle.

No one knows what causes PPP, says Saigal, and the condition often disappears as men age. There's also no real treatment for PPP, although some people – like the gentleman who appeared on The Doctors – will opt for laser removal.

 Saigal feels that's unnecessary.

"The penis is a very sensitive area of the body," says Saigal. "Personally, I don't think it's a good idea to do that. You'll be left with some scarring or at the very least, some discoloration. It's a trade-off. You can have the papules or you can have scarring."

 PPPs are just one of a handful of genital conditions that can plague men, says Saigal.

Phimosis is a condition in which the foreskin is so tight it can't be retracted over the tip of the penis, and can sometimes require surgery.

"It's the most common reason for circumcision in adult men," says Saigal.

The condition -- derived from the Greek word "phimos," meaning "to muzzle" – occurs in men who are uncircumcised. Phimosis occurs naturally in newborn males, but the condition usually resolves itself in the first few years. After puberty, phimosis can happen as a result of scarring of the foreskin, either due to injury or chronic inflammation.

Poor hygiene can be a contributing factor to phimosis and to the conditions balanitis (inflammation of the head of the penis) and balanoposthitis (inflammation of the head of the penis and the foreskin). Some types of masturbation have been known to cause phimosis, including rolling the penis between two palms or between one hand and another surface, such as the abdomen or thigh.

"If you have a problem with hygiene, you can get infected and then the skin becomes scarred and you can't pull it over the head of the penis," says Saigal. "It can be a problem with regard to sexual activity and with regard to keeping it clean. And it's also a set-up for penile cancer. But it's a very rare problem."

While phimosis can be painless and is not considered a serious issue, men should seek medical attention if the condition makes urination difficult or impossible. Treatment options include topical creams, a gradual stretching of the prepuce (the fold of skin covering the tip of the penis), foreskin surgical repair or, in some cases, circumcision.

Then there's Peyronie's disease, named for the French surgeon who documented it in 1743.
With Peyronie's, the penis develops a hard lump – or plaque – within the layers of erectile tissue, either on upper or the lower side of the penis. It will sometimes occur in a mild form that causes inflammation for several months before disappearing. Or it can become permanent, eventually reducing flexibility of the penis, causing it to bend or arc during erection, sometimes by as much as 90 degrees.  Scientists aren't certain of the cause of Peyronie's, although it's thought to be linked to a wound that hasn't healed properly.

"It's the result of microtrauma to the penis," says Saigal. "The inner lining of the penis is a sort of tough lining that covers the spongy tissue of the penis. The tough lining gets bent during sex, little ruptures happen and blood leaks out. In time, that forms a calcified scar or plaque -- you can feel a hard lump there. When the penis gets erect, that part of the penis doesn't stretch properly. It bends."

Saigal says men with Peyronie's disease can experience problems with sexual activity (the bending will sometimes prevent penetration) and their erections can be painful.
Peyronie's happens in about 4 percent of men and is associated with Dupuytren's contracture of the hand, a condition that affects the connective tissue in the palm, causing the fingers to permanently bend down.

"Some men are more prone to form those kinds of plaques or scars," he says. "They have a predisposition for it."

While Saigal says there's no sure cure for Peyronie's disease, there are a series of treatments, including medication, injections and, as a last result, surgery. A new option, however, may be on the horizon.

"There's a new medication coming out and it's worked very well for men with Dupuytren's contracture," he says. "It may be useful in Peyronie's disease, but those trials are ongoing."

 Saigal says while most men don't seek help until "it becomes a problem with sex"—which is probably true for many genital issues — early treatment is best.

"If they notice a hard area on the penis, if there's a problem with a bend they didn't notice before, they should bring it up to their doctor and start on oral therapy," says Saigal. "It could make a difference before things get too extreme."

Meanwhile, the attorney for the penis surgery patient says the lawsuit is still on. While the young man may be dealing with extreme embarrassment, at least the operation didn't do more damage. As doctors sometimes say, the penis is the dipstick of a man's health.