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Penile Cancer – 7 Things You Need to Know!

The mere mention of penile cancer conjures up much fear and uncertainty among public imagination, especially among grown men. It is not a common cancer in Singapore, hence it is not well known to the public. We shall explore more details in this article about this little known cancer.

What exactly is penile cancer?

Penile Cancer happens when the normal cells of the skin and tissue of the penis turns malignant and grows beyond control, forming a tumour. Penile cancer may eventually spread to other parts of the body including other glands, lymph nodes or organs.

Penile cancer is typically a disease of older men, with most patients around the age of 60 when diagnosed. In developed countries like the USA, Europe, Singapore, penile cancer is rare, accounting for less than 1% of all cancers diagnosed. This is in contrast to less developed countries like South America, Parts of Africa and Asia where penile cancer can account for 10 to 20% of all cancers diagnosed.


Signs and Symptoms of penile cancer

The majority of penile cancers arise from the head of the penis or from the foreskin. The most common findings on examination is a painless lump or an ulcer. The symptoms may include bleeding, rash or balanitis. 30 to 60 percent of patients also have swollen lymph nodes in the groin as well. 


What is the cause of penile cancer?

The majority of penile cancers are squamous cell carcinoma (SCC) and its many variants. Other cancers which can affect the penis include basal cell carcinoma (BCC), Kaposi Sarcoma (KS), melanomas and other lymphomas.


Who is at risk for penile cancer?

  • Patients with previous known medical condition of the penis. This would include warts, infections, previous injury, tears or strictures
  • Phimosis. Uncircumcised males sometimes have a thickening and scarring of the foreskin. This is a condition known as phimosis, which is a difficulty in retracting the foreskin over the head of the penis. 
  • Human Papillomavirus infection (HPV). HPV can be found in 30% to 50% of penile cancers.
  • Smoking and Tobacco Exposure
  • Human Immunodeficiency Virus (HIV) Infection
  • Patients with previous Ultraviolet treatment for psoriasis.

Who to prevent penile cancer?

  • Patients who have phimosis can consider getting a circumcision
  • Vaccination against HPV early can also be useful in preventing infection and possible penile/anal cancer. Screening for High Risk HPV through a swab can also be useful in patients who have risk factors.
  • Patients who are smokers should definitely stop smoking not only to prevent penile cancers but other forms of cancers as well.

What are the treatments for penile cancer?

Treatment of penile cancer depends on the type and staging of the cancer. If disease is limited, organ preserving treatment options include topical medications, lasers, radiation therapy or micrographic surgery. If the cancer is advanced and locally extensive, a partial or even full amputation of the penis might be required.


What are the complications of penile cancer?

After treatment, patients might be faced with complications depending on the kind of treatment. For organ preservation treatments, issues with cosmesis, erectile dysfunction and reduced sensation are common. For surgical treatments, for example a penile amputation, patients might require an external opening known as a urethrostomy for urination. Patients might also require a surgical reconstruction of the amputated organ for cosmetic issues.


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6 Common Causes of Penile Discolouration

Most men tend to not pay regular attention to their general skin condition, but when it comes to matters of the penis, it is almost always a cause for immediate concern; after all, it is the source of our manhood. More often than not, any unusual appearance such as discolouration, dry skin, red spots or bumps may result in considerable anxiety.

It is not uncommon for men, especially those with darker skin, to have slight variations in the colour of the penis. In fact, for men of all races, it is normal for the penis to be slightly darker than the skin on the rest of the body. This applies also to the labia of women.

When an adolescent male or female undergoes puberty, the body produces the sex hormones, testosterone and oestrogen, which results in the development of secondary sexual characteristics. Excess levels of these hormones in the genitals respond to melanocytes, the skin cells that cause pigmentation. These physiological changes are responsible for darker genitalia in both men and women.

Mild penile discolouration is generally nothing to worry about. In fact, during sexual arousal, the penis can take on a reddish, sometimes almost purplish colour, due to increased blood flow to the organ. However, there are other causes of penile discolouration that may be more severe and require treatment.

 

6 Common Causes of Penile Discolouration

 

via GIPHY

1. Contact Dermatitis

Contact dermatitis is a skin reaction to contact with an irritant. This can happen anywhere on the body, including the penis. When this happens, it is usually caused by latex condom usage. The skin of the penis can turn red and itchy. Sometimes the skin can break causing serous discharge, and bacterial infection can occur. Mild cases can be treated with a corticosteroid cream. Non-latex condoms can be used if you have a latex allergy.

 

2. Penile Injury

A penile injury can lead to rapid discolouration due to bruising, in the form of purple, dark brown or even greenish hues. Sometimes, a red patch with prominent blood vessels just under the surface of the skin can occur due to a hematoma. This usually fades after several days and treatment is typically not necessary.

However, if there is severe pain along with the discolouration after a traumatic episode, immediate medical attention is required as this could be due to a penile fracture, which is a more severe issue.

 

3. Lichen Sclerosus

Lichen sclerosus is a lifelong condition that can go through periods of remission and flare-ups, and is characterised by white patches on the penis. It is more common in those who are uncircumcised. In addition to blotchy white spots, the skin of the penis can also become itchy, fragile and tear or bleed easily. Other symptoms include painful sex and an inability to retract the foreskin fully.

The cause of lichen sclerosus is unknown, but an overactive immune system or an imbalance of hormones may play a role. It is not contagious and cannot be transmitted through sexual intercourse. Treatment usually includes a strong steroid ointment applied directly to the affected skin. If only the foreskin is affected, circumcision may be advised.

 

4. Penile Melanosis or Post Inflammatory Hyperpigmentation (PIH)

Penile melanosis, or PIH, is a benign condition simply caused by overproduction of melanin, in which the skin can appear in a wide variety of colors including different shades of brown, grey or even blue.

Overproduction usually occurs after an injury to the skin of the penis, the most common being excessive rubbing of the penis from vigorous sex or self-pleasuring. It will fade over time, or if a man is bothered by it, possible treatments such as topical retinol (vitamin A) every night before bed, laser therapy, or microdermabrasion can help to reduce the discolouration.

 

5. Sexually Transmitted Diseases (STDs)

Purple sores on the penis can occur as a result of genital herpes or syphilis. These STDs can be accompanied by other symptoms such as pain, fever, itchiness, burning, and fatigue. If STD is suspected, it is imperative to head to a clinic to see a physician as soon as possible to be tested and get treated.

Also Read

 

6. Penile Cancer

Penile cancer tends to start on the skin of the penis and spreads towards the deeper tissues. 95% are squamous cell carcinomas, while penile melanoma accounts for 0.7%. Penile cancer is rare and the cause is not entirely known, but risk factors include smoking, HIV and high risk strains of Human Papillomavirus (HPV) infection. Symptoms include changes in the colour and thickness of the skin of the penis, foul smelling discharge under the foreskin, and abnormal non-resolving growths or ulceration of the penis. A diagnosis of penile cancer requires an urgent biopsy.

 

There are other conditions that can cause penile discolouration. It is important to determine the exact cause as treatment varies according to the cause. It is always best to visit a doctor for a physical examination and proper evaluation.

If you need to speak to our doctors , please visit our men’s clinics.  Alternatively, you can email us hello@dtapclinic.com or call us for an appointment.

 

Take Care.

 

Other Read:

Also on DTAP’s blog: std check up singapore

Genital Warts: The Cauliflower-Like Lumps on the Genitals

Genital warts are white or flesh-coloured, smooth, small bumps that can appear anywhere in the general area of the genitals. They can also grow larger and appear as fleshy, cauliflower-like lumps on the genitals. Neither of which are more dangerous than the other, it is merely a characteristic and the stage that the illness was noticed.
Genital warts is an STD symptom caused by the Human Papilloma Virus (HPV).

HPV can cause multiple illnesses in the body as there are multiple strains of the virus attributing to different diseases in humans. Out of the hundreds of known strains of HPV, about 30 strains of the virus cause diseases of the genital area. These include warts, or in more sinister cases, cancer of the anus, cervix, vagina, and penis. Read: Causes of Vaginal Lumps & Bumps & Perianal Warts (Peri-Anal Warts)

Most of the other strains have no known effect on humans.


How do I get infected by the Human Papilloma Virus (HPV)?

Human Papilloma Virus (HPV) is a contagious disease that is transmitted through genital skin contact or through direct contact with genital fluids of a person already infected with HPV.
For transmissible illness such as these, using barrier methods of protection for sexual intercourse such as condoms should be emphasised. However, condoms are not very effective against transmitting HPV just because the HPV virus does not require penetrative sex to transmit the virus.

It can also be transmitted from a mother to an unborn child if the mother has an active HPV infection during the course of the pregnancy.


How do I know I am infected with HPV? How can it be detected?

A majority of people infected with HPV do not realise they even have the virus as it does not present with any symptoms.

Some people will notice bumps or warts around the genital area, otherwise known as genital warts. These usually occur one to three months after initial infection with HPV.


The most sinister manifestation of the HPV disease is cervical cancer affecting women in their 30s or 40s. The simplest way to detect cervical cancer is by identifying if an individual is an active risk of getting the disease and doing regular PAP smears. MOH guidelines are also apparent on the timing and interval for PAP smears for women in the reproductive age group. Sometimes a biopsy of unhealthy cervical looking tissue may be needed.

For men-who-have-sex-with-men (MSM), it is recommended that they do an anal PAP smear to investigate for HPV.

We also provide Rapid HPV Testing (next day result) in all our clinics in Singapore.


How can HPV & Genital Warts be treated?

In most cases, the HPV infection is self-limiting therefore no treatment is deemed necessary.

Unless an individual has issues with antibodies or a weak immune system in general, the body should be able to contain and eradicate the virus from the body in due time.
If an individual has an impaired immune system or a weak immune response, a lingering infection or a co-infection with another sexually transmitted illness can occur.

In cases of genital warts, the treatment options are largely dependent on the severity of the infection. The most common treatment options include creams and paint-on ointments. These induce a state of cell death so warts around the genital will eventually wither and fall off the skin.

Some patients may be offered cryotherapy where the wart is frozen then removed. The wart is frozen prior to that so that there will be no transmission of the wart after.
Apart from the above surgical options for wart removal also exist. This is where a surgeon uses electrocautery or a scalpel and surgically excise warts. See: Genital Warts Removal

Unfortunately, the majority of genital warts or other warts can recur very frequently and is rather common to have warts recur post removal. Sometimes, repeated treatments are required for complete remission, but patients should be aware of the recurrence rates in such an infection.


HPV and Cervical cancer

Some HPV viruses are known as high-risk viruses. This is particularly true in virus strains 16 and 18. This is because it induces changes in the cells in the cervix of a woman and causes cervical if not detected early.

It is in this light that it is recommended that all sexually active women are advised to go for regular PAP smear tests, screen for HPV infections and visit your doctor for HPV vaccination in Singapore.


HPV and PAP Smear

Pap smear is a relatively painless test that can be quickly done. It involves inserting a speculum into the vagina of the patient to allow for inspection then a tool is inserted to obtain scraping. The patient should go back to resume activities of daily living with no hindrance once after the procedure completed by our female doctor.
These scrapings and obtained cells are then examined under a microscope to look for abnormal cells.

We also provide Rapid HPV Testing & Pap Smear in all our clinics in Singapore.

HPV and HPV Vaccination

Human Papilloma Virus (HPV) is a group of virus that can cause:

  • Vaginal Cancers
  • Vulvar Cancers
  • Anal Cancers
  • Penile Cancers
  • Oropharyngeal Cancers (cancers of the throat and tongue)
  • Genital warts or Papillomas

HPV vaccination is used to protect against HPV-related diseases and cancers.
To complete the HPV vaccination, 3 doses of injections will be given. The recommended HPV vaccine schedules are:
First dose: During your doctor visit.
Second dose: 1 – 2 months after the first dose
Third dose: 4-5 months after the second dose


Get More protection with New 9-valent HPV vaccine (Gardasil 9)

There are over a hundred strains of HPV and they are each given a designated number e.g. HPV 6 or HPV 16 or HPV52.
HPV strains that cause warts will NOT cause cancers and HPV strains that cause Cancer will NOT cause warts.

Compared to the older Gardasil, the new GARDASIL 9 offers a wider range of protection against HPV strains.
Both Gardasil and Gardasil 9 give you protection against the cancer-causing HPV 16 and 18 and the wart-causing HPV 6 and 11.
Gardasil 9 protects additional 5 other high-risk types: 31, 33, 45, 52 and 58.
Together these types cause about 90% of cervical cancers.

Another HPV vaccine Cervarix, on the other hand, protects only against the commonest cancer-causing HPV 16 and 18. There is no wart protection with Cervarix.
If you are interested in getting the HPV testing & PAP smear, genital warts treatment or HPV vaccine, please visit our STD clinics and speak to our male and female doctors.
If you or your partner are experiencing any possible signs or symptoms of infection, or have had any potential risk exposures, please see our STD doctors today.
Take Care. Be Safe!



Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. Anal Pap Smear for Anal Cancer Screening
  3. HIV Rash: What You Need To Know
  4. Genital Blister, Genital Ulcers & Genital Warts – What You Need to Know
  5. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  6. 11 Causes of Dyspareunia (Pain During Intercourse)
  7. 10 Common HIV related to Opportunistic Infections
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Herpes: Everything You Need to Know!
  13. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  14. Syphilis Symptoms (Painless STD Sores & STD Rashes)