Pearly Penile Papules

 

Pearly penile papules (also known as hirsuties coronae glandis, hirsutoid papillomas, or simply (PPP) are small protrusions that form a ridge on the glans or “head” of the penis. The papules most commonly appear as one or several rows of small, pearly or flesh-colored, smooth, dome-shaped bumps situated circumferentially around the corona, or “rim” of the glans. They may range in size from less than 1 millimeter to 3 millimeters in length.

 

Although they are sometimes confused with HPV warts, pearly penile papules are a normal, entirely harmless anatomical variation that cannot be transmitted between individuals. They are not caused by sexual activity or lack of hygiene, and they are not infectious or contagious, unlike genital warts. Additionally, they are not malignant or pre-malignant, meaning cancerous, or malevolent in any way.1 It is important to differentiate harmless conditions like pearly penile papules and Fordyce spots from actual sexually transmitted infections, as individuals with pearly penile papules often feel stigmatized by potential sexual partners who do not understand that the condition poses no risk to either person's health. Pearly penile papules are a common skin variation and are estimated to be present in roughly a quarter of adult males, with actual percentages reported between 14 and 43 percent.2 For unknown reasons, pearly penile papules appear more commonly in males who are uncircumcised.

 

 

 

 

Symptoms

 

Not counting the appearance of the papules themselves, pearly penile papules are an entirely asymptomatic condition, experiencing no symptoms. However, psychological distress due to the appearance of PPP may result in low self esteem, self consciousness, anxiety, and in general, issues with intimacy as a whole.

Causes and Risk Factors

 

Medical science has yet to determine the actual physiological cause of pearly penile papules. Although, it is theorized that the bumps are merely vestigial remnants of sensitive penile protrusions known as “penile spines” found in the same location in other primates.3 In those species that retain the full expression of penile spines, the spines contribute to sexual pleasure and quicker orgasms. This effect is not observed in human males, as pearly penile papules do not appear to have any physiological role in one's penile sensitivity or sexual performance. However, race and circumcision are suggested risk factors in developing pearly penile papules. Several reports suggest an increased incidence of PPP in uncircumcised versus circumcised males (22% vs. 12%, respectively). One study found a greater incidence in black versus white males, in those circumcised (21% vs. 7%, respectively) and uncircumcised (44% vs. 33% respectively).2

 

 

 

Prognosis

 

Although age is not a clear defining factor in the onset of pearly penile papules, most individuals report onset of pearly penile papules between 20 and 40 years of age. Additionally, there have been many reported cases of PPP onset in males shortly after reaching puberty.4 Because pearly penile papules can be so small, some males do not even realize they have them until much later in life.

Diagnosis

 

A diagnosis of pearly penile papules can be obtained from a dermatologist or similarly trained physician. The differential diagnosis (elimination of possible alternative conditions) includes condyloma acuminata (genital warts), molluscum contagiosum, ectopic sebaceous glands, and lichen nitidus. Condyloma acuminata are unlike pearly penile papules, due to their less uniform shape and size. Additionally, they  appear to be more wart-like, and might change in appearance over time.5 In addition, genital warts are not typically arranged in neat circular rows surrounding the corona of the glans, as are pearly penile papules. Lesions of molluscum contagiosum tend to be larger in size and marked by navel-like depressions, sometimes with a pink hue. 

Ectopic sebaceous glands and lichen nitidus are both commonly located on the penile shaft and can thus be eliminated from diagnosis. Furthermore, ectopic sebaceous glands are yellowish in color and can often discharge a cheese-like material. On the other hand, lesions of lichen nitidus tend to be flat-topped and are often polygonal in shape. In cases in which the diagnosis is uncertain, a biopsy can be performed, as pearly penile papules have a unique microscopic anatomy.5

 

Treatment

 

Pearly penile papules have the potential to regress over time, however this is not the case for all individuals. Because PPP poses no health risk, treatment is typically only advised if the protrusions are causing psychological distress. Before beginning any form of treatment, it is essential that patients receive a proper diagnosis to avoid the cost and hassle of undergoing a possibly ineffective and unnecessary removal procedure. Surgical treatment for pearly penile papules involves the surgical removal of each papule on the penis, an operation which requires hospitalization and the administration of anesthesia. Under no circumstances should an individual attempt to perform surgery on their own penis. These treatments include (in order of effectiveness):

  • Carbon Dioxide Laser Surgery
    Highly targeted carbon dioxide lasers are used to produce beams of infrared light, which disintegrate the papule tissues at the molecular level. This method is the safest and most effective surgical option available for the treatment of pearly penile papules.

  • Radiosurgery
    High dose radiation is used to selectively ionize the tissue, producing free radicals that are deleterious to the cells. When used to remove pearly penile papules, this procedure is more accurate than excisional or Hyfrecator surgery, but less so than carbon dioxide laser surgery.

  • Cryosurgery or Freezing
    The papules are cooled to extremely low temperatures using liquid nitrogen until they fall off.

  • Excisional Surgery
    A scalpel or lance is used by the surgeon to cut and removes each papule one by one. This method is generally less accurate than others and may result in damage to the surrounding tissues. Manageable pain is to be expected during the recovery stage.

  • Electro-dessication with Curettage using Hyfrecator
    The papules are dessicated (put in a state of extreme dryness) with electricity, after which the residual tissues are removed by scraping or scooping with surgical instruments. This method can be painful unless the patient is anesthetized and may result in permanent scarring. Manageable pain during recovery is to be expected.

 

In addition to the aforementioned surgical treatments, individuals with pearly penile papules have employed a number of holistic home remedies of variable medical efficacy. These treatments nearly always include directly applying liquid(s), gel(s), or paste(s) to the papules for weeks at a time until the bumps appear to shrink in size. Commonly applied ointments include toothpaste, eucalyptus oil, lemon juice, and castor oil.6 Careful research is highly recommended before beginning any type of holistic treatment. Once again, it is recomended to consult a specialist before beginning treatment of any kind. 

 

 

 

 

Coping

 

Individuals with pearly penile papules commonly experience a great deal of anxiety and psychological stress concerning the appearance of their penis. Males with pearly penile papules may feel self-conscious and inferior to those who do not have the condition. These feelings may manifest in sexual difficulty, low self-esteem, and general problems with intimacy.

The best advice for an individual with pearly penile papules for whom surgery is not a viable consideration is simply to love your body. Pearly penile papules is not going to scare away a partner who genuinely cares for you. If you happen to encounter such a person, he or she was certainly not worth the time investment. In the meantime, accept that you are among a select group of rare anatomical variants and focus on the positive aspects. Some partners of individuals with pearly penile papules even claim that the papules enhance their receptive sexual sensations. While it is understandable to feel some anxiety over a physical “abnormality,” especially when it affects such a delicate region of the body, acceptance and respect for oneself is inarguably the healthiest (and most cost-effective) mode of treatment.

 

Concluding Remarks

 

Pearly penile papules are common, asymptomatic lesions that may cause serious concern for patients despite their benign nature. Misconception about their appearance and stigmatization can lead to strained relationships, as fear of a possible sexually transmitted infection calls into question the fidelity between partners. It is important to remember that this anomaly is shared by many other individuals, and has absolutely no medical concerns. Lastly, self love is an important aspect to PPP; cosmetic imperfections or not, as confidence, communication, and acceptance is the best treatment. 

 

References

 1. Duffill, Mark. “Pearly Penile Papules.” DermNet New Zealand. 2008.

 2.  “CO2 Laser Treats Pearly Penile Papules.” American Health & Beauty. 2009. 

 3.  “Penis Spine, Pearly Papules, and Pop Benedict's Balls.” A Primate of Modern Aspect. 2011. 

 4.  “Embarrassing Bodies: Pearly Penile Papules.” Embarrassing Bodies. 2014.

 5.  “Pearly penile papules.” U.S. National Library of Medicine. Oct 2009. 

 6.  “How to Cure Pearly Penile Papules Disease.” Pearly Penile Papules Guide. 2011.

 

 

Last updated 14 May 2019.