“Physical fitness is not only one of the most important keys to a healthy body, it is the basis of dynamic and creative intellectual activity.”
— John F. Kennedy
Penis conditions may present with any of the following:
Children are born with foreskin that is stuck to the glans penis and cannot be retracted. This is entirely normal and parents should not try to forcibly retract it. Foreskin gradually separates by the time they are around 5 -10 years of age. Tight foreskin that cannot be retracted easily is called phimosis. If it is very tight, it can prevent flow of urine, balloon and cause infection and pain. In adults it can split during intercourse and lead to further scarring. It can also give rise to recurrent infections due to accumulation of smegma and urine around the glans, under the foreskin. It is important to maintain penile hygiene by retracting the foreskin daily and wash with soap & water. If conservative measures fail, it can be cured by circumcision.
Short Frenulum of the penis:
The narrow band that runs from back of the foreskin to the opening of urethra can be short and give rise to pain on erection and splitting. This can be treated by Frenuloplasty.
It is a condition of unknown cause which starts pain in the penis on erection and development of a lump, usually on the upper aspect of the penis. It can be very distressing to the patient but is totally harmless condition which may take up to a year to stabilise. It may leave curvature of the penis and cause erectile dysfunction and difficulty penetrating. Various treatment options are available including injection therapy, shockwave therapy, surgical correction of the curvature.
What is erectile dysfuntion
The consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual performance.
How common is it?
You are not alone! It is estimated that there are 2.5 Million men in UK, 18 Million men in USA (between ages 40-70) who suffer from the problem. Nearly 2% Population @ 40 years, 25% Population @ 65 years, 35 -50% of Diabetics are in the same boat.
What causes it?
There is no single cause. Usually a mixture of factors contributes to the problem. These may include:
- Cardiovascular disease
- Hyperlipidemia (high Cholesterol)
- Diabetes mellitus
- Drug side effects: e.g. medication for high blood pressure etc.
- Smoking and alcohol use
- Trauma – damage to spine or pelvic nerves by injury or operations
- Pelvic surgery
- Neurological disorders – Multiple sclerosis
- Hormonal disorders
- Psychological factors- stress, relationship problems
Can anything be done about it?
Of course, there are several remedies to overcome the problem. You will need a detailed clinical examination and sometimes special tests to rule out diabetes, low testosterone etc.
What options do I have?
- Alteration of modifiable risk factors: e.g. cutting down smoking, excessive alcohol etc.
- Oral Medication: Availability of oral drugs has revolutionized the treatment of ED. Latest drugs are CIALIS (Tadalafil) – can be taken from 30 minutes to 12 hours prior to sexual activity. Efficacy of Tadalafil may persist up to 24 hours, LEVITRA (Vardenafil) – which is 10 times more potent than Sildenafil. Others include Viagra (Sildenafil) etc. However, they are not for everyone and may have side effects like head ache, nausea etc. CIALIS can also be used in a small dose on a daily basis, so you do not have to do any planning and is more spontaneous.
- Local Therapies: Topical Alprostadil cream (Vitaros), MUSE (tiny pellet administered via urethra), Penile injection therapy – Using ALPROSTADIL (Caverject)
- Physical method: Vacuum tumescence device, Shock wave Therapy
- Surgery: last resort. Only suitable for a small proportion of carefully selected patients. The methods include venous ligation, or penile implant.
- Sexual and relationship therapy. Your local ‘RELATE’ may be the starting point.
Erectile dysfunction medication – Viagra, Levitra & Cialis
What is the next step?
Do speak to your GP or practice nurse, who may be able to assess and initiate therapy if suitable. You may be referred to Erectile Dysfunction clinic for further assessment and management. We all appreciate that it does take a lot of courage to speak to people about sensitive issues like these.
Further penile related information
Please see below links to information leaflets from British association of urological surgeons, on penile conditions and their treatments
Erectile dysfunction (impotence)
Penile straightening procedures
Penile cancer surgery
Surgery on your foreskin
External urinary opening (meatus)
Non-procedural penis information
- Erectile dysfunction (treatment options)
- International index of erectile function (IIEF)
- Peyronie’s disease
- Phosphodiesterase (PDE-5) inhibitors (sildenafil, avanafil & tadalafil) for erectile dysfunction
- Premature ejaculation questionnaire
- Sexual Health Inventory for Men (SHIM)
- Vacuum erection assistance devices (VEDs)