Inspect the Penis and Scrotum

In the examination of the penis and scrotum, note the following:

Whether the patient is circumcised

The size of the penis and scrotum

Any lesions on the penis and penile edema

Figure 18-11 shows ectopic sebaceous glands on the shaft of the penis. The glands appear as pinhead-sized, whitish-yellow papules. These are commonly seen in normal men on the corona, the inner foreskin, and the shaft of the penis. Their appearance is very similar to Fordyce's spots of the oral mucosa (see Fig. 12-18). Ectopic sebaceous glands also may be found in normal women on the labia minora and labia majora (see Fig. 19-13).

Pearly penile papules are very common around the coronal sulcus and have no racial predilection. They are thought to be embryonic remnants of a copulative prehensile organ. These fine papules are small, asymptomatic lesions that develop after puberty in 10% to 15% of men. They are skin colored, filiform in shape, and arranged in rows at the junction of the glans penis and sulcus coronarius;they are more common in uncircumcised men. They should not be confused with condylomata acuminata. Figure 18-12 shows pearly penile papules.

Figure 18-13 shows the penis of a patient with the chancre of primary syphilis. Although the typical syphilitic chancre is described as nontender, approximately 30% of patients with primary syphilis describe some pain or tenderness. Usually only a single lesion is present. The edge of the chancre is usually indurated. Moderate nontender inguinal adenopathy was present in this patient.

Figure 18-14 shows chancroid in two patients. In contrast to the chancre of syphilis, the ulceration of chancroid is extremely painful. The ulceration has a purulent, grayish surface that becomes granulating. Characteristically, the base of the ulcer and its vicinity are not infiltrated.

Syphilis Primary PenisPenis Syphilis
Figure 18-13 Chancre of primary syphilis.

There is usually moderate tender adenopathy associated with the genital lesions. Another important difference between the ulceration of chancroid and the chancre of syphilis is the frequent presence of multiple lesions in the former, as shown in Figure 18-14A. The patient in Figure 18-14B had a similar lesion on the other side of his penis.

Venereal warts, or condylomata acuminata, may be found near the meatus, on the glans, in the perineum, at the anus, and on the shaft of the penis. Condylomata acuminata are the characteristic lesions of human papillomavirus (HPV) infection. Typically, these papules have a verrucous surface resembling cauliflower. They are highly contagious, with transmission occurring in 30% to 60% of patients after a single exposure. Figure 18-15 shows a patient with condylomata acuminata on the shaft of his penis (see also Fig. 18-40).

Are there any papules on the penis or scrotum? Figure 18-16 shows the classic genital papular lesions in a patient with scabies.

Human Penis Yeast Infections
Figure 18-14 Chancroid. A, Note the multiple lesions. B, The patient had another lesion on the other side of his penis.
Condylomata Acuminata
Figure 18-15 Condylomata acuminata of the shaft of the penis.

Balanitis is inflammation of the glans penis. It is most often caused by Candida infection and is found mostly in uncircumcised men. The warmth and moisture in this area facilitate the growth of the yeast organisms. The infection begins as flat erythema on the inner side of the foreskin and glans. Pustules develop that break open and leave a moist, bright red, eroded surface. If the infection involves the glans and foreskin, the term balanoposthitis is used. Figure 18-17 shows Candida balanitis. Notice the erosions on the distal shaft and glans penis. The foreskin has been retracted.

The scrotum is inspected for any sores or rashes. Pinpoint, dark red, slightly raised, telan-giectatic lesions on the scrotum are common in individuals older than 50 years. They are angiokeratomas and are benign. Fabry's disease, which is a rare, sex-linked inborn error of glycosphingolipid metabolism, is characterized by pain, fever, and diffuse angioker-atomas in a ''bathing suit'' distribution, especially around the umbilicus and scrotum. The scrotum of an 18-year-old patient with Fabry's disease and multiple angiokeratomas is shown in Figure 18-18.

Candida Penis
Figure 18-17 Candida balanitis.

Figure 18-18 Angiokeratomas in a patient with Fabry's disease.

Figure 18-19 Kaposi's sarcoma and acquired immunodeficiency syndrome (AIDS)-related scrotal edema.

Figure 18-19 Kaposi's sarcoma and acquired immunodeficiency syndrome (AIDS)-related scrotal edema.

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Responses

  • denise knight
    What happen when syphilis occur in penis?
    2 years ago

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