Male Genital Problems
Tight Foreskin (Phimosis)
The foreskin is the hood of skin that covers the head of the penis (glans). Phimosis is a condition when foreskin becomes too tight and cannot be fully retracted. If the foreskin is retracted but cannot be brought forward again then urgent medical treatment should be sought.
Phimosis is normal in baby boys because the foreskin is still attached to the glans. From the age of two years the foreskin should start to separate gradually from the glans; however, it may take several years for this process to complete.
It is perfectly normal for young boys to have phimosis until the age of 15 years. Blowing up of the foreskin during urination (ballooning of the foreskin) can occur with phimosis and also in boys with a normal foreskin.
In children, phimosis usually does not require treatment unless the foreskin becomes regularly infected or it becomes too tight that will interfere with passage of the urine.
In adults, phimosis may cause no symptoms most of the time and only becomes troublesome during erection or attempting sexual intercourse.
However, phimosis can cause hygiene problems as it becomes difficult to clean the glans efficiently. Other problems related to phimosis include infection of the foreskin (balanitis) and rarely, in severe cases, it may cause acute retention of urine.
Treatments of phimosis include:
Steroid cream may help to soften the foreskin in selected cases, but the effect is usually short-lived.
Stretching of the foreskin is best avoided as it can make the phimosis worse by encouraging tearing and scar formation of the foreskin.
Antibiotics can help to treat infection.
Condom use may help to reduce discomfort during intercourse.
Circumcision is the mainstay treatment for most cases in adults and selected cases in children.
The frenulum of the penis is the elastic band of tissue under the head of the penis (glans) that connects to the foreskin. If the frenulum is tight, it can cause difficulty in retracting the foreskin.
A tight frenulum can also tear during sexual intercourse resulting in formation of a scar tissue.
Tight frenulum can be successfully treated with a minor surgery called frenulopasty.
The testicles (testes) are situated inside the scrotum. The functions of the testes include making the male hormone (testosterone) and producing sperms. The sperms pass along ducts in the testes to a tube called epididymis, then pass via another tube called vas deferens into the penis. If one or both testes cannot be felt inside the scrotum, then medical advice should be sought.
Testicular lumps and swellings are common in boys and men, and the majority are caused by benign (non-cancerous) conditions. It is important that men carry out regular (perhaps weekly) self-examination of the testes to feel for testicular lumps. If you feel a lump then you should see your GP as soon as possible.
A sudden onset pain and swelling in one of the testes could be a sign of a condition called testicular torsion. This is an emergency condition where the testis is twisted interfering with its blood supply.
If you suspect that you may have a testicular torsion, then you should urgently go to the nearest Emergency Department. The condition requires urgent surgery to restore the blood flow to the testis; otherwise the testis will die within few hours.
Causes of testicular lumps
There are many causes of lumps including:
Hydrocele: swelling caused by a build-up of fluid around the testis.
Epididymal cysts: lumps caused by a collection of fluid in the epididymis.
Varicoceles: swelling caused by varicose veins above the testis.
Epididymo-orchitis: inflammation of the epididymis and the testis commonly caused by infection.
Inguinal hernia: a hernia arising from the groin can extend down into the scrotum. However, this is not a urological condition and requires your GP to refer to a general surgeon.
Testicular cancer: this is a rare cause of a testicular lump with approximately less than 4 in 100 testicular lumps are cancerous. Testicular cancer is the most common cancer in men between the age of 20 and 50 years; although, some forms of testicular cancers can occur in older men.
Assessment of testicular lumps
This includes a full medical history, physical examination and possibly additional tests, depending on your circumstances, such as blood tests, a testicular ultrasound scan and a CT scan.
Treatment of testicular lumps
This depends on the underlying cause. Infection requires treatment with appropriate antibiotics. Most of the other benign conditions do not need treatment unless they cause significant symptoms such as pain and cosmetic embarrassment.
Treatment options for benign conditions may include:
Treatment of testicular cancer involves removal of the testis (radical orchidectomy) as soon as possible. An artificial (silicone) testis can be placed in the scrotum at the same time or at a later date.
Removing one of the testes should not affect sexual performance, libido and ability to father children. However, some men have low sperm count before treatment and in this situation removing one testis can reduce the ability to father children. Therefore, men who have not completed their family, will be offered to have their sperm stored (sperm banking) before surgery.
After surgery you will be referred to the oncologist for follow up and to decide if there is any need for further treatment including radiotherapy or chemotherapy.