As a primary care physician, if you ask me what medical issues induce the most intense amounts of anxiety, besides the expected—a cancer diagnosis, panic attacks, and chest pain—I’d definitely include the presence of genital lesions on that high-anxiety list.
I recently had a young sexually active man see me in clinic for newly erupted spots on his genitals. Before walking into the exam room, my nurse warned me about how nervous he appeared. If he was trembling before I walked in, he seemingly began to near-convulse when he first saw me.
“I thought you were a male doctor!” he exclaimed.
I get this a lot. My name can be rather ambiguous for many, and I completely realize that I do not fit the typical “doctor” stereotype: older, male, gray hair, and glasses. If anything, I’m the exact opposite.
After great reassurance and special finesse in my attempts to calm him, the color on his face gradually returned to normal, and he finally allowed me to examine him. With a simple visual exam, I was able to quickly diagnose and even treat and destroy these seemingly elusive lesions in clinic.
He apologized at the end of the visit for his nervousness, and once he was reassured and relaxed, even continued to ask me numerous other questions in regards to sexual health thereafter. In fact, I now see this young gentleman in my office quite frequently for various medical issues.
This is unfortunately a more-than-common scenario that I encounter as a physician, and have learned that sometimes these anxiety-provoking, sexual health-related symptoms are just enough to put some people over the edge of insanity. It can be overwhelming to simply not know or understand whether or not it’s a sexually transmitted infection, especially when you cannot be certain of its potential consequences.
How did I get it? Is my partner cheating on me? Is it treatable? Can I spread it? Is my life over?
So this has reminded me of the importance of some potential educational opportunities that involve male genital conditions. Let’s discuss the top five:
Top 5 Male Genital Lesions
1. Genital warts:
Genital warts are by far one of the top causes of both genital lesions and sexually transmitted infections (STI’s). They are caused by the Human Papilloma Virus (HPV)—yes, the same virus that is also responsible for cancer of the cervix in females (yet often in different strains).
They are flesh-colored, purplish, bluish, or brown, small, round, and typically raised (but can also be flat) bumps that are painless. The top surface may be smooth or appear cauliflower-like. If you’ve ever had or seen a wart elsewhere on the body, most often hands (especially in children), they may appear similarly. They are often close in proximity to each other and may appear even in groups.
They can spread on your own skin or to your sexual contacts quickly, yet are easily treatable with office liquid nitrogen application that “freezes” these spots and they subsequently fall off. Or an alternative, if the lesions are more than just a few, is a prescription topical liquid that you can apply on your own several times a week in order to destroy them until they fall off. Therefore, it’s vital to stop them in their tracks to help prevent their spread.
2. Genital herpes:
Genital herpes is definitely one of the most commonly found sexually transmitted infections on the male genitals, and is caused by the Herpes Simplex Virus (HSV). These are quite distinct when compared to genital warts. They are small fluid-filled blisters or “ulcers,” in which the top layer of the skin appears as though it’s been lifted off. And they are painful to the touch. They can appear in clusters with surrounding redness.
Swab cultures and blood tests for herpes are inaccurate and greatly confusing to patients (and doctors) because they are not often very diagnostic. Therefore, the best way to diagnose genital herpes is by a simple visual exam of the lesions.
There’s no cure for genital herpes, unfortunately. Once contracted, the virus lies dormant in your body and emerges to cause these painful sores during times of stress and/or when your immune system is down, and self-resolves as it withdraws in hiding once again. Prescription anti-viral drugs can help shorten the duration of the symptoms when symptoms emerge, however, are not a cure.
3. Molluscum Contagiosum:
Molluscum Contagiosum, like herpes and HPV, is also caused by a virus, but from a different family called the “poxviruses.” Anyone can get them almost anywhere on the body simply by coming into contact with the virus, either by touching someone with an active lesion or by touching an object carrying the viruses. Kids compose one of the greatest population of those infected with molluscum.
However, molluscum is also commonly sexually transmitted when occurring on the genitals or the vicinity. They are flesh-colored raised bumps with a smooth surface, and sometimes with a “dimple” on the top center. They, too, may occur in clusters. They are often mistaken for herpes or genital warts. However, unlike herpes, they are painless; and unlike warts, they often have a shiny, waxy appearing surface and can sometimes contain fluid within.
Your doctor can either freeze these with liquid nitrogen, or prescribe a topical solution that you can apply on your own to destroy them.
4. Ingrown hair/Folliculitis:
Not every genital lesion is caused by an STI. Ingrown hairs and folliculitis, inflammation of the hair follicles, are very common and not sexually transmitted. If you shave, wax, or participate in any hair removal in this region, you can expect either process to occur at some point. Folliculitis lesions are reddish small bumps at the base of hair shafts. Ingrown hairs are noticeable hairs that have turned inward underneath the skin layers, causing inflammation and a surrounding red bump.
Prevention is key in both processes. Therefore, attempt hair removal only after the surface of the skin has been thoroughly cleansed. Change your shavers often. And strive to shave only in the direction of the hair growth.
Mild folliculitis and ingrown hairs do tend to resolve on their own. However, if there is presence of pus, pain, or worsening redness or swelling, it may require antibiotics. Seeing your doctor sooner, rather than later, is recommended.
5. Balanitis:
I saved the most common genital condition for last: balanitis. Balanitis is the inflammation of the head of the penis, referred to as the “glans.” This inflammation often occurs due to yeast overgrowth. Just like women who get yeast infections in the vaginal area, and just like babies who get diaper rashes in the genitals, men can also get yeast overgrowth due to excessive moisture. Men who are not circumcised have a much higher risk since the foreskin covers the glans and aids in moisture buildup in the region. It is not a sexually transmitted infection.
It often appears diffusely red, and can be accompanied by a white cottage-cheese like discharge and even a yeasty-foul odor. It is often very itchy.
Just like other yeast overgrowth conditions, treatment often consists of an antifungal cream, such as over-the-counter clotrimazole 1% applied several times a day for several weeks. Keeping the area clean and dry is also helpful, and allowing it to air dry as much as possible will aid in recovery.
If you find yourself experiencing this recurrently, however, getting tested for diabetes is recommended, as diabetics have higher risk of yeast infections and tend to get them when their blood sugars are uncontrolled.
The key take-home points:
1. Most genital lesions are treatable, and often curable.
2. A visit to your doctor sooner, rather than later, is most helpful.
3. Most genital lesions are diagnosed based on a visual exam.
4. It is not the end of the world.
And most importantly…
5. Please use a condom every single time!
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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.