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What's Normal?

Normal Variations - Do Not Adjust Your Set !

"Oh my God ! Look at those lumpy bits. I'm gonna die, I've got genital warts or maybe it's syphilis ! Why did I take that risk ? How can I possibly go to the clinic? My life is ruined". Eventually, six months later, the above distraught individual finally plucks up courage to go to the GU Clinic, only to be told those lumps are completely normal, they have always been there - you have just never looked that hard before.

The above story is not fantasy. It happens everyday in GU Clinics up and down the country. First of all, if people are worried, they should have no hesitation in going to a GU Clinic that are staffed by kind sympathetic people who have seen it all before. In the meantime, this section deals with common, normal lumps and bumps that can often be mistaken for something more serious by people who have never seen them before. Let's face it, how can mere mortals be expected to know these subtle variations, they haven't examined thousands of genitals, whereas, we have --- we get paid for it ! Let's do the men's bits first, as believe it or not, they are usually the most neurotic and anxious in this area.

Pearly penile papules

You can't accuse us GU Doctors of not being poetic or having sense of fun and imagination. However, the term pearly penile papules does describe them - it's like that tin of varnish, and it does exactly what it says on the tin. Just take a look at the picture, where you will see those nice rows of small pearly papules all around the raised up bit at the head of the penis. See the picture - All men have some of them, some men have lots of them, and some have few, but if you look carefully you will always find these little dots all around the rim at the head of the penis. They are normal glands and cannot be removed. They produce tiny amounts of oily secretions that keeps the skin healthy. If a man has a circumcision, it obviously dries out the head of the penis and these gland areas, and they often become extremely difficult to find.

Pearly Penile Papules

Smegma

Yes - This smells exactly like it sounds ! It must be one of the few words in the English language that can create a sense of revulsion at the mere mention. The stuff can smell like toe jam or even worse, over ripe brie that has been forgotten about and suddenly re-discovered. The glands I described above, ie. penile papules and other glands in the foreskin area produce oily chemicals that need to be washed away DAILY. It is extraordinary the number of men who don't pull back the foreskin and wash out the area with soap and water. Even after just two or three days without doing this, when the foreskin is pulled back, the smell is atrocious. Sadly, the least appealing part of working in Genitourinary Medicine is when you peel back the foreskin and you get a whiff of the noxious fumes. It was so bad once, I told one young chap - "Look take that home and wash it, and bring it back here this afternoon, and then I'll have a look".

 

Have a look at the picture. This was a young man in his mid twenties who had no idea that he should be pulling back the foreskin to wash out the stuff underneath. We are looking at possibly several years of concretions here. Within one week of soaking it in soap and water, and washing it gently the penis was in pristine condition and would pass any inspection with flying colours. A case of male smegma

Women also, of course, can get this cheesy unpleasant material in the genital area if they don't wash with soap and water but it's usually not as bad as the men, because it's not covered up as much. If someone has very delicate genital tissues they may prefer to use a soap that has no chemicals or perfumes in it, ie. Simple Soap, which can be bought in any supermarket. However, it's important to mention that water alone will not do, as these secretions are oily and need the help of soap or soap substitute to clear them.

Lymphocele

This is a cord like swelling just below the head of the penis and can be quite alarming when it's first discovered. There are several drainage systems in the body - some carrying blood back, ie. veins, and there's another system called lymphs, where fluid from the tissues is carried back in lymph channels. These can sometimes block up and solidify, giving the swelling you see here in the picture. It usually occurs after vigorous sex or masturbation. Quite commonly, if the area is examined, you can see the swollen lymph channels, but then gradually subside. However, if one of them solidifies, ie. clots up, the swelling doesn't go down and it stays as a hard cord like area, which can be easily felt. Some patients think they've got skin cancer there and can be alarmed. There's no treatment needed for this. It just gradually disappears itself.

Lymphocele

WOMEN'S SECTION

The female genital area can be a minefield of anxiety and surprises. There are lots of lumps and bumps and glands that can cause alarm, particularly if they are looked for with a sense of guilt !

Vestibular glands

Just at the entrance to the vagina there are small little sticky outy bits towards the back. They are exactly identical, ie. they are on both sides and match up perfectly. In some women they can be quite large and can easily be mistaken for genital warts, even by experienced GU staff. This picture here shows a good example of these small frond-like bits of tissue. Of course, these are completely normal and should not be tampered with. Even this case was initially mistaken in the GU Clinic for genital warts and the patient treated with wart treatment

Vestibular Glands
 

THINGS COMMON TO BOTH MALE AND FEMALE

The Fordyce saga

These small white glands are just underneath the skin and appear in patches in both the male and female genital areas. The males are more often found around the prepuce or the skin that pulls back. They can be very prominent in some people and can be easily mistaken for genital warts. However, these do not change, whereas warts always grow bigger if they are left alone. Have a look at the picture there and you can see some Fordyce spots, and you can also see a proper genital wart beside them. This shows a good contrast. Similarly, look at the picture from the female area and you will see these lumpy bits quite often found near the outer lips of the genital area.

Fordyce Spots Female Fordyce Spots

Sebaceous cysts

These are quite firm, yellow lumps, that collect just underneath the skin in both male and female, and can occur anywhere in the genital area, but in females it is more commonly around the outer lip area, and in men they are usually found on the scrotum. This picture here shows some sebaceous cysts in the outer lips. They are just blocked up glands and they rarely, if ever, cause any problem. They can be alarming and may be a bit unsightly, but there is no need to do anything about them, unless the patient is actually alarmed or worried, or very very rarely if they become infected, they can be removed surgically. By and large, it's best to leave them alone, don't squeeze them or try and get rid of them yourself - just leave them.

Sebaceous cysts

 
Reproduced with the kind permission of Chester Sexual Health

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