Penis problems - Andrology Australia

The Healthy Male
Issue 23 – Winter 2007
Andrology Australia is supported by a grant
from The Australian Government Department
of Health and Ageing.
Contents
2
Community education
International Men's Health
Week 2007
2
Recent Events
Paving the way for
the future
3
Focus on
Penis Problems
5
Professional education
Online education available
5
Research roundup
An insight into Indigenous
health
6
In brief
6
Latest news
Newsletter of Andrology Australia – Australian Centre of Excellence in Male Reproductive Health
Does size really matter?
It’s the age old question, much discussed
by both men and women. But when
the question of penis size is asked in
relation to body image and male identity,
according to men, size does matter.
Previous research has suggested that penis
size is associated with men’s perceptions
of their masculinity, virility, potency, and
self-worth. To better understand the
relationship between penis size and body
image, a study was recently conducted at
La Trobe University’s Australian Research
Centre in Sex, Health and Society.
The first part of the study was a qualitative
interview with 20 men to gain an
understanding of the importance of penis
size. Around 500 men responded to the
second part of the study; a web survey that
explored the relationship between perception
of the penis, genital image and body image.
Christopher Fox, PhD student, said the results
showed that penis size is an important issue
for men and is a key part of men's body image.
“Results of the study showed that 86 per cent
of men believe the length of their erect penis
is important, with almost one in four men
believing it is “very important”,’ said Fox.
“Four out of five men said they are not
completely satisfied with their genitals,
and 43 per cent have considered having an
operation to lengthen their penis,” he said.
“When we talk about body image,
genitals need to be included as much as
pectoral muscles, or body size and shape
as social messages have a big influence
on how men perceive their bodies.”
Other research has also highlighted that
some men’s unwillingness to expose their
genitals can have an adverse affect on
their sexual and reproductive health.
“A quarter of men have been teased about
their penis size, so they’re embarrassed
to then seek help from their doctor for
health problems such as testicular cancer
and erectile dysfunction,” said Fox.
“Penis size has a significant level of
importance for men, so when dealing
with medical issues, this needs to be
taken into account.”
From the Director
For the six and a half years that this
newsletter has been produced, we’ve
covered many topics in relation to men’s
health. In this time we’ve rarely talked
about one of the key organs in the male
reproductive system and some of the
problems it can experience: the penis.
most of these conditions aren’t serious and
don’t need treatment. However, there are
some other conditions such as a foreskin
problem called paraphimosis, that require
immediate treatment otherwise permanent
damage to the penis can be sustained.
Aside from sexual dysfunction, other
penis problems are quite common in men.
These problems include lumps, bumps,
rashes, inflammation and erections that
last too long and can damage the penis.
This issue of the newsletter looks in
more detail at penis problems. If you
have concerns about the shape or size
of your penis, or you’re worried about
your foreskin, rashes, discomfort, lumps
or any other changes, see your doctor.
As some of these problems change the
look of the penis, they can cause great
distress and may even prevent some men
from being sexually active because of
embarrassment. The good news is that
Professor Rob McLachlan
Community education
Thousands of Australian men read the
shocking facts about men’s health during
International Men’s Health Week this year
(June 11–17).
Around 50,000 of Andrology Australia’s
innovative promotional ‘underpants’
containing shocking men’s health statistics
were distributed to individuals and
organisations nationwide. The underpants
were designed to raise awareness of the
high rates of health problems affecting
men below the belt.
Dr Carol Holden, chief executive of
Andrology Australia, said the number
of Australian organisations actively
supporting International Men’s Health
Week has more than tripled in two years.
“The demand for resources to help spread
the men’s health message has been
phenomenal,” said Dr Holden.
“We’ve distributed 5,000 posters and 50,000
of the promotional ‘underpants’ which also
encourage men to not suffer in silence.”
As well as providing resources, Andrology
Australia ran a competition for the month
of June to raise awareness of men’s
health. The winner will receive an all
expenses paid workplace barbecue with
Andrology Australia Ambassador Merv
Hughes wielding the tongs.
“Getting blokes around a barbie is a good
way to get them talking,” said Merv.
“I’m happy to be able to go out and talk to
men about the benefits of being healthy,
and the importance of talking to someone
if they suspect they have a problem in
their undies.”
Merv was guest speaker on behalf of
Andrology Australia at three major
Victorian men’s health events during
the week; Hepburn Springs, Frankston
and Heathcote. Thank you to everyone
who held an event or display during
International Men’s Health Week and
contributed to raising awareness of men’s
health in the community.
Congratulations!
International Men’s Health Week 2007
Congratulations to Karen
Challis at All Systems
Plumbing! Karen has won
the Andrology Australia
International Men’s Health
Week workplace barbecue
with Ambassador Merv
Hughes.
The winner of the
individual prize of a
signed copy of Merv’s
book ‘Caught in the deep’
and an autographed
cricket ball is Barbara
Higgins at the City of
Yarra. Congratulations
Barbara!
Recent events
Paving the way for the future
Andrology Australia recently convened
an advisory forum in Adelaide to
assist in planning future strategies for
the program. The forum encouraged
extensive and open consultation
with key representatives from
various stakeholder groups and other
Andrology Australia associates.
More than 100 participants attended
the meeting with broad representation
from professional, academic,
government, education and public
health backgrounds. This diverse
range of expertise ensured that
recommendations for the future program
direction incorporated a broad range of
activities aligned to identified needs.
A number of recommendations
were made during the course of
the meeting that focused on both
consumer- and disease-related
issues. These will help frame the
development of the Andrology Australia
Strategic Plan for the subsequent
operational cycle (2008-2012).
A highlight from the meeting was
the consistent feedback of the unique
leadership position that Andrology
Australia offers to men’s health
in Australia. Andrology Australia's
collaborative model has been effective
in developing strategic alliances and
quality outputs; and this model can
inform other health service providers.
Ambassador Merv Hughes and Director
Professor Rob McLachlan at the Forum dinner.
Three key themes also emerged:
the development of the program as
a portal for a broad range of men’s
health information; recognition of a
holistic health approach; and re-focus of
information provision from a disease/
organ focus to symptom/presentation.
Furthermore, the request by participants
to reconvene the forum on a regular
basis reinforced the success of the
meeting. Regular meetings would allow
further opportunity for wide discussion
on biomedical, education and social
aspects of male reproductive health, not
represented solely in any other forum.
Participants noted that the forum
provided an excellent opportunity to meet
others from a variety of backgrounds
and expertise to broaden their own
interest and collaborative alliances. Such
collaborations are imperative to continue
to develop the field and interest in male
reproductive health across Australia.
Focus on: Penis Problems
Author: Dr Ross Cartmill
Lumps, foreskin problems and inflammation of the penis are common
problems men can experience. Men who are not circumcised are more
likely to experience problems with their foreskin. Most inflammations
and lumps are not too serious and can easily be treated; however,
some penis problems can increase the risk of penis cancer. Priapism is
an erection that lasts more than three hours, and can cause damage
to the penis so must be treated promptly. If you have any changes in
the skin or foreskin of your penis, see your local doctor.
The foreskin
At birth, the foreskin and the glans penis are joined. As boys start
growing, an increase in hormones contributes to the foreskin and
glans separating and the foreskin is then able to be pulled back.
This happens in most boys at around three years of age.
The foreskin of an uncircumcised child should not be forcibly be
pulled back as this can cause bleeding and injury. By forcefully
retracting the foreskin, scarring can happen which can then cause
problems with the foreskin retracting, which is called phimosis.
Penis lumps
There are different types of lumps and bumps that can appear on the
penis, many of them are harmless. If you are concerned about any
lumps on your penis, see your doctor to rule out sexually transmitted
infections and penis cancer, albeit rare. Some common lumps include:
All uncircumcised adult men should have a genital examination
by their doctor and have their foreskin retracted to check for
signs of penis cancer.
Cysts
Sometimes the sebaceous glands on the penis and scrotum can
become enlarged and blocked, turning into cysts. These do not usually
need any treatment. Sometimes they can become painful and infected
if they continue to grow.
Ulcers
These appear as craters in the skin and often have a clear liquid or pus
in the crater (red wound or a sore).
•
•
A single ulcer is often quite serious and should be checked by
a doctor immediately. Causes of a single ulcer include syphilis,
tropical diseases and penile cancer.
Multiple ulcers are more common and are less serious, but should
still be checked by a doctor straight away. Herpes is the most
common cause of multiple penile ulcers.
Papules
These are small lumps that are raised on the skin and most do not
have a serious cause. One of the most common types of papules is
called pearly penile papules and these appear as one or more rows
of small, smooth lumps located in a circumference around the back of
the glans penis (head of the penis). These look very similar to, and are
often mistaken for genital warts. These papules are not infectious and
do not need to be treated.
Causes of other papules include psoriasis, and sexually transmitted
infections such as genital warts. Genital warts are caused by the
human papilloma virus (HPV). Warts can often happen in clusters
and can be very tiny. Genital warts are spread through skin-to-skin
contact, so it is important to use condoms if you or your parter are
infected. In women, HPV is associated with precancer changes in
the cervix. Genital warts are treated by freezing them with liquid
nitrogen. Although this gets rid of the warts, it does not get rid of
the virus and warts may reappear on the skin or occur in the eye of
the penis. This may need an inspection of the inside of the penis to
fully treat the warts.
Plaques
Plaques are raised lumps that are bigger than one centimetre in diameter.
They do not usually have a serious cause, but some are infectious and can
develop into more serious conditions such as penile cancer. Some causes
of plaques include balanitis (see below) and eczema.
Balanitis
What is balanitis?
Balanitis is a very common inflammation of the glans penis (helmet
of the penis) that can affect males at any age. This inflammation can
affect circumcised males; however, it is more common in men who
have not been circumcised.
What causes balanitis?
Balanitis often happens when the foreskin is not pulled back, or
is unable to be pulled back due to scarring, and the inside of the
foreskin is not kept clean. Inflammation caused by a bacteria or
fungus is common and can be caused if the sensitive skin under the
foreskin collects sweat, dead skin and bacteria. Balanitis can also
be caused by irritation from chemicals in soap, clothing, washing
powder and the latex in condoms. Allergies to certain drugs, viruses
such as human papilloma virus (which can cause genital warts) and
obesity can also contribute to balanitis.
In adults, balanitis can be a sign of diabetes. After urinating, some
urine may become trapped under the foreskin. The combination of
a moist area and glucose in the urine can lead to bacteria growing
and then infection. If you have balanitis and the condition keeps
happening, speak to your doctor and ask to be tested for diabetes.
What are some of the signs of balanitis?
Men with balanitis may experience the following complaints:
•
•
•
•
•
Inability to pull back the foreskin
Itchiness
Rash
Sore or tender glans penis
Redness or swelling
•
Discharge from the penis.
How is balanitis treated?
Treatment for balanitis depends on the cause of the inflammation.
Most often, washing the penis and under the foreskin with soap
and warm water is recommended. If the cause is from allergic
reactions to washing powders etc., try using different brands and
other chemicals. If there is an infection, the doctor may prescribe
antibiotics or antifungal medication. In severe cases of balanitis,
circumcision may be recommended.
Paraphimosis
To avoid future bouts of balanitis, do not use strong soaps and
chemicals, and pull back the foreskin and clean it daily.
Paraphimosis happens when the foreskin has been retracted behind
the head of the penis and cannot go back to its original position.
If the foreskin stays in this position, it can cause pain, swelling and
can stop blood flow to the penis. This is a serious medical problem
and must be treated immediately or the penis can sustain longterm or permanent damage.
What is Balanitis Xerotica Obliterans, BXO?
Balanitis Xerotica Obliterans (BXO) is not to be confused with
balanitis (inflammation of the glans penis). BXO is a rare condition
where scar tissue forms in the foreskin. A ring of white tissue
develops at the tip of the foreskin, tightening the foreskin at the tip,
and this may prevent the foreskin from retracting (phimosis). BXO
may spread to the glans penis, but this is not common.
It is important to speak to your doctor if you are concerned
about white scarring of your foreskin, to distinguish BXO from
early penis cancer. BXO is a progressive disease and it is usually
treated by circumcision.
Phimosis
What is phimosis?
Phimosis is when the foreskin is too tight, or the tip of the foreskin
narrows and is unable to be pulled back to expose the head of the
penis.
What is paraphimosis?
What causes paraphimosis?
Paraphimosis can happen at any age, and can be caused by injury
to the head of the penis. It can also happen to infants if parents
pull back their foreskin and do not pull it forward again afterwards.
How is paraphimosis treated?
The glans penis and the foreskin often swell up with paraphimosis.
It is important to apply ice to reduce the swelling and then try and
move the foreskin forward to the usual position. Other methods
used to reduce swelling include injecting medicine that lessens
swelling, or inserting a needle and releasing some blood. If the
foreskin does not return to its normal position, a surgeon may have
to cut the foreskin to release it, or circumcision may be necessary.
Priapism
What causes phimosis?
What is priapism?
Phimosis is often seen in children or young adults (primary or
congenital phimosis). The condition is at its highest incidence rate
before puberty.
Priapism is an erection that lasts for more than three hours and is
usually very painful. Blood becomes trapped in the penis and does
not return to circulation; it is not necessarily because of, or related
to, sexual stimulation. If priapism is not treated, it can lead to
permanent damage to the erectile tissue and the inability to get
an erection at all. Priapism can happen to males at any age.
Phimosis can also happen because of injury or damage that causes
the foreskin to tear (secondary or acquired phimosis). As the tear
heals, scar tissue forms which reduces the elasticity of the foreskin.
This scar tissue can then stop the foreskin from stretching open far
enough to pull back. The scarring from BXO can also cause phimosis.
Phimosis can often follow infection or inflammation such as balanitis.
Adult men with phimosis should be checked for balanitis, diabetes
and cancer.
Are there any other symptoms with phimosis?
Severe phimosis can cause pain when urinating, urinary retention,
urinary tract infections and the skin on the penis can become
infected. In older men with severe phimosis, the foreskin can
look swollen.
How is phimosis treated?
Phimosis can be treated with steroid creams applied once or
twice daily for a couple of weeks. Studies have shown that the
creams have a success rate of more than 85 per cent, and this
can increase if the foreskin is gently stretched together with
the cream application.
If the steroid creams do not work and phimosis is severe,
circumcision is another option to consider.
What causes it?
The most common cause of priapism is drug treatments for erectile
dysfunction, in particular, penile injection treatments. About a
quarter of other cases of priapism are associated with medical
conditions such as advanced cancer, leukaemia and sickle cell
anaemia. Other possible causes include damage to the nervous
system, injury to the penis, the use of some medicines and illegal
drugs. Sometimes the cause of priapism is unknown.
How is it treated?
It is important to see a doctor straight away because the sooner
the prolonged erection is treated, the less damage will be done
to the erectile tissue. If treatment is sought within four to six hours,
the doctor may provide a decongestant medication to help the
erection go down. Another option is for the doctor to use a needle
and syringe to release the extra blood trapped in the penis. If this
does not work, surgery may be needed to try and avoid permanent
damage to the penis.
If priapism was caused by erectile dysfunction drugs, alternative
treatments should be used instead. Also, if priapism has been caused
by other medications, trying a different medication may help.
Professional education
Online education available
Andrology Australia is committed to
providing a variety of online education
opportunities for GPs and other health
professionals on male reproductive health.
Providing education online is necessary to
ensure that doctors in regional and remote
areas have access to quality information
without needing to participate in face-toface workshops.
A series of clinical guidelines on the
diagnosis, management and treatment of
a number of men’s health problems are
currently available on the website (www.
andrologyaustralia.org). The guidelines
are predominately based on the European
Association of Urology guidelines and input
from local specialists. To ensure relevance
to general practice, the guidelines have
also been reviewed by GPs with assistance
from the Department of General Practice,
Monash University.
The guidelines have been put together to
complement the online Active Learning
Module (ALM), which is made up of a series
of four interactive case studies on the
reproductive health of younger males. The
third case study of the ALM is now available
on the Andrology Australia website.
Craig, a 32 year old, has presented with
small testes, male infertility and reduced
sperm production. The objectives of the
module include:
• recognising that male infertility is a
common factor for infertile couples
• recognising the need to evaluate both
partners early on in investigation
management and counselling matters
• the effect of new technologies such
as ICSI allowing sterile men to father
children
• knowing when to refer on.
Also, the online Active Learning Module
on prostate cancer testing is now available
from the Andrology Australia website.
This, the first of three peer reviewed case
studies, allows you to explore the risk
factors associated with prostate cancer and
become familiar with the latest policies
regarding testing for prostate cancer.
The ALM was developed by The Cancer
Council Queensland, The Australian Prostate
Cancer Collaboration, Andrology Australia
and ThinkGP.
• an overview of treatment options
extending from natural fertility to
specialist treatment options
Research round-up
An insight into Indigenous health
Aboriginal and Torres Strait Islanders
experience high rates of diabetes, heart
disease and hypertension and their life
expectancy is much less compared with the
non-Indigenous population.
Chronic diseases, especially diabetes
and heart disease, can affect sexual and
reproductive function. Given that Indigenous
males are at high risk of chronic disease, it
is highly likely that many Indigenous men
will also have sexual problems.
To improve understanding of sexual and
reproductive health problems amongst
Indigenous males, Mick Adams, former
Queensland Aboriginal and Islander Health
Forum (QAIHF) CEO, has conducted a survey
on Aboriginal Male Health. The survey was
part of Mick’s doctorate, and is the first
research study of this kind to be done by
an Aboriginal or Torres Strait Islander male
in Australia.
Mick presented some of the findings from
the survey at the Andrology Australia
Advisory Forum in May. The survey found that
Indigenous men go to the doctor as often
as non-Indigenous men. However, recurring
themes of shame, embarrassment and a
reluctance to discuss health issues emerged
from the qualitative aspect of the survey.
Indigenous men are more likely than other
Australian men to have urinary symptoms
that may indicate prostate disease;
however, they are screened for prostate
disease at only one third of the rate of nonIndigenous men. Erectile dysfunction was
found to be linked with personal and social
factors in Indigenous men, for example,
age, low education and marital status.
For some men, sexual dysfunction appeared
to be a factor in inter-partner violence, and
for most men it played a role in intimate
relationship difficulties. Almost no men
had sought clinical treatment for their
problems, although some discussed various
methods to stimulate erectile function using
traditional methods or drugs such as Viagra.
Sexual abuse was also more prevalent in the
Indigenous population when compared with
the general Australian male population.
About one third of men reported some type
of unwanted childhood sexual experience,
and less than one in five of these men told
someone about the abuse before taking
part in the survey.
These important findings will be used to
develop culturally sensitive health education
programs for Aboriginal and Torres Strait
Islander males and medical professionals.
Mick’s postgraduate scholarship is supported
by Andrology Australia. Professor Michael
Dunne (QUT) is principle supervisor of the
study; Dr Noel Hayman (University of Qld)
and Professor David de Kretser (Governor of
Victoria) are acting as co-supervisors.
Mick Adams after presenting results from
his survey into Indigenous health.
In brief
Walktober
Andrology Australia will be
supporting Kinect Australia’s
campaign ‘Walktober’ during
October 2007.
Walktober is an umbrella campaign
to increase individual and broader
community awareness of the
importance and benefits of walking.
The campaign also promotes and
links a diverse range of programs
and activities held during October
throughout Victoria. Andrology
Australia will contribute to the
campaign by promoting physical
activity in men and the benefits this
has on male reproductive health.
Visit www.walktober.com.au for
further information about Walktober.
Medicine Today –
Androgens and drug
update
Dr Carolyn Allan and Prof. Rob
McLachlan recently published
information on androgen deficiency
in men, and also the drugs used
to treat it (Medicine Today 2007;
47–54 and 60–70). The reviews were
written to assist GPs in the diagnosis
and management of men with
androgen deficiency. Presentation of
androgen deficiency may be subtle,
so it is important that the diagnosis
is actively considered. Health
professionals who would like a free
copy of this information, please
email [email protected]
Continence Awareness
Week 2007 (Aug 6-12)
This year, Continence Awareness
Week will focus on men’s health,
with an emphasis on diet and
lifestyle issues that affect bladder
and bowel control.
Incontinence in men is largely
related to prostate problems and
medical conditions such as diabetes,
obesity, constipation and chronic
cough. The Continence Foundation
of Australia is encouraging men
to be proactive during Continence
Awareness Week and to take the
first step towards regaining control
by speaking to their doctor or
contacting the National Continence
Helpline on 1800 33 00 66.
For further information visit
www.continence.org.au
Latest news
Circumcision: the debate
continues
The practice of circumcision is
controversial. Some see the operation
as barbaric and unnecessary; others
see it as a medical benefit that reduces
the risk of foreskin problems and
helps stop the spread of infections.
Circumcision has been performed
for thousands of years because
of religious, cultural and medical
reasons. Worldwide, around twenty
per cent of men are circumcised,
and due to an increased demand for
the procedure in South Africa, thirtyfive per cent of men in developing
countries are now circumcised1.
The circumcision debate has recently
resurfaced because of research in Africa
that showed a significant protective
effect of circumcision against HIV.
Although circumcision could be a useful
procedure to reduce the spread of HIV in
Africa, these results do not necessarily
translate to a western population.
Additionally, circumcision does not
provide full protection against HIV and
should not be considered a substitute
for condoms for reducing HIV risk.
Newsletter of Andrology Australia
Australian Centre of Excellence in Male Reproductive Health
Editor: Cassy Bezeruk
Andrology Australia
C/O - Monash Institute of
Medical Research
Postal Address:
Monash Medical Centre
246 Clayton Road,
Clayton Victoria 3168
Street Address:
27-31 Wright Street,
Clayton Victoria 3168
Telephone:
1300 303 878
Facsimile:
+ 61 3 9594 7111
Internet:
www.andrologyaustralia.org
Email:
[email protected]
Andrology Australia is administered by
Monash Institute of Medical Research
In Australia, less than ten percent
of boys are circumcised. There are
advantages and disadvantages
linked to the procedure.
Some of the reasons parents choose
to not circumcise their sons include
the risks of surgery, and concern that
sexual pleasure may be lessened.
However, men who are not circumcised
are more susceptible to infections
and transmitting sexually transmitted
infections including chlamydia and
syphilis. There is also a higher risk of
penile cancer; a very rare condition.
Men who are circumcised do not
experience medical problems involving
the foreskin (for example, phimosis
and balanitis). There is also a reduced
risk of getting urinary infections, and
the possible benefit that it reduces
the risk of HIV transmission.
There is no right or wrong decision
about circumcision. The benefits
and risks of circumcision need to be
understood so that parents of newborn
boys can make an informed decision
about what is best for their son.
1 Demand for male circumcision rises in a bid to
prevent HIV, Bulletin of the World Health Organization
2006, 84; 505-588.
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DISCLAIMER
This newsletter is provided as
an information service.
Information contained in this newsletter
is based on current medical evidence
but should not take the place of
proper medical advice from a qualified
health professional. The services
of a qualified medical practitioner
should be sought before applying the
information to particular circumstances.