Clinically Reviewed By
Mr Alberto Coscione
Consultant Urological Surgeon · Reviewed June 2026 · Review due June 2027
About Benign Penile & Scrotal Conditions
Benign penile and scrotal conditions are extremely common, and the vast majority are not serious. However, they can cause discomfort, pain, cosmetic concern, or significant anxiety despite the fact that men may delay seeking help due to embarrassment.
Our consultants provide completely confidential assessments in a supportive, non-judgemental environment. Most conditions can be accurately diagnosed at a single consultation, and treatment — when needed — is often straightforward.
The conditions covered on this page include phimosis, hydrocele, epididymal cysts, Peyronie's disease, balanitis, and several other benign penile and scrotal conditions. An accurate diagnosis is always the first step, and in many cases, reassurance alone is all that is required.
Phimosis
Phimosis describes a tight foreskin that cannot be fully retracted over the glans (head) of the penis. It is one of the most common penile conditions seen in a urology clinic and is very treatable.
Primary Phimosis
Present from childhood and persisting into adult life. The foreskin has simply never separated sufficiently from the glans. Common and normal in young boys, but may require treatment if persistent in adults.
Secondary (Acquired) Phimosis
Develops later in life, usually due to recurrent infection, inflammation, or a specific skin condition — most notably lichen sclerosus, which causes progressive scarring of the foreskin.
Symptoms & Impact
- Pain during erections or sexual intercourse
- Difficulty with hygiene beneath the foreskin
- Recurrent balanitis (inflammation of the glans)
- Urinary symptoms — reduced stream, ballooning of the foreskin
Treatment Options
- Topical steroid cream — first-line treatment; effective in approximately 80% of cases when used correctly over 4–8 weeks
- Preputioplasty — a minor surgical procedure to widen the foreskin opening, preserving the foreskin
- Circumcision — day-case surgery; recommended in cases of lichen sclerosus, recurrent balanitis, or failed conservative management
Lichen Sclerosus
Lichen sclerosus (LS) is a chronic inflammatory skin condition that causes progressive scarring and tightening of the foreskin and, in advanced cases, the glans. It requires specific diagnosis — usually by skin biopsy — and targeted treatment. Circumcision halts progression in the majority of cases. Long-term follow-up is recommended as there is evidence LS may carry a small increased risk of penile pre-cancerous lesions.
Hydrocele
A hydrocele is a fluid-filled sac that surrounds one or both testicles, causing painless swelling of the scrotum. It is one of the most common causes of scrotal swelling in adult men and is almost always benign.
Primary (Idiopathic) Hydrocele
No underlying cause identified. Most common in older men. Fluid accumulates gradually between the two layers of the tunica vaginalis. Typically painless, though large hydroceles can cause a dragging discomfort.
Secondary Hydrocele
Develops because of an underlying condition such as infection (epididymo-orchitis), injury, or, rarely, more serious causes. A scrotal ultrasound is therefore always recommended to exclude an underlying worrying cause.
Diagnosis & Management
- Clinical examination
- Scrotal ultrasound — confirms diagnosis and evaluates the underlying testis
- Observation — appropriate for small, asymptomatic hydroceles
- Hydrocelectomy — day-case surgical repair; recommended for large, uncomfortable, or symptomatic hydroceles
Epididymal Cysts
Epididymal cysts are very common benign cysts arising from the epididymis — the coiled tube that lies along the back of the testicle. They are smooth, soft, and clearly separate from the testis itself. They may be single or multiple and can occur on one or both sides.
The great majority cause no symptoms whatsoever. Men most frequently discover them incidentally — either by self-examination or during investigation for another concern. When a cyst contains sperm cells it is technically termed a spermatocele, though this distinction rarely changes management.
Diagnosis & Treatment
- Scrotal ultrasound is the investigation of choice — it confirms the cyst's origin from the epididymis and, critically, excludes any abnormality within the testis itself
- Reassurance and monitoring — appropriate for the vast majority; cysts rarely enlarge significantly and do not carry any risk of malignancy
- Epididymal cyst excision which is a surgical excision under general anaesthetic as a day case; reserved for cysts causing significant discomfort or psychological distress. Men who have not yet completed their family should note that surgery carries a small risk of affecting fertility on that side
Peyronie's Disease
Peyronie's disease is caused by the formation of fibrous scar tissue (plaques) within the tunica albuginea which is the tough sheath surrounding the erectile tissue of the penis. As these plaques are non-elastic, they cause the penis to curve during erection, often with associated pain and erectile dysfunction. It affects an estimated 5–10% of men.
Acute (Inflammatory) Phase
Active plaque formation — typically lasts 6–18 months. Characterised by painful erections, progressive curvature, and sometimes palpable nodules. The degree of curvature may change during this phase. Treatment aims to limit progression.
Chronic (Stable) Phase
Curvature and plaque size are stable for at least 3–6 months. Pain typically resolves. This is the point at which surgical correction can be considered if the curvature prevents or significantly impairs intercourse.
Treatment Options
- Active surveillance — in the stable phase with mild curvature not affecting function
- Collagenase clostridium histolyticum (Xiapex) injections — an intralesional injection therapy licensed for moderate curvature (30–90°) in the stable phase; partially dissolves collagen within the plaque. Note: availability in the UK is currently limited following market withdrawal in 2020 — your andrologist will advise on current access
- Nesbit procedure — shortening of the convex side of the penis; suitable for shorter curvatures with good erectile function
- Plaque incision or excision with grafting — for more severe curvatures; straightens the penis while preserving length
- Penile prosthesis implantation — the preferred option when Peyronie's disease is accompanied by significant erectile dysfunction that has not responded to medical therapy
Specialist Andrology Referral
Treatment for Peyronie's disease is delivered by our andrology colleagues if clinically warranted. Our team will assess your condition and, where appropriate, arrange a prompt referral to a specialist andrologist for targeted treatment.
Balanitis & Balanoposthitis
Balanitis refers to inflammation of the glans penis. When the foreskin is also involved, the condition is termed balanoposthitis. Both are common and usually respond well to treatment once the underlying cause is identified.
Common Causes
- Candidal (fungal) infection — the most common cause; often associated with diabetes or antibiotic use
- Bacterial infection
- Contact dermatitis — reaction to soaps, condoms, or topical products
- Lichen sclerosus
- Zoon's balanitis — a chronic, benign inflammatory condition seen in older uncircumcised men
Symptoms
- Redness, soreness, and swelling of the glans
- Discharge or an unpleasant odour
- Itching or discomfort
- Tightness of the foreskin (secondary phimosis)
Treatment is directed at the underlying cause — antifungal cream for candidal balanitis, antibiotics for bacterial infection, avoidance of irritants for contact dermatitis. Men with recurrent episodes, particularly in the context of phimosis, may benefit from circumcision.
Important — Atypical or persistent lesions
Any persistent, atypical, or non-healing lesion of the glans or foreskin must be carefully evaluated to exclude more serious penile conditions. Biopsy may be recommended if the diagnosis is unclear.
Other Penile & Scrotal Conditions
Other benign conditions may affect the penis and scrotum. Our consultants can assess and advise on all of these, and where specialist treatment is required, we will arrange an appropriate referral.
Penile Skin Conditions
Conditions such as lichen planus and psoriasis can affect the penile skin and foreskin. These are managed in conjunction with dermatology colleagues where appropriate.
Penile Warts (HPV)
Genital warts caused by human papillomavirus (HPV) are primarily managed via a GUM (genitourinary medicine) or sexual health service, where specialist treatment and sexual health screening are available.
Meatal Stenosis
Narrowing of the urethral meatus (the opening at the tip of the penis) can reduce and deflect the urinary stream. Often associated with lichen sclerosus. Treated by meatotomy or meatoplasty — a minor surgical procedure to widen the opening.
Scrotal Skin Conditions
Eczema, sebaceous cysts, and other benign scrotal skin conditions are commonly encountered. Sebaceous cysts of the scrotum may become multiple and can be excised if symptomatic or cosmetically troublesome.
Vasectomy
Vasectomy is a minor surgical procedure for permanent male contraception. It involves dividing or sealing the vas deferens — the tubes that carry sperm from the testicles — so that sperm can no longer reach the ejaculate. It is one of the most reliable forms of contraception available, with a failure rate of less than 1 in 2,000.
The Procedure
- › Performed under local or general anaesthetic as a day case
- › Takes approximately 20–30 minutes
- › The no-scalpel technique is not offered at London Urology Specialists — referral to a specialist colleague available if preferred
- › You can usually return to work within a few days
What to Know
- › Should be considered permanent — reversal is possible but not guaranteed
- › Does not affect sexual function, libido, or hormone levels
- › A semen analysis at 12 weeks is key to confirm that the procedure has been successful
- › Alternative contraception must be used until clearance is provided
- › A small number of men (1–2%) experience chronic post-vasectomy pain syndrome (PVPS) which is a persistent scrotal discomfort that can usually be managed conservatively
Circumcision
Circumcision is the surgical removal of the foreskin. It may be recommended for medical reasons such as phimosis, recurrent balanitis, and lichen sclerosus or performed as an elective procedure. It is one of the most commonly performed urological operations worldwide.
Medical Indications
- › Phimosis (tight foreskin that cannot be retracted)
- › Recurrent balanitis or balanoposthitis
- › Lichen sclerosus (BXO)
- › Paraphimosis (foreskin trapped behind the glans)
The Procedure
- › Performed as a day case under local or general anaesthetic
- › Takes approximately 30–45 minutes
- › Dissolvable stitches — no removal required
- › Full recovery typically within 4–6 weeks
Where phimosis is the primary issue and the patient wishes to preserve the foreskin, a preputioplasty (widening of the foreskin) may be offered as an alternative. Your consultant will discuss all available options with you.
Investigations & Treatment
Most benign penile and scrotal conditions can be accurately diagnosed at the initial consultation through clinical examination alone. Where imaging or further investigation is required, the following are most used:
Scrotal Ultrasound
The most important imaging modality for scrotal pathology. Differentiates cysts from solid lesions, characterises hydroceles, and evaluates the testis.
Skin Biopsy
Recommended when the diagnosis of a penile skin lesion is uncertain, or when lichen sclerosus, or other inflammatory conditions are suspected.
Urinary Assessment
Urine flow rate, post-void residual measurement, and urine culture where urinary symptoms or meatal stenosis are present.
Treatment is always tailored to the individual, to the specific condition, the patient's symptoms, and their clinical and personal circumstances. The range of treatment spans from reassurance and topical therapies through to outpatient procedures and day-case surgery. Our consultants will discuss all options clearly before any treatment is undertaken.
Meet your Specialists
Assessment and treatment of penile and scrotal conditions is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists.
Key Takeaways
Benign penile and scrotal conditions are among the most common urological presentations, and they are very rarely harmful. With the right assessment, an accurate diagnosis can be reached quickly and a clear management plan put in place.
For many men, that plan begins and ends with a single consultation. There is no reason to delay seeking advice — our consultants will treat your concerns with the confidentiality, professionalism and respect they deserve.
Further Reading — BAUS Patient Information
Frequently Asked Questions About Penile & Scrotal Conditions
Concerned About a Penile or Scrotal Condition?
If you have noticed a lump, swelling, pain, skin change or any other symptom affecting the penis or scrotum, our specialist team can provide a thorough assessment, explain the most appropriate treatment options, and arrange any onward investigations or specialist referral if required.