MALE GENITAL CONDITIONS
TIGHT FORESKIN (PHIMOSIS)
Phimosis is a condition where foreskin becomes too tight and cannot be fully retracted. If the foreskin is retracted but cannot be brought forward again then urgent medical treatment should be sought.
Tight foreskin is common in children and often requires no treatment unless in certain situations such as the presence of scar tissue, repeated foreskin infections and if it becomes too tight that will interfere with passage of the urine. In adults, phimosis may lead to a number of problems such as interfering with sexual intercourse, inability to clean the glans, infection of foreskin (balanitis) and rarely, in severe cases, it may cause acute retention of urine.
Steroid cream may help to soften the foreskin in selected cases, but the effect is usually short-lived and circumcision is the mainstay treatment.
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TIGHT FRENULUM
The frenulum of the penis is the elastic band of tissue under the head of the penis (glans) that connects to the foreskin. If the frenulum is tight, it can cause difficulty in retracting the foreskin and can also tear up during sexual intercourse, resulting in the formation of a scar tissue.
Tight frenulum can be successfully treated with a minor surgery called frenulopasty.
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VARICOCELE
Varicocele is a condition where the veins inside the scrotum become enlarged, similar to varicose veins that can appear in the legs. The exact cause is unclear, but it is thought to be related to faulty valves in the veins that regulate blood flow from the testicles leading to blood pooling in the veins, causing them to swell.
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Varicocele symptoms may include a lump or a swelling above the testis and can cause a dull ache or feeling of heaviness, which may get worse with standing or physical activity. In addition, it is also a common cause of male infertility due its negative affect on sperm production, quality and count.
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Treatment is recommended in men with symptoms, or have concerns about fertility. There are a number of treatment options available such as surgical ligation of the veins or embolisation. Microscopic varicocele repair (microsurgery) is often the preferred choice due to its high success rate and lower risk of complications.
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TESTICULAR/SCROTAL LUMPS
Testicular lumps and swellings are common in boys and men, and the majority are caused by benign (non-cancerous) conditions. It is advisable that men carry out regular (perhaps weekly) self-examination of the testes to feel for testicular lumps. If you feel a lump then you should see your GP as soon as possible.
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The causes of testicular lumps include:
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Hydrocele: fluid around the testis.
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Epididymal cysts: lumps caused by a collection of fluid in the epididymis
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Varicoceles: swelling caused by varicose veins above the testis
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Epididymo-orchitis: inflammation of the epididymis and the testis commonly caused by infection.
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Inguinal hernia: a hernia arising from the groin can extend down into the scrotum. However, this is not a urological condition and requires your GP to refer to a general surgeon.
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Testicular cancer: this is a rare cause of a testicular lump with approximately less than 4 in 100 testicular lumps being cancerous. It tends to affect men between the ages of 20 and 50; although, some forms of testicular cancers can occur in older men.
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Treatment of testicular cancer involves removal of the testis (radical orchidectomy) as soon as possible and an artificial (silicone) testis can be placed in the scrotum at the same time or at a later date. Treatment of non-cancer conditions depends on the underlying cause, infection requires treatment with appropriate antibiotics, the other conditions can be managed with surgery or intervention if they cause bothersome symptoms such as pain or cosmetic embarrassment.
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