Common Penile & Testicular Problems
By Donald Zimmer

Just as it can provide much pleasure, the male organ can also be a source of considerable anxiety. And not just in matters of performance, either; a sudden change in the penis' appearance or a persistent aesthetic oddity can give rise to serious stress. In some cases, such worry is merited, as a strange physical feature can be symptomatic of an underlying problem. In others, however, what you see as a penile problem is actually rather commonplace, and no cause for real concern.

This week, instead of responding directly to select letters, I'll be addressing some of these physical concerns that crop up in so many of your inquiries. Let's have a look at some of the most frequently encountered penis abnormalities; their symptoms, their underlying causes and their treatments.

Peyronie's disease
What it looks like: Peyronie's disease can present itself as a bump or thickening along the shaft of the flaccid penis, or as a bending or dramatic curvature of the erect organ.

What causes it: Peyronie's is caused by the accumulation of scar tissue on a certain area of the penis, which causes the penis to bend when erect. The origins of the scarring are unknown, but many believe it to be the product of an early injury to the penis. Peyronie's affects around 1% of the middle-aged male population.

How to treat it: In roughly 20% of cases, Peyronie's will go away on its own. Otherwise, certain medications (high doses of vitamin E therapy, anti-inflammatory drugs and the oral application of para-aminobenzoate) will address the pain associated with the disease, and surgery can help remedy severe cases.

Penile papules
What it looks like: Also known as "pearls," penile papules manifest themselves as small, white- or flesh-colored bumps on the surface of the penis.

What causes it: No known cause for penile papules has been discovered. Its frequency is also something of a mystery: the reported portion of the affected male population has ranged everywhere from 8% to 48%.

How to treat it: As penile papules are completely harmless, there is no need to treat them. For those who wish to remove them for cosmetic reasons, laser surgery is available.

Balanitis
What it looks like: The skin covering the head of the penis becomes inflamed, causing swelling, redness, itching, pain, and occasionally, an odd-smelling discharge.

What causes it: Balanitis occurs most often in uncircumcised men, and usually comes about because of poor hygiene. The accumulation of dead skin, bacteria and sweat under the foreskin causes the irritation. Infection and dermatitis can also be responsible for balanitis.

How to treat it: Sometimes, a good scrubbing is enough. If infection is the cause, however, oral antibiotics or antifungal medication may be necessary.

Uneven testicles
What it looks like: One testicle is slightly larger than the other.

What causes it: It's very common for one testicle (oftentimes the left one) is larger than the other. It's also common that one hangs lower than the other, which can give the illusion of greater size.

How to treat it: Testicle implants are available, although usually restricted to those in real need of them (such as testicular cancer patients). To undergo this procedure to correct what is a normal condition would be the height of vanity, but it may be possible at certain hospitals or clinics.

Hypospadias
What it looks like: The meatus, the urethral opening hole on the penis through which urine and ejaculate pass, is abnormally positioned. In mild cases it appears just short of the top; in extreme cases it appears on the underside of the penis, or even as far back as the scrotum. In some instances, two meatuses can be present on the penis, with urine passing through one and ejaculate through the other.

What causes it: Hypospadias is the result of defective development of the penis. It occurs, to some degree, in one out of every 125 male babies.

How to treat it: Surgery will not correct hypospadias entirely, but it can help.