Archive for October 29, 2015

Painful Tears in Foreskin

Q. I am a 55-year-old uncircumcised male. Recently, I have developed small tears in my foreskin that are quite painful. Their appearance does not seem to correlate with my sexual activity. Gold Bond cream has been somewhat helpful in healing the areas. Aquaphor or petroleum-based products seem to make the problem worse. What could be causing this problem?

A. Many uncircumcised men suffer from phimosis, a condition characterized by tightening of the foreskin such that when it is retracted it cracks. These cracks become infected, which leads to swelling and pain. The result is a vicious cycle — more shrinking of the foreskin, leading to further cracking. Rarely, a skin cancer can develop on the foreskin that cracks and causes pain very similar to phimosis. At times the only way to tell is to biopsy the foreskin. Your doctor should be able to do this.

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No Feeling after Penile Implant

Q. I had a penile implant some months ago, and since then, I really have no feeling in the penis and do not ever have a climax. Is there some kind of a medication or something that can be applied to the penis to bring back feeling?

A. Your problem is quite interesting. I am assuming you had normal sensation and ejaculations before the surgery. If this assumption is correct, then I can think of one possibility, depending on how the device was placed. If a penile prosthesis is implanted using an infrapubic approach (that is, it is put in from above the penis), then the sensory nerves that serve the penis could be damaged. These nerves are a part of the support ligaments to the penis, located between the penis and the pubic bone. When the penis is cut open near these ligaments, damage can occur.

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Injury to Penis During Sex

Q. About three or four weeks ago while having sex, with me on top, my boyfriend’s penis slipped out and I came down on it, bending it with my weight. Of course he has been in pain since then. He still gets erections and has orgasms, but he complains of dull pain while having sex (unless we are moving slow and carefully). He compares it to the feeling of pulling a groin muscle. Do you know what has been damaged and what he should do about it? How long will it likely take to heal? Can there be long-term problems from this? How would he know?

A. Your boyfriend is not alone. This happens to many men. When the penis suffers a bend while erect, it often causes a tear in the tunica albuginea. This is the layer of collagen that surrounds the erectile tissue, called the corpus cavernosum. During an erection, the corpus cavernosum fills with blood. The tunica enables the erect penis to maintain its length and girth, rather like the side wall of a car tire filled with air enables it to hold its shape.

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Hypospadias & Male Fertility

Q. My husband had many surgeries as a child for his hypospadias. We have been trying for a year to get pregnant. I have been checked out and I am OK. Today, the doctors say that hypospadias is not a problem. But 28 years ago, it was really different. Can he still have kids? I don’t know if they still do the same surgery today or not.

A. Hypospadias is a condition where the urethral meatus (opening) is not on the tip of the penile glans; instead, the opening occurs on the ventral side (bottom or underside) of the penis. We don’t really understand why this malformation occurs. It may result from lower levels of male hormones at the time the genitals are formed, while the baby is still in the womb. During pregnancy with a male fetus, the hormone hCG from the mother’s placenta will actually stimulate the fetus’ testicles to make testosterone, which in turn prompts the formation of the male external genitalia. The testosterone is converted to the more potent DHT before it carries out these actions. A problem may occur at any point in this process, so the culprit may be abnormal placental hCG production, low testosterone production from the testicle, or incomplete conversion to DHT.

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Hair on Penis

Q. I have a hairy penis. How do I remove the hair from it?

A. Hair on the genitals is common and not a medical problem. If you find it bothersome, however, you may have it removed permanently by electrolysis — the same procedure used for hair removal on the legs. This procedure can be done in a dermatologist’s office. Each hair is grasped with tweezers that have electric current going through them. The electric current is used to kill the root of the hair to prevent the hair from coming back. The process is not painless, but other methods do not destroy the root, and the hair will simply grow back in one to three months.

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Foreskin Won’t Retract

Q. I am an uncircumcised male. During an erection, my foreskin is tight and will not move and expose my penis. Is this normal, or are there any ways to cure this?

A. You are describing a condition called phimosis, in which the foreskin cannot be retracted behind the glans penis (head of the penis). Normally, the foreskin is loose and can be retracted for proper hygiene. However, when there is scarring of the foreskin, it contracts over time and becomes tight, preventing easy retraction.

I am sure this is uncomfortable while you are erect. In fact, phimosis often doesn’t get diagnosed until after puberty, when boys start having erections. Often it causes pain during sex; the skin and can crack or tear, causing bleeding.

There are more serious concerns as well. Studies have shown an association between penile cancer and phimosis. If you cannot retract the skin to clean the penis, then you also can’t see the surface of the glans, and a cancer there might go undiagnosed. Another worrisome condition is paraphimosis; this happens when a tight foreskin is retracted but cannot be replaced; it remains behind the glans penis, constricting it and causing painful swelling and engorgement of the blood vessels. If not addressed quickly, the swelling can become so severe that it shuts off the blood supply to the glans. This is a surgical emergency.

So, don’t try to force the skin back. Instead, see your doctor. There are several options for you. One is simply to have a circumcision, a surgical procedure to remove the foreskin. The surgery is performed under a local anesthetic (only the penis is put to sleep), and you go home the same day. Another option is called a dorsal slit; in this procedure, the foreskin is cut on one side, relaxing it so that it opens up. Again, this is an outpatient procedure done with a local anesthetic. I hope you will consider one of these two treatments to better protect your health.

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Foreskin Stuck in Retracted Position

Q. My boyfriend is uncircumcised. Recently half of his penis came out of the uncircumcised area. Now the head is out, and right after the head there is an extra piece of flesh that looks like a ring. He says it hurts from that “ring” to the front of the head. What is happening? Is he still uncircumcised

A. This is a common problem for uncircumcised men. We refer to it as paraphimosis. You see what happens when the foreskin is pulled back behind the head of the penis (the glans) — it can get stuck there in the tight ring in the skin. In fact, every time the man has an erection and the skin is pulled back below the glans, it must be physically returned to its normal position. Sometimes when it is stuck behind the glans and not returned, the result can be severe inflammation (swelling) of the glans. If the foreskin is left retracted too long, it can become an emergency that requires surgery to put it back in place. I would suggest he seek medical attention as soon as possible.

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Fishy Odor in Uncircumcised Man

Q. My male partner has a very strong fishy odor. He is uncircumcised. Could this be a sexually transmitted disease, or just a bacterial infection from not being circumcised? Should I ask him about the odor, or will that just make him feel bad? What’s the risk of me getting whatever he has?

A. Uncircumcised men can accumulate glandular secretions under the foreskin that smell. These secretions can accumulate in as little as one day; when the foreskin is retracted, the residue appears whitish in color. Such secretions are commonly referred to as smegma. The odor does not mean there is a bacterial infection or STD. I don’t think there is any risk based on what you have told me, but if you are concerned, you need to express that to him and have him checked.

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Epidermal Cyst on Penis

Q. I have a burrow-like opening on the shaft of my penis, and inside is a seed-like object. What is this?

A. Of course I can’t be sure what you have without examining you personally. You should certainly see a doctor to find out exactly what you have. From your description, however, a possible explanation is that you have an epidermal cyst. This is the most common type of cyst (fluid-filled growth) found on the body. These cysts are commonly found on the scrotum and, less frequently, on the shaft of the penis.

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Cleaning an Uncircumcised Penis

Q. What is the best way to clean the penis if you are not circumcised?

A. The best way to clean an adult uncircumsised penis is to retract the foreskin and wash the glans with soap and water daily. When a man is not circumcised, the foreskin can secrete a cheesy substance called smegma. This should be washed off daily.

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