Penile Problems

Changes you might notice that warrant evaluation include:

• • Lumps or Firm Areas Under the Skin: These could be common and benign findings such as epididymal cysts (small, fluid-filled lumps near the epididymis at the back of the testis), sebaceous cysts (small bumps from blocked oil glands, often on the shaft), or scar tissue/plaques (like the initial stage of Peyronie's disease). Pearly Penile Papules (small bumps around the glans) are also very common and completely normal. While most lumps are harmless, any new or changing lump should be assessed, particularly if it feels firm or is growing.
• • Changes in Skin Texture or Colour: Conditions like lichen sclerosus (often called balanitis xerotica obliterans or BXO when it affects the glans and foreskin) are relatively common inflammatory skin conditions that can cause distinct white, thickened, scarred, or fragile patches of skin, particularly around the glans and foreskin, or sometimes further up the shaft. This can lead to symptoms like itching, pain, tearing, tightness of the foreskin (phimosis), or narrowing of the urethral opening. Other rashes, irritations, or discolouration can also occur due to allergies, infections (fungal like thrush, bacterial, or viral like genital warts), or inflammatory conditions.
• • Foreskin Issues: A foreskin that is difficult or impossible to retract fully (phimosis) can be present from birth or develop later in life. Acquired phimosis can be caused by chronic inflammation, infection, or underlying skin conditions like lichen sclerosus. It can lead to hygiene problems, recurrent infections (balanitis), pain during erection, tearing, or difficulty/pain during sexual activity. Conversely, if the foreskin is retracted and gets stuck behind the glans (paraphimosis), this causes swelling and pain and requires urgent medical attention to prevent tissue damage.
• • Overall Changes in Shape or Size: Beyond the specific curvature of Peyronie's disease, persistent swelling, generalised inflammation, asymmetry, or concerns about perceived size or appearance can all be reasons for consultation.

While many of these issues are common and usually not indicative of serious disease, it is always best to get any new or concerning change reviewed by a doctor experienced in genital health to get a proper diagnosis and discuss any necessary treatment or management strategies. Self-diagnosis can cause unnecessary anxiety.

Potential causes of pain or difficulty specifically with penetration can include:

• • Peyronie's Disease: If present, the curvature, shortening, or associated pain/discomfort from Peyronie's can make penetration physically difficult or painful for you or a partner. (See our dedicated page on Peyronie's Disease).
• • Frenulum Breve: A short or tight frenulum (the elastic band of tissue connecting the foreskin to the underside of the glans) can cause a pulling sensation, tearing, bleeding, or pain during erection or penetration due to excessive tension. This is a common and often easily treatable cause.
• • Phimosis or Foreskin Issues: A tight foreskin that cannot retract properly over the glans during erection (phimosis) can cause stretching, tearing, and pain during penetration. This may require treatment to resolve. (See the section on penile skin and shape changes and our foreskin conditions page).
• • Scarring: Scar tissue on the shaft, glans, or around the urethral opening from prior injuries, surgeries, infections, or conditions like lichen sclerosus can cause rigidity, inflexibility, or narrowing that makes penetration painful or difficult.
• • Inflammation or Infection: Balanitis (inflammation of the glans), posthitis (inflammation of the foreskin), or balanoposthitis (inflammation of both) can be caused by infection (fungal like thrush, bacterial), irritation, or underlying skin conditions, leading to soreness, redness, swelling, and pain during sexual activity. Sexually transmitted infections can also cause pain or discomfort.
• • Urethral Issues: Inflammation or scarring (stricture) within the urethra (the tube urine and semen pass through) can cause pain during ejaculation, but sometimes also contribute to discomfort during erection or penetration.
• • Lack of Arousal or Lubrication: Insufficient arousal can lead to erections that are not fully rigid, potentially causing buckling, bending (sometimes mimicking Peyronie's sensation), and pain during attempted penetration. Inadequate natural or artificial lubrication for one or both partners can cause friction and discomfort.
• • Psychological Factors: Performance anxiety, fear of pain, stress, past negative sexual experiences, or relationship issues can significantly impact sexual response and lead to physical symptoms including perceived difficulty or pain with penetration. Addressing the psychological aspects is often a key part of successful treatment.
• • Partner Factors: It is important to acknowledge that pain during penetration or difficulty completing intercourse can also be related to a partner's experience, such as conditions like vaginismus (involuntary tightening of the muscles around the vagina), vulvodynia (chronic vulvar pain), or other painful sexual conditions they may be experiencing. In some cases, a holistic perspective considering both partners' sexual health and experiences may be necessary and is part of a respectful, inclusive approach to sexual wellbeing.

Finding the exact cause often requires a thorough history, physical examination, and sometimes specific tests. Please don't suffer in silence or feel embarrassed about this; painful or difficult penetration is a very real and often treatable issue that we can investigate together.

1. Is it normal for my penis to have a curve when erect?

Yes — a slight curve of the penis during erection is common and usually falls within the range of normal anatomy. Many men have a natural bend upwards, downwards, or slightly to the side.
However, if the bend is significant, has appeared recently (especially after minor injury or sex), is worsening, causes pain, interferes with penetration, or is associated with a hard lump under the skin (a plaque), it may suggest Peyronie’s disease.
→ Learn more about penile curvature (Peyronie’s Disease)

2. Should I be worried about a small lump under the skin of my penis?

Most small lumps on the penis, scrotum, or genital area are harmless — such as epididymal cysts, sebaceous cysts, or normal variants like pearly penile papules or Fordyce spots.
Still, any new lump, sore, or skin change that persists, bleeds, grows, or looks unusual should always be checked promptly by a healthcare professional. Persistent changes can occasionally indicate something more serious.
→ See the section on penile skin & shape changes
→ Read the Red Flag Symptoms Warning for urgent signs

3. Can premature ejaculation be treated effectively?

Absolutely. Premature Ejaculation (PE) is very common and, for most people, highly treatable.
Treatment may involve:

• • Behavioural techniques (e.g. stop-start)
• • Psychosexual counselling
• • Topical anaesthetic creams/sprays
• • Oral medication such as SSRIs (used off-label for PE)

A consultation helps determine which combination of approaches suits you best.
→ Read about ejaculating too soon
→ Visit the dedicated Premature Ejaculation page

4. Are painful erections always a sign of a serious problem?

Not always. Painful erections may result from:

• • Tight foreskin (phimosis)
• • Short frenulum (frenulum breve)
• • Inflammation or scarring (balanitis, posthitis)
• • Peyronie’s disease (pain with curvature)

However, severe or prolonged pain with an unrelieved erection (priapism) is a medical emergency. Persistent or recurring pain should always be evaluated by a specialist.
→ Learn more about pain with penetration
→ Find out about Peyronie’s disease

5. What should I do if I notice a persistent sore or growth on my penis?

Any sore, ulcer, lump, or growth on the glans, foreskin, or shaft that does not heal within two to three weeks must be reviewed by a doctor — ideally a urologist experienced in genital skin conditions.
Most persistent lesions are benign (e.g. infections or inflammation), but some could represent early penile cancer, where early diagnosis is crucial.
→ Check the Red Flag Symptoms Warning

6. When should I seek urgent medical attention?

You should seek immediate or urgent review if you notice:

• • A persistent sore or lesion not healing after 2–3 weeks
• • Bleeding from the foreskin or a penile lesion
• • New thickened or wart-like growths
• • Persistent colour change on the glans or foreskin
• • Severe unrelieved pain with erection (priapism)

→ Review Red Flag Symptoms

1. 1. European Association of Urology (EAU) Guidelines on Male Sexual Dysfunction and Reconstructive Urology (2024 Edition).
2. 1. British Association of Urological Surgeons (BAUS). Information about your penile condition: Peyronie’s disease. Leaflet No. A24/088, review due Sep 2026.
3. 1. Terrier JE, Nelson CJ. Peyronie’s disease: Contemporary evaluation and management. Int J Urol. 2020;27(6):504-513.
4. 1. Nehra A et al. Peyronie’s Disease: A Review of Etiology, Diagnosis, and Management. J Sex Med. 2015;12(8):1764-1779.
5. 1. Bella AJ, Lee JC, Carrier S et al. Standard operating procedures for penile duplex ultrasound. J Sex Med. 2013;10(1):174-8.
6. 1. Chung E. Peyronie’s disease: Epidemiology, genetics, pathophysiology, diagnosis and work-up. Transl Androl Urol. 2016;5(3):280-289.
7. 1. EAU Guidelines on Premature Ejaculation and Erectile Dysfunction, 2024 update.
8. 1. NICE Clinical Knowledge Summaries (CKS): Erectile Dysfunction, Premature Ejaculation, Phimosis.