Illustrated: Male genital problems

Contributed by Dr Philip Marazzi, a GP in East Horsley, Surrey

Bruising
This patient was rather alarmed by the impressive bruising that developed following insertion of a stent six days previously. He had not been warned by the cardiologists. No specific action was required and the patient was reassured.

Varicocele


This young patient was concerned about the enlargement on one side of his scrotum. An ultrasound confirmed the presence of a varicocele. He was referred to urology due to the ongoing discomfort he was suffering. The veins were ligated and his symptoms improved.

Zoon's balanitis

This patient presented with this rather aggressive looking rash. He was initially treated for possible thrush, but swabs were negative and a lack of response to treatment prompted a referral. The diagnosis of Zoon's balanitis was confirmed and the patient reassured as the condition is not pre-malignant. He underwent circumcision.

Penile wart


This patient developed a wart in a tender area. He was referred to the GUM clinic for a full screen to exclude any other STIs and was subsequently treated with topical podophyllum.

Lichen sclerosis


This patient's penis had the characteristic white appearance of lichen sclerosis, which had been present for a long time. He was lucky not to suffer from any symptoms related to the condition, which can include scarring and subsequent urinary symptoms. He did not use treatment.

Bruising


This patient was concerned when these bruises appeared after rather vigorous sexual intercourse. Again, reassurance was all that was required.

Allergy


This 79-year-old patient developed angio-edema in recent years. This had normally presented itself with the swelling of his lips but on this occasion his penis was affected. Treatment with oral steroids and high-dose antihistamines was effective. In spite of all standard investigations, no cause was found.

Radiotherapy


This patient had presented with haematuria and was found to have carcinoma of the bladder. Following initial transurethral resection of the bladder tumour and Bacillus Calmette-Guerin instillation, he developed recurrent disease in his urethra and underwent radiotherapy. He needed a catheter and the treatment produced this marked genital oedema. He did not respond to treatment and his general condition deteriorated. He died a little while later.

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