What Are Penile Disorders

Penile disorders revolve around the penis, the male external organ used to urinate and partake in sexual activities. 

Penile disorders range from:

• Common disorders including, erectile dysfunction, Peyronie’s disease, phimosis and priapism
• Rare penile disorders, including hypospadias, paraphimosis and penile cancer

Understanding penile disorders; its preventative measures, the importance of routine check-ups, early diagnosis and treatment methods is important to men’s health. 

Common penile disorders

Erectile dysfunction

Erectile dysfunction (impotence) is the inability to get an erection or to maintain an erection during sexual intercourse. It is a common disorder, affecting 2 in 3 men over the age of 45. There are a range of physical and psychological causes, usually a combination of both. Erectile dysfunction may be due to a problem with the male reproductive system, for example, Peyronie’s disease, prostate disease and hypogonadism. Physical factors influencing the onset of erectile dysfunction are age, co-morbid health problems like type 2 diabetes and cardiovascular disease, and drugs used to treat conditions like high blood pressure or high cholesterol.

Typically, it is caused by stress, tiredness, smoking and alcohol. Medical intervention should be sought if erectile dysfunction is persistent, painful, and affects urination or sexual activities. The doctor will treat any underlying health conditions first if causing erectile dysfunction. If experiencing erectile dysfunction, lifestyle changes are recommended, for example, reduce smoking and consumption of alcohol, to maintain a healthy mind and body. 

 Pharmacological treatment involves PDE-5 inhibitors which increase blood flow to the penis, examples include Viagra. These drugs work by dilating the blood vessels in the penis to allow better blood flow. Non-pharmacological treatment includes vacuum pumps which increase blood flow to the penis. Psychological treatments like cognitive behavioural therapy and sex therapy are also available to support those affected.¹

Peyronie’s disease

Another common penile disorder is Peyronie’s disease, where fibrous scar tissue (plaque) develops under the skin of the penis. The accumulation of plaque causes the penis to curve with or without erection, this can be painful, especially during sexual intercourse. The cause of Peyronie’s disease isn’t fully known, but it is thought to be caused by acute or chronic physical injury to the penis, or via an autoimmune disease. Injury to the penis can occur during sex or other physical activity causing it to bleed and swell; plaque may form on the injury site, causing the penis to curve. Autoimmune disease can cause your immune cells to attack the penile tissue, leading to the formation of plaque.

The main objective when treating Peyronie’s disease is to reduce pain and to correct the curvature in the penis. In rare cases, Peyronie’s disease goes away without treatment. However, most cases are treated with pain management medication and surgical/non-surgical techniques to correct the curvature of the penis.

To help with the pain, oral medication like NSAIDs can be prescribed, and Verapamil can be injected into the penis. Non-surgical options to target the curvature of the penis include injections of collagenase which break down plaque; this treatment is reserved for penises with more than a 30-degree curvature. Medical therapies include mechanical traction devices to stretch and straighten the penis, and shockwave therapy directed at the plaque to reduce the sensation of pain.²

Phimosis

Phimosis is when the foreskin is tight around the head of the penis and cannot be pulled pack. In young boys, typically under the age of 4, phimosis is normal. However, in older boys and adult men, it is often caused by inflammation or an infection under the foreskin. In most cases of phimosis, it is painless, however, an extremely tight foreskin can cause pain when urinating or having sex.

To prevent phimosis, maintain good hygiene by pulling back the foreskin to clean. When the disorder occurs naturally without any symptoms, which is the case amongst young boys, treatment is not required. For symptomatic cases, medicated creams like hydrocortisone may be used. When persistent symptoms occur, circumcision may be advised.³

Priapism

Priapism is a condition causing long-lasting and painful erections, typically persisting for more than 4 hours, without sexual stimulation. There are two types of priapism: high-flow (non-ischaemic ) and low-flow (ischaemic). High-flow priapism is resultant of physical trauma to the penis.

Damage to the arteries causes increased blood flow to the penis, which causes persistent erection. Low-flow priapism occurs when blood flow becomes stuck in the erection chamber; it is the most common presentation of priapism with it affecting 5.34 per 100,000 men every year.⁴ 

Many factors can cause Priapism such as, blood disorders like sickle cell anaemia and leukaemia can affect blood flow to the penis. A common cause of Priapism is drugs and medication, with drugs like antipsychotics and antidepressants altering blood flow to the penis. An erection lasting longer than 4 hours is considered a medical emergency as the deoxygenated blood in the penis can cause tissue damage.

Leaving Priapism untreated can cause permanent damage to penile tissue and lifelong erectile dysfunction. Treatment methods for low-flow Priapism include removing the excess blood, and medication that shrinks the size of the blood vessels to reduce blood flow to the penis. High flow Priapism often does not need treatment as it normally resolves on its own.⁵

Uncommon penile disorders

Hypospadias

Hypospadias is the abnormal development of the penis whereby the urethra is abnormally positioned, this condition is prevalent in 1 in 150 male babies. The cause of hypospadias is unknown but there are likely to be genetic, endocrine and environmental factors. Treatment approaches depend on the severity of the condition, extreme cases of hypospadias are subjected to corrective surgical procedures. Surgical objectives include moving the urethra opening to the tip of the penis and closing the hole that was previously there.⁶

Paraphimosis

Similar to Phimosis, Paraphimosis is when the foreskin is pulled back behind the head of the penis, but becomes stuck and cannot be placed forward again. Symptoms include pain, swelling and loss of blood flow to the penis. Paraphimosis can be prevented by being careful when pulling back the foreskin and making sure to carefully replace the foreskin to its original position. Circumcisions can be used to prevent and treat paraphimosis. In an emergency, a doctor may cut a slit in the foreskin for it to retract.³

Penile cancer

Penile cancer is a rare condition associated with the skin of the penis, commonly affecting men over the age of 50. Symptoms include persistent growths on the penis, rashes, bleeding, foul-smelling discharge, and thickening of penile skin. The main cause of penile cancer is human papillomavirus (HPV), which can be contracted by skin-to-skin contact of the genital area.

Risk factors like phimosis, smoking and weakened immune systems can increase your chance of getting penile cancer. Biopsies can be used to diagnose penile cancer, early screening is advised to catch the cancer in its early stage. Early-stage penile cancer is more treatable, with treatment involving chemotherapy and laser therapy. Penile cancer found in the late stage may include surgery as a treatment method.⁷

Prevention and maintenance

Maintaining penile health is important to keeping you healthy, certain lifestyle habits can prevent issues from occurring. Maintain good hygiene habits and wash well every day, especially under the foreskin. Check your penis regularly to prevent and catch penile disorders in its early stage. Avoid activities that may risk your penile health, try limiting the number of sexual partners and use condoms when necessary. If participating in any sports or rough activities, use a protective cup if necessary. Regular checkups with a healthcare professional are extremely important to maintain penile health.

Routine genital exams screen for most penile disorders, including cancer. Early detection and intervention are important as treatment is most effective in the early stages, especially for penile cancer.⁸

Support

The psychological impact of penile disorders can affect a man's emotional well-being and self-esteem. Addressing the stigma associated with these conditions is crucial for fostering open conversations and reducing unnecessary shame. Seeking professional help is essential, as mental health professionals can provide guidance, support, and coping strategies to navigate the emotional aspects of these conditions. Establishing support systems, including friends, family, and support groups, can contribute significantly to alleviating the psychological burden.

Summary

To summarize, penile disorders can vary in prevalence and severity. Disorders like erectile dysfunction are very common amongst older men, whilst rarer conditions like penile cancer are less common. Treatment is dependent on the severity of the condition, some are harmless and go away naturally, for example, phimosis. Others may need treatment intervention often in the form of pharmacological treatment. In severe cases where the penile disorder is extremely painful or affects urinating or sexual activity, surgery may be considered. Penile disorders are more common than we think, it should be a topic in an open conversation about men’s health. Early intervention is key, as it is advised that men perform regular self-checks as well as routinely seek medical checkups and advice.