Clinical pictures: Male genital problems

Dr Philip Marazzi discusses some common male presentations.

Epididymal cyst

The epididymal cyst is probably the most common lump seen in male patients. These cysts vary in size from a pea to a peach. This young man, like most, was very worried, having become aware of the swelling while he was in the shower. He was certain that he had a testicular cancer. The swelling was separate from the testicle and clearly benign. An ultrasound scan confirmed the diagnosis and no further action was required.


Penile candida

This man presented with a very painful foreskin. It was extremely uncomfortable every time he developed an erection because the skin split. Topical antifungal cream was effective in controlling the infection and helping the skin to heal. He was advised to ensure that his partner also treated herself, to ensure that he did not become reinfected.


Fixed drug eruption

This patient developed a rash on his glans. Other than its alarming appearance, it was asymptomatic. He had recently been prescribed the COX-2 inhibitor etoricoxib for gout. A dermatologist considered this might be the cause because no other likely culprits were apparent. Withdrawal of the drug was followed by resolution of the rash, which did not reappear. The patient has subsequently taken colchicine for his acute gout.


Orchitis

This man required catheterisation following surgery. A few days later, he developed a very tender, swollen testicle, due to acute orchitis. He was quite unwell, with a pyrexia. He was treated with a combination of amoxicillin and metronidazole, covering aerobic and anaerobic organisms. He improved over a few days, but it took several weeks for the testicle to become normal.


Penile ulcer

This 75-year-old man had endstage renal failure requiring haemodialysis. He also developed a penile ulcer. It was thought to be due to herpes simplex and related to his immune-suppressed state. Viral and bacterial swabs were negative on culture and antiviral therapy was not effective. The ulcer eventually healed on its own, although the patient's general health continued to deteriorate and he died a little while later.


Fordyce spots

Teenagers can be very concerned about the appearance of these spots. They are caused by sebaceous gland hyperplasia and may also be seen in the mouth. They often cause anxiety and are mistaken for warts or other STIs. They are very common and of no significance. Reassurance and explanation are normally all that is required.


Bruising

This man sustained a ‘groin strain’ playing rugby. The actual injury is probably due to a tear in the adductor muscles. This was moderately severe and would probably be graded two on a scale of one to three. He was alarmed to find this rather dramatic bruising. Advice to rest and use a combination of ice and warmth helped to heal the injury and he was playing rugby again in three weeks.


 

Orchidopexy

This 44-year-old man had a long history of problems with his testicles. The left side had been operated on in childhood to repair the scrotum. He had for some years been troubled by discomfort from the right testicle because it often rode upwards out of the correct position in the scrotum. The testicle was normal and his fertility had not been impaired. He underwent orchidopexy to fix the testicle into the scrotum once and for all.


  • Dr Marazzi is a GP in East Horsley, Surrey

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