Inflammation and benign lesions of the penis
How the warm, moist space under the foreskin favours inflammation, how repeated inflammation and lichen sclerosus scar it into phimosis, how low-risk HPV makes warts, and how a fibrous plaque bends the penis in Peyronie disease.
By the end, you can
- Describe the structure of the penis and foreskin and why the preputial space is prone to inflammation.
- Explain the causes and mechanisms of balanitis and balanoposthitis, including the link with diabetes.
- Explain how scarring from inflammation or lichen sclerosus causes phimosis, and how paraphimosis threatens the glans.
- Describe condyloma acuminatum and distinguish low-risk from high-risk HPV infection.
- Explain how a fibrous plaque in the tunica albuginea causes the curvature of Peyronie disease.
- Recognise the classic appearances, classifications and tests of penile inflammation and benign lesions, and explain how antifungals, steroids, circumcision, wart treatments, HPV vaccination and Peyronie treatments act on their mechanism.
What it is
Inflammation of the glans is balanitis, of the foreskin posthitis, and of both balanoposthitis. Repeated inflammation and the chronic skin disease lichen sclerosus can scar the foreskin so it cannot be retracted (phimosis). The commonest benign growths are genital warts (condyloma acuminatum) from low-risk human papillomavirus (HPV); Peyronie disease is a fibrous plaque in the tunica albuginea that bends the erect penis.
4 types to tell apart
- Infective balanoposthitis
- Candida (especially with diabetes), bacteria such as streptococci and anaerobes, and sexually transmitted infections.
- Non-infective balanitis
- Irritants, poor or excessive washing, and skin diseases such as lichen sclerosus, psoriasis and Zoon (plasma cell) balanitis.
- Phimosis and paraphimosis
- Phimosis: a foreskin too tight to retract (normal in young boys; scarred when acquired). Paraphimosis: a tight foreskin trapped behind the glans.
- Benign lesions
- Condyloma acuminatum (HPV 6 and 11), pearly penile papules (a normal variant) and Peyronie disease (a localised fibromatosis).
Normal function
Erectile bodies, glans and foreskin
The shaft holds three erectile bodies: the two side by side above, each wrapped in a thick, tough tunica albuginea, and the below, which carries the and expands at the tip into the . The rim of the glans is the .
The skin of the shaft is thin and loose. Unless circumcised, it folds over the glans as the foreskin (prepuce), whose inner surface is a moist, thinly keratinised squamous epithelium like the surface of the glans. Shed epithelial cells and secretions collect between them as smegma.
In boys the foreskin is normally attached to the glans and gradually separates during childhood. Once separated, it should retract over the glans and return easily. The space beneath it is warm and moist, which favours microbes when hygiene is poor or urine and sugar are trapped there.
Underlying change · Step 1 of 4
Balanitis and balanoposthitis
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 2 of 4
Scarring: lichen sclerosus and phimosis
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 3 of 4
Genital warts: low-risk HPV
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 4 of 4
Peyronie disease: a plaque that bends the penis
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .