Is This Normal? 10 Common Penile “Flaws” You May Have

A penis is a special organ—a man’s joy, if not pride—and certainly one of his most prized, appreciated and cherished possessions, to which he has a significant attachment. As multifunctional as a Swiss Army knife, it allows him to stand to urinate (an undervalued capability), rises and firms to the occasion to allow for sexual penetration, and ejaculates genetic material–the means to perpetuate the species. A marvel of hydraulic engineering, within nanoseconds of sexual stimulation it is uniquely capable of increasing its blood flow 50 times over baseline, transforming its shape and size. Penis magic!

Each and every penis is unique. As variable as snowflakes, they come in every size, shape, and color. Beyond “size matters”—often a source of male preoccupation—men are often obsessed, if not preoccupied, with the appearance of their genitals. In my interactions with patients, concerns are often voiced about symmetry, color, pigmentation, angulation, spots, blemishes, vein patterns, shrinkage, and other oddities. Unless you are in the habit of closely inspecting other men’s genitals (as urologists are), you are unlikely to realize how common and completely normal most of these genital variations are.

10 Common Penile “Flaws” You May Have That Are Actually Quite Normal

  1. Penis leans to one side. No human is perfectly symmetrical and the flaccid penis rarely hangs perfectly centered. Wherever your penis naturally lies when you are clothed—whether left or right—is not indicative of your political leaning or left vs. right-sided brain predominance and is of absolutely no significance or consequence whatsoever!Interesting trivia: “Throckmorton’s sign” is a term used jokingly by medical students, residents and attending physicians. A positive Throckmorton sign is when the penis points to the side of the body where the pathology is, e.g., if a man is getting surgery for a right groin hernia and the penis points to the right side. The Throckmorton sign indicates the proper side of the pathology at least 50% of the time! Operating room humor!
  2. Slight penile curvature when erect. Again, although perfect symmetry may be desirable, the norm for the erect penis is not to be perfectly straight. There is often a subtle bend to the left, right, up or down. Some men have a penis that has a banana-like curvature. Slight bends—considered totally normal—are to be distinguished from Peyronie’s disease, a condition in which there is significant angulation due to scarring of the sheaths of the erectile chambers. It is a potentially serious condition that can cause painful erections and erectile dysfunction.
  3. One testicle hangs lower. If you ever wondered why one of your testes is slightly bigger or heavier and hangs lower than the testes on the other side, you are in good company. Paralleling women with breast asymmetry, the vast majority of men have testes asymmetry, so your mismatched gonads are perfectly normal.
  4. Dark genital skin. Hyperpigmentation (darkening) of the median raphe (the line running from anus to perineum to scrotum to undersurface of the penis) and other areas of the penis is extremely common. In fact, it is normal for the penile skin color to be darker than other areas of the body, because of the effect of sex hormones on the cells that produce pigment (melanocytes). The circumcision line, as well, is often deeply pigmented
  5. Freckles, moles and skin tags. The penis is covered by skin–just like the rest of the body–and is therefore subject to common benign skin growths, including moles, freckles and skin tags. These are generally harmless and usually, do not require any treatment unless desired for cosmetic reasons. However, if you have a growth that changes in size, color or texture, you should have it checked out because penile cancers do occur on occasion. Skin tags are small fleshy protuberances and can be confused with genital warts, so if you have any doubt, get checked.
  6. Other penis and scrotal bumps and lumps. Pearly penile papules are raised “pearly” bumps that appear around the corona (the base of the head of the penis). They consist of one or more rows of small, fleshy, yellow-pink or transparent, smooth bumps surrounding the penile head. They are benign and do not cause harm, but sometimes are treated for cosmetic reasons, usually with freezing or lasering. Sebaceous glands produce oil that nourishes the hair follicles of the genitals. These glands appear as numerous small yellowish bumps on the scrotum and penile base. In some men, they are prominent and referred to as sebaceous gland hyperplasia. At times, they can exist without a hair follicle even being present. Regardless, they are a normal occurrence.
  7. Scattered scrotal spots. Angiokeratomas are benign purplish skin growths with a scaly surface that are not uncommonly present on the scrotum. They consist of dilated thin-walled blood vessels with overlying skin thickening. These skin lesions can occasionally bleed and also cause fear and anxiety since they can resemble more serious problems such as melanoma. If in any doubt, get it checked out.
  8. Veiny vanity. Every man has a unique penile venous pattern, the anatomy as unpredictable as the distinctive venous anatomy of the hand and wrist. In some men, the veins are twisted and prominent and in other men, they are barely noticeable. No matter what the pattern, venous anatomy is highly variable and individualized and is normal.
  9. Loose skin. Unlike most other skin on the body that is more tightly attached, penile skin is loosely attached to underlying tissues, allowing for expansion with erections. Since the physical state of the penis can vary from totally flaccid to totally rigid, when the penis is fully deflated, the skin may appear to be somewhat floppy and redundant, which is absolutely normal. Scrotal skin often becomes increasing lax with the aging process, such that the testicles typically hang quite low in the elderly male, paralleling the common situation of pendulous breasts of the elderly female.
  10. Shrinkage. Penile size in an individual is quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” can be provoked by exposure to cold (weather or water), the state of being anxious or nervous, and participation in sports. The mechanism in all cases involves temporarily reduced blood circulation. Don’t worry, that sorry and spent looking penis can magically be revived with some TLC!

Bottom line: If you have an imperfect penis…welcome to the club! No penis or scrotum is perfect. Far from being an object of beauty, genital imperfections are the norm, so there is no need for feeling self-conscious. Just be happy that your little “fella” can function properly and enjoy his own happiness from time to time! Function over form!

Written by Dr. Andrew Siegel


Should You Be Screened for Prostate Cancer?

5 Nov 2018 Blog

According to the American Cancer Society, about 1 man in 9 will be diagnosed with prostate cancer during his lifetime. Other than skin cancer, prostate cancer is the most common cancer in American men.

It’s recommended that beginning at age 40 (depending on risk level), men should have a discussion with their health care provider about prostate cancer screening. It’s up to each individual to make an informed decision carefully considering the uncertainties, risks, and potential benefits of screening.

Benefits of Prostate Cancer Screening

Although screening is an individual decision, there are potential benefits to getting screened for prostate cancer:

  • The 5-year relative survival rate of prostate cancer is nearly 100%. 15-year is about 95%. This means that the survival rate is very high, it just needs to be detected first and early on.
  • Since the recent push to prevent prostate cancer, tests have become more diverse and more accurate. While they still aren’t 100% accurate, they can provide good insight to your urologist on whether further testing or other actions need to be taken.

What are the Screening Options for Prostate Cancer?

There are a couple options for prostate cancer screening, including:

  • Prostate Specific Antigen (PSA) – This blood test measures how much PSA is in a man’s blood.
  • Digital Rectal Exam (DRE) – Your doctor will insert a gloved, lubricated finger into the rectum to feel the prostate gland. They will assess if the shape, size and texture and feel normal.

Early detection can save lives. Visit our locations page to make an appointment with one of our urology specialists to decide if prostate cancer screening is right for you.

5 Fascinating Myths About Robotic Surgery, Debunked

12 Jul 2018 Blog

With the robotic-assisted surgery arena growing bigger by the day—and commanded solely by the company behind da Vinci® robots—it’s no wonder that people may be becoming concerned about where the doctor ends and the machine begins (or simply fear robots will replace human beings altogether). In fact, these robots can be used in a variety of procedures—including urological, colorectal, cardiac, gynecological and thoracic surgeries. For urologists, the da Vinci robot is most commonly used to perform surgery for prostate cancer, as well as:

  • Bladder surgery
  • Kidney surgery
  • Urinary obstruction surgery
  • Uterine and vaginal vault prolapse surgery

We’re here to cast a better light on this misunderstood and life-changing surgical technique by dispelling some well-circulated myths and give you peace of mind when discussing your surgical options.

Myth #1: The robot performs the surgery and the surgeon is hands-off.

Fact: Though the word robot may imply autonomy, the robot serves as nothing more than a tool—not a replacement—for a surgeon.

During a robotic-assisted surgery, the surgeon is stationed at a console and manipulates the arms of the robot using hand and foot controls. When the surgeon stops, so does the robot; the robot is not simply handed instructions and then let loose on your insides.

Myth #2: Robots replace the hands of surgeons, so clearance of cancer may not be as likely.

Fact: The whole point of robotic-assisted surgery is that the robot is able to make precise movements in a way that human hands simply are not capable of. Additionally, the robots are equipped with cameras that offer 3D definition vision that surpasses the abilities of the naked eye. These heightened abilities of the camera allow the surgeon to get a sense of the hardness and texture of organs in the body, which means tactile sensation is neither needed nor missed.

Myth #3: The robot can malfunction during my surgery and put my life at risk.

Fact: The robot goes through a thorough check and maintenance exam prior to every procedure. If anything is suspected to be wrong, the robot will not be used. Additionally, the robot is built with multiple safety features that prevent any malfunction from occurring when it’s in use; the arms will lock in place or gently hover, but cannot be forced in any direction.

Myth #4: Robotic surgery has no clear advantages over any other type of surgery.

Fact: Like other laparoscopic procedures, robotic-assisted surgery offers distinct advantages over open surgery, including:

  • A shorter hospital stay and recovery time
  • Less blood loss during the procedure
  • Less risk of complications during and after surgery
  • Lower risk of infection

Coupled with that, a recent small controlled study revealed that compared to flouro-guided surgery, there was a 78 percent decrease in radiation exposure.

Myth #5: Any surgeon can perform robotic-assisted surgery.

Fact: Like any specialized skill, it takes a foundation of training and experience to execute a technique. Remember, it is the surgeon behind the machine who is ultimately performing the surgery. The robot is simply a tool, a means to an end to achieve the best possible outcome.

Robotic-assisted surgery requires a whole different set of proficiencies compared to open surgery or other laparoscopic techniques; many surgeons are still not yet trained to master the nuances of this device. At New Jersey Urology (NJU), we are proud to employ surgeons who have extensive experience in performing procedures using this advanced technology.

Don’t let technophobia get the better of you. If your urologic condition requires surgical intervention, schedule a consultation with the robotic surgery specialists at NJU today to discuss your options.

3 Common Myths About Prostate Cancer Treatments, Debunked

14 Sep 2017 Blog

The internet is a never-ending double-edged sword. On the one hand, a world of indefinite knowledge is simply a click or touch away. On the other, misinformation is sometimes hidden under the guise of truth. This seems to be the case for a variety of topics, including prostate cancer.

Thankfully, we’re here to shed some light on some untruths regarding prostate cancer that the web has spun for far too long.

Myth #1: Ginger can treat and prevent prostate cancer.

Fact: Before we start badmouthing ginger, what we can say about this biting root is that it does have some wonderful stomach-soothing properties. Plus, it tastes great in tea. That said, it does absolutely nothing when it comes to treating or preventing prostate cancer.

Unfortunately, certain websites that cater to “natural” remedies for everything from hangnails to cancer will cling to small studies—such as this one—that merely hint or suggest a small kernel of truth to an otherwise unsubstantiated lie.

Myth #2: Golden berries aid in destroying prostate cancer cells.

Fact: This is also quite false. Think about it: If these berries had even the slightest hope of curing cancer, don’t you think science would be on this like white on rice?

Well, it isn’t. A simple Google search will show that there are no studies currently being conducted nor are there studies even suggesting that golden berries will effectively treat anything, let alone cure cancer.

What you will find, however, is a long list of “natural” websites regurgitating the same anecdotal evidence regarding this “magical” fruit. That, regrettably, is not proof.

Myth #3: Frequent ejaculation may reduce the risk of prostate cancer.

Fact: Of all the things you could do in your spare time to reduce your risk of developing prostate cancer, this one … Well, it basically lives at the bottom of the list.

There are studies that suggest a decreased risk of prostate cancer, but the number of ejaculations to decrease the risk has never been quantified. Also, researchers can’t figure out what one has to do with the other in the first place. That lack of understanding doesn’t bode well as a confidence booster, especially when it comes to health.

In short, we don’t recommend putting all of your eggs into this particular basket, no matter how enticing the idea may seem.

These medical rumors are truly dangerous as they promote themselves as alternates to lifesaving, science-based treatments, like robotic-assisted laparoscopic prostatectomy and radiation therapy. By debunking these harmful myths, we hope to encourage men like you to be proactive with your health. We further implore you to trust science to help you detect prostate cancer early with yearly exams, prostate-specific antigen (PSA) blood tests and doctor follow-ups.

For more information about prostate cancer or to schedule an appointment with one of our urology specialists, contact us at one of our convenient locations today.

Do Male Fertility Supplements Work?

16 Aug 2017 Blog

If you’re a male that struggles with infertility, you might have been tempted to try one of the many male fertility supplements that are available on the market. But do they really help increase sperm count and mobility, or are they completely ineffective?

A lot of research has been done to study the effectiveness of fertility supplements, but evidence is still limited because of the variations in dosage and questions about the cause of infertility in patients.

Supplements for Male Infertility

Though the effectiveness of supplements is questionable, there are a few supplements that have shown promise for increasing sperm count and mobility:

  • Zinc and Folate Supplements Folate is known as a vitamin that’s used for healthy pregnancies, but it can also increase sperm count and motility when used in combination with zinc supplements.
  • Vitamins A, C, and E These antioxidant vitamins might help increase fertility because they can potentially reduce oxidative stress. Stress is known to reduce sperm count.
  • Coenzyme Q-10 Similar to vitamins A, C, and E, coenzyme Q-10 has been known to protect cells from oxidative stress, which can be beneficial for damaged sperm.
  • Carnitine Carnitine is an amino acid that helps your body turn fat to energy. According to recent studies, it can also help sperm cells generate the energy they need to function optimally.
  • Selenium Selenium has been shown to increase sperm count and motility when taken with other vitamins, especially if a man has low selenium levels.

Treating Male Infertility in New Jersey

Sperm cells are sensitive, and they require good nutrition and antioxidants to perform properly. In order to come up with the best treatment for male infertility, it’s important to consult a physician before trying any supplements. In order to get to the root of the problem, a urologist will typically perform at least one of the following tests:

  • Sperm and semen analysis
  • Physical exam
  • Hormone evaluation
  • Testicular biopsy

If you’re struggling with male infertility and are ready to get answers, contact an NJU office near you. Our urologists will give you the care you need to effectively treat infertility.

Men’s Health Month: Cancer in Men

16 Jun 2017 Blog

June is men’s health month and we want to take the time to educate you on important facts regarding your health or the health of the men in your life.

Top Cancers in Men

Out of the top 6 most common cancers in men, 3 of them are urology related:

Prostate Cancer

Prostate cancer is #1 on the list of most common cancers in men. According to the most accurate recent figures in 2014, 233,000 men will be diagnosed with prostate cancer, which is about 27% of all cancer diagnoses. About 1 in 6 men will be diagnosed with prostate cancer in their lifetime. The average age for this diagnosis is between the ages of 65-69 and that accounts for 65% of all diagnoses.

The prostate is a gland that assists with reproduction, but as you age, it increases in size and can lead to complications such as BPH and prostate cancer.

What can you do?

There are two tests you can get, the PSA and DRE tests. Getting screened isn’t necessarily a guarantee you can get diagnosed and treated, but it can help if your urologist thinks you make be at risk for prostate cancer. Talk to your urologist if you think you should be screened.

Bladder Cancer

Bladder cancer is #4 on the list of the most common cancers in men. It’s estimated that about 56,000 men will be diagnosed with bladder cancer. Unlike prostate cancer, which tends to be more genetically caused, bladder cancer is preventable. However, if not treated early, bladder cancer can spread to lymph nodes of the pelvis, abdomen or even the neck.

What can you do?

A mentioned, while the risk of bladder cancer can increase from family history and other genetic factors, age and smoking are the two biggest risk factors. Most men diagnosed are over the age of 70, but smoking can increase your risk at any age. Quitting smoking can help significantly reduce your chances of getting bladder cancer (and lung cancer, which is #2 on the most common cancers in men list)

Kidney Cancer

Lastly, kidney cancer, also known as renal cancer, is #6 on the list. About 39,000 cases of kidney cancer are expected to be diagnosed in men. Most cases of kidney cancer first appear in the lining of small tubes in the kidney called tubules. Luckily, most of the time this is found before it spreads. Most men diagnosed are 60 or older.

What can you do?

Two big risk factors for kidney cancer are smoking and obesity. If you quit smoking and try to live a healthier lifestyle (being more active, eating more rich fruits and vegetables and less fatty meats) can greatly reduce your chances of getting kidney cancer

In light of men’s health month, schedule an appointment with your urologist for a check up!

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