Penile Disorders

Penile Pain

Penile pain – if examination is normal, foreskin is retractable and no evidence of Peyronies or urethral stricture then referral to urology usually unnecessary. Consider pain relief meds or psychosexual therapy.

A psychosexual service is available at Unity Sexual Health.

Email: ubh-tr.unitypsychosexual@nhs.net

Peyronie's Disease

Peyronie's disease can present with a variety of symptoms including:

• Penile pain during erections
• Penile angulation
• Palpable fibrous plaque in shaft of penis
• Erectile dysfunction

The condition can be self-limiting so local urologists have advised to only consider referral if the patient has had symptoms for at least 6 months. Vacuum pump therapy can be useful to prevent progression and may be considered as an alternative to surgery in some men.  Peyronie's can be associated with diabetes and this should be excluded.

Further advice  can be found on the Peyronie's disease page of the patient.info website.

There is also a useful patient leaflet produced by the British Association of Urological Surgeons

Phimosis

In boys less than 10 years then this is usually physiogical and will resolve without treatment. In children 10 years and over and adults then referral for circumcision may be indicated. In either case referral for circumcision is subject to criteria based access policies as below:

Penile Conditions – Surgical Opinion and Treatment including Circumcision in all Male Patients Over the Age of 16

Penile Conditions – Surgical Opinion and Treatment including Circumcision in Patients under the age of 16

Please note that an inability to retract the foreskin in an adult is a risk factor for penile cancer and patients 18 and over with this problem should be referred routinely under the CBA policy.

Torn Frenulum

The frenulum can sometimes tear during sexual activity. This does not normally need surgical management and reassurance and advice about use of lubricants and intercourse is usually sufficient:

What should I do if my penis is torn? - NHS (www.nhs.uk)

Patients with concerns about sexual health may be able to self – refer to Unity for assessment and support:

If you are requesting frenuloplasty or an opinion on the need for possible surgery then this is not routinely funded. Please follow the link below to access the policy:

Penile Conditions – Surgical Opinion and Treatment including Circumcision in all Male Patients Over the Age of 16

Sexually Transmitted Infections

For advice on assessment and treatment of suspected infections affecting the penis please see the Sexual Health Guidelines section of Remedy.

For genital lumps the following is recommended under the Unity Sexual Health FAQs section :

‘I’m unsure of diagnosis of a genital lump, how do I refer the patient to you for second opinion?

Red Flags

Red flags for suspected cancer  - see below and  Urology 2WW section

• A penile mass or ulcerated lesion where a sexually transmitted infection has been excluded.(This includes progressive ulceration or a mass particularly in the glans penis or prepuce, but can involve the skin of the penile shaft. For lumps within the corpora cavernosa that do not involve the penile skin, please use the routine referral process.)
• A persistent penile lesion after treatment for a sexually transmitted infection has been completed.
• Unexplained or persistent symptoms affecting the foreskin or glans (This does not include simple phimosis. Please ensure fungal infections and balanoposthitis have been excluded or treated before considering referral.)

Please note that an inability to retract the foreskin in an adult is a risk factor for penile cancer and patients 18 and over with this problem should be referred routinely following a Prior Approval application.

Other benign penile conditions

Patients with other benign penile or scrotal conditions cannot be referred routinely for NHS treatment due to funding policy restrictions.

This includes:

• Peno-scrotal webbing.
• Bowenoid papulosis - Erythroplasia of Queyrat and bowenoid papulosis (pcds.org.uk) - refer via 2WW if malignancy suspected (see red flags above).
• Condyloma acuminata (ano-genital warts) - Warts (pcds.org.uk). See also local guidelines: Sexual Health Guidelines and Referral
• Ectopic sebaceous glands (Fordyce spots)- Fordyce spots (pcds.org.uk)
• Pearly penile papules - Pearly penile papules (pcds.org.uk)

Patients requesting referral should be advised the following:

The procedure you are requesting is not routinely funded by the NHS. The only way to have this funded would be to secure Exceptional Funding having put forward a strong argument for clinical exceptionality. 

Referral

For penile conditions which fall under funding policies please ensure criteria are met before referring.

Referrals should be submitted via eRS.

If advice is required about appropriateness of referral then please consider using the Urology Advice and Guidance service available via eRS.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.