Some men may worry about skin discoloration or bumps that appear on the penis. Most of these are not anything to worry about, but worth noting in this chapter. There are multiple reasons why men may have bumps on their penis. One of the most common can simply be an allergic reaction. However, there are other causes unrelated to allergic reactions – such as Fordyce Spots, Pearly Penile Papules, and Folliculitis. There are some visual spots/bumps on the penis that may indicate a sexually transmitted infection such as syphilis, genital herpes, or genital warts. Growths on the penis in rare cases may indicate penile cancer. In addition, men who have not been circumcised and have a foreskin often have issues that uncircumcised men may not.
It is common for the skin of the penis to be a slightly different color than skin on the rest of the body. Like other skin, normal spots like freckles and even smooth moles can be present. However, from time to time there may be a new skin discoloration that appears. A condition called post-inflammation hyperpigmentation occurs when melanin (skin pigment) is overproduced after injury to the skin of the penis. Most often this occurs after some type of penile skin injury such as pinching of the skin during sexual activity or getting pinched in clothing (zipper type injuries).
Skin discoloration can also be caused by bruising after an injury. Like other bruises, the skin can turn dark purple then have a green tinge as it heals. Bleeding within the penis can cause the penis to turn red as blood accumulates under the skin. Both of these are caused by injury to the penis and may require medical attention.
Finally, men who have vitiligo (a skin condition where the skin loses its pigment in spots all over the body resulting in white skin and even white hair growing out of the white skin patches) may see it spread to the penis causing lack of pigmentation on the penis (either in certain spots or spreading to the entire penis).[i]
Just like any other skin surface, the penis skin can have an allergic reaction to irritants. This often causes redness or a rash and can be accompanied by itching. One of the most common reasons for an allergic reaction on the penis is using latex condoms or other products during intercourse. Most condoms are made of latex and men who are allergic to latex can have a skin reaction to the condom. Non-latex condoms can be used by men who have this allergy. In addition, condoms are often coated in lubricant and spermicide. Some men are actually allergic to the lubricant or spermicide and this can cause a similar red, itching reaction. Most often the reaction will occur anywhere on the penis that comes in contact with the condom (or its lubricant and/or spermicide), but may be more severe at the base of the penis where the condom rolls. Personal lubricants or spermicide products used with certain types of birth control can also cause these allergic reactions. Changing the type of condom, lubricant, or using a birth control method that doesn’t require spermicide often prevents future issues. In fact, there are personal lubricants that are designed to be hypoallergenic (less likely to cause allergic reactions).
Other irritants can also cause problems. Some men may be allergic to medications that a woman uses vaginally (such as a vaginal antifungal medication). If this occurs, use of a condom can create a barrier between the penis and medication in the vagina thus preventing a skin reaction.
Lastly, other causes of allergic reactions can be due to detergents used to wash underclothing or soap used during showering. However, in these cases the allergic reaction is often not confined to the penis, but other skin areas that come in contact with the clothing, soap, or other products.
Folliculitis is an inflammation of the hair follicle. We don’t often think of hair growing on the penis, but the majority of men will have hair growing sparsely on the shaft of the penis (see Chapter 22), especially near the raphe ridge on the underside of the penis. Folliculitis appears as an inflamed bump with a hair (even a very small hair) growing out of the middle. During puberty, the hair may not have grown out of the skin yet, but the bump appears over a hair follicle. These are often white, pussy, and tender like a small pimple. These often occur in athletes or active teenagers because sweating in the crotch can increase the risk of hair follicles becoming infected. Washing with warm water and soap can usually help clear out the infected follicle. Below is an image of folliculitis no on the genitals, but folliculitis bumps on the penis would look nearly identical.
Another cause of folliculitis occurs in men who shave hair off the penis. This can cause ingrown hairs. Usually these stop occurring a short time after shaving stops. Due to the large number of blood vessels in the penis and the thin skin, it is not wise to shave the penis. If penile hair is bothersome, it is better to trim or pluck rather than shave to prevent ingrown hairs, folliculitis, and cuts.
Fordyce spots are actually very common – occurring in the majority of men (80-90%). These are small, painless bumps that are white, yellow, or flesh colored. They are often seen on the shaft of the penis but do NOT involve a pore where a hair grows. Click HERE to see an example of fordyce spots on the penis. They are painless, don’t itch, and don’t cause any problems. As stated earlier, in most cases they are the same color as the skin or pale, but they can also be red or purple. In most cases they’re barely noticeable, but they can be as large as 1-3mm in size. They can bleed in rare cases if torn away from the penis during intercourse. Oftentimes, they are caused by hormone shifts (so they may occur more in puberty than adulthood). However, they can also be caused by sweating in the groin (common in athletes). Usually, no treatment is necessary; however, keeping the area clean by washing the genitals regularly (especially after sweating) with soap and water can help.
Fordyce spots will not be infected and typically will not have hair growing out of them (folliculitis), nor will they look like a blister or take on a cluster or cauliflower look (genital warts). However, sometimes it’s hard to tell. If you have a bump that won’t go away and you’re not sure what it is, it’s always good to talk to a healthcare provider.
Pearly Penile Papules
Pearly penile papules (also called hirsutoid papillomas) are more common in uncircumcised men. These small bumps can be either white or skin colored and they grow in rows on or under the corona of the glans of the penis, sometimes along the frenulum. There may be one row or multiple rows. These are harmless and require no treatment. Click HERE to see an exmaple of pearly penile papules.
Penile syringomas are extremely rare and have only been documented in a few clinical case reports. These appear as fleshy bumps that look similar to skin tags and may be similar in color to penis skin or have a purple to red color. Click HERE to see an example of penile syringomas.
Sexually Tnasmitted Diseases
Other bumps and sores on the penis can occur and sometimes may be a sign of an infection (which may have been sexually transmitted). These are discussed more in-depth in the Sexually Transmitted Diseases section (click HERE).
Sores and warts are often an indication of a sexually transmitted infection. However, syphilis can present as a small open sore (usually painless) called a chancroid (click HERE to see an image). Chancroids appear on the penis and will typically stay there for a few weeks then disappear. This requires treatment, even if the sore does go away--it can be life-threatening as time goes on.
Painful blisters or weeping sores can be caused by genital herpes. These are highly spreadable, even by simply touching your own sore and then touching your eye could transfer the herpes infection to the eye. Click HERE to see an image.
Genital warts are often caused by human papilloma virus or HPV – a sexually transmitted infection. These warts can look much like other warts (click HERE to see an example) either being rounded, flat, or growing in clusters like cauliflower. Genital warts are most commonly found on the shaft of the penis. There are topical creams that can be applied to make the warts go away (or they can be frozen off in a clinic office); however, the virus itself can keep coming back and warts can keep reforming. Genital warts can cause changes in the cells of the genitals which can trigger penile cancer.
There can be a whole host of other causes for bumps on the penis. Although rare, they may also be an extension of a fungal infection like jock itch that has spread to the penis (click HERE). New growths that don’t mimic folliculitis, Fordyce spots, or pearly penile papules are worth talking to your medical provider about. Especially if you’ve been sexually active with a new partner.[i]
Penile cancer also causes changes on the skin of the penis (click HERE to learn more about penile cancer).
[i] http://www.geniderm.com/45-causes-of-bumps-on-penis/ (12/2/16) & http://emedicine.medscape.com/article/446554-overview?pa=J98v36jwdxQdDjls8nKPcblePXUIRx7y%2F9dajaE5JjZ%2FxSuJsLcz37H9n6l%2Fjkzh6mJ9hANLysSdQfMwnsEri3f7Bj2Gvk6BKC47oRZ1BB8%3D#a6
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