External genitalia problems in men
Foreskin problems can occur at all ages. The most common problems are skin abnormalities which may require medical treatment or biopsy, and a tight foreskin known as phimosis. Phimosis in young children is generally normal, and no further intervention is requires unless there is recurrent swelling and redness of the foreskin, or recurrent urinary infections. Phimosis in adults generally requires some sort of surgery to resolve.
There are different degrees of circumcision. As there are fine touch receptors in the foreskin that are not present elswhere, the type of circumcision performed may influence the degree of sexual sensation experienced afterwards. It is not always necessary to remove all of the forskin, and sometimes it is possible to preserve it and perform a lesser operation. There are many ways of performing a circumcision, a careful reconstruction using very thin suture material provides the best cosmetic and functional results. Circumcision can be performed under either general or local anaesthetic.
Scrotal lumps can be alarming. The most important issue is determining whether the lump is in the testis itself or originates from another part of the scrotal contents. This can readily be determined with careful examination by a urologist, and sometimes an ultrasound may be required. In the event that an intratesticular lump is found, urgent surgery may be needed. For all other lumps, surgery is optional and a discussion regarding the causes and natural history of the lump in question and benefits of surgery needs to take place before deciding on treatment.
Chronic scrotal pain can be a debilitating problem. There is often a clear cause, such as a previous operation or inflammation of the epididymis or scrotal contents, sometimes however scrotal pain can be generated by the development of abnormal nerve connections in response to inflammation, or entry of urine due to a prostate problems. The treatment of scrotal pain can be prolonged and difficult, we have had good results with a structured regime of specific analgesic and anti-inflammatory drugs, chronic pain management techniques, injections and as a last resort surgery.