This group includes several medical conditions and cosmetic abnormalities that may cause significant shame in private life or relationships and may lead to psychological, sexual, aesthetic and functional difficulties. The conditions are listed here only in outline. The aim of reconstructive surgery is to correct the cosmetic concern and, as far as possible, restore associated functional problems. Every operation requires an individually designed plan.
Conditions may include:
- cosmetic problems caused by excessive penile skin;
- webbed penis or penoscrotal webbing, where scrotal skin extends along the underside of the penis;
- buried penis, where the penis is concealed beneath the skin or fatty tissue of the pubic region;
- trapped penis, where scarring causes the penis to become confined beneath pubic or scrotal skin, often after circumcision;
- penile torsion, usually less than 90 degrees but occasionally greater than 180 degrees;
- phimosis;
- penile agenesis, or absence of the penis;
- micropenis;
- cosmetic problems following penile surgery or girth-enhancement procedures;
- ulcerative lesions and other cosmetic conditions of the penis, including cysts, haemangioma, lymphocele or conditions following Fournier’s gangrene;
- positional abnormalities of the penis and scrotum, such as penoscrotal transposition;
- underdeveloped, abnormally positioned or additional scrotal tissue, with or without undescended testes;
- bifid scrotum;
- phimosis and lichen sclerosus.
In phimosis, the foreskin cannot be retracted behind the glans. In newborns, the inner layer of the foreskin normally adheres to the glans and generally separates by two to three years of age; true phimosis is therefore assessed after this period. In congenital cases, the foreskin may be elongated and tubular. In acquired disease, it may be scarred, cracked or porcelain white, particularly in lichen sclerosus. Relative phimosis may be apparent only during an erection. Phimosis can interfere with urination and hygiene, allowing dead skin cells, bacteria and smegma to accumulate and causing inflammation. During an erection it may also cause pain. If a tight foreskin becomes trapped behind the glans, known as paraphimosis, impaired blood supply may cause tissue damage or necrosis. Treatment is surgical and may involve a dorsal incision, circumcision or another foreskin-preserving plastic procedure. Paraphimosis may sometimes be reduced manually; if this is unsuccessful, urgent surgery may be required.
Lichen sclerosus may appear as patchy whitish discolouration of the inner foreskin and can lead to scarring and phimosis. It may extend into the urethra and cause narrowing, and a precancerous condition may develop. Depending on the extent of disease, treatment may include topical steroid preparations, circumcision, urethral reconstruction and other penile reconstructive techniques.
Further information is available on the English-language website of our partner centre.