The Care and Feeding of the Penis, by Aek

This is installment two of “The Care and Feeding of” series. I thought that since I did one on the testicles back in January, this month’s installment will be on the penis. I mean, it’s only logical since the penis receives so much attention from its own as well as others (for better or for worse). I’ve been debating how to best format this post as well as what to include, as the info could differ somewhat depending on the readership (US readers vs. international readers).

But I figured I’ll cover basic external anatomy, basic care of, and a few medical problems.  Full disclosure I suppose: this is a longer post than the last one.

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Basic (External) Anatomy of the Penis

So I’m sure everyone’s quite familiar with the external (aka, surface) anatomy of the penis. It includes: the shaft, the glans (penis head), the foreskin, the frenulum, and the meatus (opening of the urethra). For circumcised guys, the foreskin (and often the frenulum) is (are) removed – what remains are a scar and remnants of the inner foreskin tissue, the amount of which can vary depending on how the circumcision was done. I will not get into circumcision in this post – so I won’t say much more of it than this. It seems, however, that many people don’t know much about the foreskin and frenulum.

Foreskin

The foreskin is actually more specialized than people often give it credit for. The “outer foreskin” is similar to the shaft skin, in that it’s thicker and less sensitive. The “inner foreskin” is more similar to the glans, in that it’s thinner and more sensitive. The foreskin folds over itself such that the inner foreskin is covered up when the penis is flaccid (soft). It’s important to know that foreskins vary greatly in length and don’t always automatically retract (pull back) upon erection. Some guys have foreskins so short that they don’t cover the entire glans even while flaccid, whereas other guys have foreskins long enough to still completely cover the glans during an erection. This is all normal.

Frenulum

The frenulum is a band of tissue that “tethers” the foreskin to the underside of the glans. Its function is to basically return the foreskin back over the glans. If you look at the underside of your tongue, you’ll notice a frenulum that keeps your tongue attached to the bottom of your mouth. The frenulum of the penis has been described as being really sensitive, enough so that some guys consider it the “male g-spot” (outside the other supposed male g-spot: the prostate).

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Basic Care of the Penis

The prevailing mantra here is: if you take care of your body, it’ll take care of you. Furthermore, don’t force it to do something it doesn’t want to do.

For all guys, circumcised or not, it’s important to wash the penis daily. There’s nothing special to this, just wash it like any other part of the body. It should be noted that some strong and/or scented soaps can irritate the sensitive tissues of the penis and cause: redness, itchiness, inflammation, dryness, etc.

Notes about/for uncircumcised guys:

The foreskin is not retractable in infants and young boys because it’s “fused” to the glans. The foreskin should NEVER be forced back if it doesn’t slide back easily. A lot of parents and pediatricians make this mistake, and it often leads to bad outcomes later on. According to one study, the foreskin is retractable in 50% of boys at 1 year, in 90% of boys at 3 years, and in 99% of boys at 17 years; several other studies generally support this. General rule of thumb: the boy should be the first person to discover that his foreskin can be retracted. Once the foreskin is retractable, it’s important to retract the foreskin and wash the area under it daily like any other part of the body. Again, use some caution with soaps; in fact, soap isn’t necessary.

Other general tips:

- Don’t use anything “weird” as a lubricant (lube) on the penis. Stick to saliva and hand lotion, or commercial lubes like KY Jelly or Astroglide. Water-based lubes are also safe for condoms. :-)
- NEVER insert anything into your penis.  The urethra is pretty delicate and easily damaged.  (This point was edited thanks to an email I received from a reader; I hadn't think people would be silly enough to actually attempt something like this . . .).

- If your penis ever gets dry, abstain from using soap on the area and apply lotion. That usually works.

- Fordyce’s spots: are bumps along the penile shaft. These can be confused with warts, but in fact they are completely harmless and normal. If you’re worried/unsure, consult your primary care doctor or a dermatologist.

- Pearly penile papules: are bumps on the corona (rim) of the glans. These can also be confused with warts or some other STD, but they’re also completely harmless and normal. If you’re worried/unsure, consult your primary care doctor or a dermatologist.

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Penis Problems

Like any part of the body, the penis isn’t immune to problems. In this section, I’ll mention the following: meatitis/meatal stenosis, skin bridges, balanitis, tight foreskin/frenulum, and Peyronie’s disease.

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Meatitis/Meatal stenosis

What are meatitis and meatal stenosis?

Meatitis is inflammation of the meatus (opening of the urethra; aka, peehole). Meatitis can lead to meatal stenosis. Meatal stenosis is the narrowing of the meatus, which reduces urine flow and may even occlude (block) the meatus. (Note: any word with “-itis” at the end means inflammation. “Stenosis” means “narrowing of.”)

Who gets it and how does it happen?

Both meatitis and meatal stenosis occur almost exclusively in circumcised infants/young boys. Some studies suggest that meatal stenosis may occur in as much as 10-11% of circumcised infants/boys (that is, about 1 in 10 circumcised infants may develop meatal stenosis). Because the glans and meatus are constantly exposed, the meatus gets irritated very easily – especially from urine and feces in diapers. This irritation can lead to inflammation (meatitis), and the inflammation can cause a lot of swelling (leading to meatal stenosis).

How is it diagnosed? What’re the symptoms?

Symptoms often include: weak urine flow, spraying of urine or abnormal urine stream, visible narrowing of the meatus, discomfort/pain when urinating, and sometimes UTIs (urinary tract infections).

Can it be dangerous?

Yes! If the meatus becomes too narrow, it can block urine flow completely. This can be life-threatening.

How is it treated?

To treat meatal stenosis, the meatus must be surgically re-opened. I won’t go into the details because it’s rather painful-sounding.

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Skin Bridges

What are skin bridges?

Skin bridges are exactly what they sound like: a bridge of skin, usually from the circumcision scar and/or inner foreskin to the glans. Some people may mistake the frenulum for a skin bridge.

Who gets it and how does it happen?

Skin bridges occur almost exclusively in circumcised infants/boys, though they can occur between the inner foreskin and the glans in an uncircumcised male if the foreskin was forcefully retracted prematurely. Remember from above, the inner foreskin and the glans are “fused” at birth. During circumcision, this fusion/adhesion must first be broken; however, during healing, the edges of the remnants of the foreskin and the glans may fuse back together, creating a skin bridge.

Can it be dangerous?

No. But, apart from being unsightly, skin bridges may uncomfortably/painfully pull on the glans and shaft skin during erection.

How is it treated?

A skin bridge doesn’t have to be treated if it doesn’t cause discomfort or pain. Treating a skin bridge is primarily cosmetic and usually involves cutting the skin bridge and maybe some further minor cosmetic surgery.

Can skin bridges be prevented?

While fairly common in circumcised males (though I don’t have exact figures), skin bridges often resolve themselves. Spontaneous erections in infants and boys usually break the adhesions, thus breaking the skin bridges before they become permanent. Some doctors recommend gently retracting the remaining foreskin/shaft skin from the glans once or a couple times a day to prevent adhesions from forming in the first place – though I suspect this is uncomfortable for the infant. Skin bridges don’t occur in males who’re circumcised later in life.

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Balanitis

What is balanitis? Who gets it and how does it happen?

Balanitis is a fairly common inflammation of the glans. In uncircumcised males it can also affect the foreskin. Balanitis tends to be more common in uncircumcised males but it can definitely affect any guy. There are many causes of balanitis: physical trauma/friction (such as too much masturbation and/or sex), bacterial, fungal (yeast), or viral.

How is it diagnosed? What’re the symptoms?

The symptoms of balanitis are usually pretty typical for inflammation: redness, soreness/tenderness, itchiness, and sometimes dryness. A rash may also be present. Often a swab of the affected area is sent to be analyzed, and if the balanitis persists despite treatment, a referral to a dermatologist may be necessary.

Can it be dangerous?

No. I suppose the caveat is that if it’s not taken care of, or if it frequently recurs, it could cause other problems such as UTIs or narrowing of the foreskin.

How is it treated?

To treat balanitis is fairly simple. If you suspect you have balanitis, immediately stop masturbating or having sex, as it might be cause from doing too much of those activities. Then stop using soap on the penis and especially under the foreskin (if you still have yours). Keep the area clean and dry as much as possible throughout the day. If symptoms persist for more than 2-3 days, see your doctor. He/she will probably prescribe an anti-fungal medication, or some other (usually topical; aka, a cream) medication.

Can balanitis be prevented?

Sometimes shit happens and despite everything things go wrong. This is true of balanitis. Maintaining good genital hygiene and safe sex practices greatly reduces the chances of ever getting balanitis. In some uncircumcised men who get frequent recurrent balanitis, circumcision may be an option – but that’s far from a guarantee as many circumcised guys also get balanitis. Diabetes is a huge risk factor for balanitis, so keeping diabetes under control is important.

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Tight Foreskin/Frenulum

What does a tight foreskin/frenulum mean?

A tight foreskin (also called “phimosis”) is one that is too tight to be comfortable retracted such that the entire glans may be exposed. A tight frenulum (also called “frenulum breve”) is where the frenulum is too tight/short and thus prevents the foreskin from being retracted very far. Both of these conditions vary in severity. Sometimes it’s quite mild, and the guy can retract his foreskin while flaccid but not erect (at least, not completely). Other times the phimosis may be so severe that the foreskin is never retractable and it may even obstruct urine flow (however, cases this severe are extremely rare).

How common is this?

Remember from above that the foreskin is retractable in only about 50% of 1-year-old infants, but is retractable in 99% of 17-year-olds. Thus at most only 1% of uncircumcised guys truly suffer from tight foreskins, and most of the time it’s fairly mild and easily treated.

Can it be dangerous?

Phimosis can only really be dangerous if it’s one of the extremely severe cases (e.g. obstructs urine flow, pain upon erection, etc). Frenulum breve is never dangerous, though the frenulum may be broken during sexual activity (in slang: snapping the banjo string), and this is quite painful and bloody. Sometimes a tight foreskin may be retracted behind the glans but can’t be returned back over the glans; this is a condition called paraphimosis and must be taken care of ASAP or it may lead to strangulation of the glans (it’s really not a big deal if it’s treated immediately). It is important to resolve phimosis early, as it not only facilitates better hygiene, but also allows the guy to experience more pleasure (as the most sensitive parts of the penis are under the foreskin – glans, inner foreskin, and frenulum).

How is it treated?

There are many ways to treat phimosis and frenulum breve, and interestingly it varies depending on where you live. For a long time in the US, circumcision was automatically recommended to treat both conditions. In most other places in the world, circumcision is reserved as a “last resort” for when all other treatments fail or for only the most severe cases.

The most common treatments involve means to loosen the foreskin and/or frenulum, either with a steroid cream applied to the foreskin several times daily for 4-6 weeks or with manual stretching exercises (see links for stretching exercises). If those methods fail, one may opt for a preputioplasty (surgical loosening of the foreskin) to treat phimosis, or frenuloplasty (surgical loosening of the frenulum) or frenectomy (surgical removal of the frenulum only) to treat frenulum breve. All of these methods are generally cheaper (and less painful with shorter recovery times) than circumcision.

1. http://www.thestudentroom.co.uk/wiki/Tight_Foreskin

2. http://www.network54.com/Forum/244184/ 

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Peyronie’s Disease

What is Peyronie’s disease? Who gets it and how does it happen?

Peyronie’s disease is the development of fibrous plaques/scar tissue inside the penis, causing painful curvature upon erection. (Note: most males have a slight curvature to their penises upon erection. This is normal.) It most commonly affects middle-aged men. No one really knows what causes Peyronie’s disease; many believe it’s due to injury/trauma during sexual activity (so don’t be too rough guys). Some studies also hint at a genetic factor, as in some men with Peyronie’s disease also have connective tissue problems in their hands and feet. One is generally advised to see an urologist to truly diagnose Peyronie’s disease, as many primary care physicians don’t understand it well enough to do so.

Is it dangerous?

I don’t think so, but it does make erections and sexual activity potentially quite painful.

How can it be treated?

From what (little) I’ve read, there aren’t any “surefire” treatments for Peyronie’s disease. Sometimes the condition resolves itself without medical treatment, and some doctors advise waiting a year or two to see if it spontaneously improves before resorting to surgery. There are also a number of experimental (non-surgical) treatments being looked into.

For more info, see:
http://wiki.medpedia.com/Peyronie%27s_Disease