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Dr Phil: Penis Part 2: Lumps, bumps & STIs (video)

Related articles:  Discharge from the penis; Genital warts; Genital infections; Lumps on genitals in men; Odd looking patch on the penis; Red, sore and itchy penis; Doc Spot - Lumps on the penis; Dr Phil - Genital infections

Hello there, I’m Dr Phil Hammond and welcome to embarrassingproblems.com and The Penis Trilogy – Part 2: Lumps, bumps & STIs.

In The Penis Trilogy – Part 1: The foreskin, my first film, I was talking about circumcision, problems with the foreskin and infections around the glans of the penis. I probably should have mentioned that if you do decide that you need to have a circumcision make sure that you go to someone [as with all surgery] who does lots of them and does them well, because you don’t want anyone chopping off slightly more than you need to. Also you want to reduce your risk of getting infections and bleeding afterwards and generally that happens if you go to someone who does a lot of them. However, as I said in my first film, in most cases of a tight foreskin, in time, with gentle easing in the bath in just ordinary bath water with no soap or detergent, the foreskin will come back and it will sort itself out. 

So let’s talk about lumps and bumps on the penis, what's normal and what isn’t.

Pearly penile papules

Around the glans - the bit that looks like Darth Vader’s helmet - a lot of men notice a little row of tiny little pimples, very regular, almost like pretty maids all in a row. Sometimes they can go down onto the shaft as well, up the edge and in the mid line, but often they happen around the edge of the helmet. A lot of boys and men worry that they have picked up something like genital warts. In fact, these things are perfectly normal. They are called ‘pearly penile papules’. You can tell they are normal because they look small and regular and they occur usually in beautiful lines. They are perfectly normal papules that occur on the penis that help with lubrication. Please don’t try to remove them! I’ve seen some men who get very obsessed who try to shave them off with a cheese grater. That can only cause more harm - you should look after your penis.

Infections  

Never try to treat your own infections. I’ve seen men who put shower gel down the hole, pipe cleaners and all sorts of things because they want to try DIY treatment. That never works out.

In men more than women you are more likely to know if you have picked up a sexually transmitted infection (STI). Women often don’t have any symptoms at all. It seems odd that the commonest symptom of an STI can be no symptoms at all. That applies to men as well, but men sometimes do have symptoms. It can be a slight change in sensation when you are peeing - it doesn’t have to be that you are peeing razor blades, it can just be ‘ooohh that’s a little bit uncomfortable', or you can feel like you're peeing razor blades. Sometimes you notice that when you ejaculate it just doesn’t feel quite the same, not quite as pleasurable, as there is a slight numbing of the nerves ... and sometimes you notice a great big lump of pus dripping out of your penis.

Extraordinary as it may seem, there are some men who I would describe as ‘genitally unaware’ who walk around dripping with pus, who don’t seem to realize there is any problem at all, and this can go on for weeks. So always have a look at your penis. If there is something there that is milky and white, that isn’t cum, it’s just appeared for no reason or if it’s particularly yellow or green, you need to get that checked out and you need to get it checked out urgently! Rather obviously, don’t have sex with anyone, even with a condom, if you find that you have got some sort of discharge or undiagnosed lump or bump. It is really, really important that you go down to your local STI clinic, GUM clinic or sexual health clinic. The beauty of these clinics is that they are all totally confidential, in the sense that your notes won’t be sent to anyone without your permission. So your GP doesn’t know about it, your mum doesn’t know about it, nobody knows about it. These infections generally won’t go away unless you get them treated and of course you could pass them on to other people.

So those are the common things you will notice:

• a discharge from the end of the penis
• pain when passing your urine
• a slightly odd feeling in your penis or when you ejaculate.

Genital warts

Of course you can get lumps and bumps on the penis. We have talked about the ‘PPPs’ – the pearly penile papules, which are normal. Genital warts tend to be more roughened and irregular like warts that you get elsewhere on your body. Sometimes they can be almost like little flat warts and sometimes they can come out on a stalk. Either way, they occur all over in an irregular basis on the penis, and they look pretty unsightly, and you think ‘OMG, what are they?’ Generally, they are not going to go away unless you get them treated. Treatment can be a bit fiddly. There is an antiviral paint, which can be applied to the penis that treats the HPV virus, or you can have them frozen off. Sometimes you have to have more than one treatment, it is a bit fiddly and can be a bit distressing, but generally they do go away in time.

Herpes

Another STI that you can get is herpes. When you have herpes for the first time it can be quite uncomfortable. It’s not as bad as you think - it’s just a cold sore gone south, a little bit like having chicken pox on your knob (they are similar viruses). But the first time you get it you can feel pretty awful, it can be quite painful and sometimes you will have an obvious blister; you may also feel generally unwell. The good news with herpes is that if you do get other attacks they tend to be less severe. The other good news with herpes is that we have fantastic antiviral medications now, such as Acyclovir. If you take them in a large dose early on they can rapidly reduce the length of the infection and reduce your risk of getting subsequent infections too. So there is lots of good news, but only if you get help.

Chlamydia, gonorrhea and syphilis

STIs like chlamydia are pretty common, you may just have a slight discomfort when ejaculating or passing urine. With gonorrhea, often you will get a more profound discharge. With syphilis, which is making a bit of a come back, you may get a sore on the penis. So it is worth when doing your daily foreskin hygiene, i.e. you are washing behind the foreskin, removing the smegma, giving it a bit of an MOT (you are not polishing and buffing it with detergents and nail scissors or anything, just gently washing it with water - see Penis Part 1, The Foreskin), if you notice anything that wasn’t there yesterday, or notice anything you are at all concerned about then get it checked out.

Treatment 

There is a certain group of men that we call ‘squeezers’ who get it into their head that they have definitely got a discharge. They squeeze the glans, they squeeze the glans and they squeeze the glans and they almost give themselves an irritation through too much squeezing. You don’t need to do that, you just need to go and get it checked out. These days they don’t put an umbrella down the end of your penis or any of that nonsense. Generally you just pee in a pot. Most STIs can now be diagnosed very cleverly with testing of urine samples. So it’s not traumatic and it’s done in confidence, you get sorted and you do some contact tracing, which is really important. A health visitor will come in or a specialist tracing nurse will come and talk about people you have had sex with and will trace them all so they can all be treated. If you don’t, you will get treatment and then you will just pass it around again.

Condoms

We tend not to call them STIs anymore. We try to call them ‘sexually shared infections’. You share pleasure, occasionally you share bugs, and if you share bugs you share treatment and you all get sorted and you carry on having fun. Of course this can all be dramatically reduced if you learn how to put a condom on. Not always easy, but worth having a go. Instructions are in the packet. You have got to get the rolled edge on the outside so that it goes down over the penis. Put it on well before you insert. At the end hold onto the base quickly before your penis shrinks down again, and withdraw holding on to it. If you learn to use a condom every time then your risk of getting any sort of lump or bump or sore on your penis is dramatically reduced. 

For more advice, take a look at the relevant sections on this website. If you want to check me out then go to drphilhammond.com.

In The Penis: Part Three we are going to be talking about erection difficulties and do you have a bend in yours? A lot of people do… See you later.

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