Dear Dr Laura,
I’ve got lots of tiny bumps around the edge of the head of my penis and I think they must be warts but I’m too embarrassed to ask my GP. I’m 21 and have only had sex with one person. I’ve met a really nice guy but I’m embarrassed to let him see me. Please help!
I can’t make a diagnosis without seeing you but your description sounds like pearly penile papules (PPP). These are normal! At least 1 in 10 men have them, they usually appear in adolescence or early adulthood and tend to shrink or disappear with age. They’re less common in circumcised men, probably because there is more friction on the head of the penis if you’re circumcised.
PPP are painless, not sexually transmitted, and not associated with sexually transmitted infections (STIs), but they do cause distress as people mistake them for genital warts. PPP are typically pink or white with a smooth surface, shaped like small domes or tiny finger-like projections. They sit in 1 or 2 rows around the edge of the head of the penis, sometimes just a small section, sometimes in a circle around all of the edge.
Other common causes of lumps on the penis are listed below and I’ll talk about each in turn:
Genital warts are sexually transmitted and very common. There were almost 450,000 new STIs diagnosed in England in 2018 and more than 1 in 10 of these (over 57,000 cases) were a first diagnosis of genital warts. They’re caused by human papilloma virus (HPV); most people who carry the virus don’t develop warts so it’s common to get the virus from someone who has no idea they carry it. New cases of warts has dropped dramatically in young people thanks to the HPV vaccine – as a male you won’t have been vaccinated at school but all gay men under aged 45 or younger can get the vaccine from sexual health clinics. The HPV vaccine also protects against pre-cancerous changes in the anus and will hopefully protect against anal cancer (which is commoner in gay men, especially those with HIV), penile cancer and throat cancer, which are associated with HPV infection. Warts tend to have an irregular ‘craggy’ surface and can be prominent or quite flat; there are several treatments including creams and freezing.
Molluscum are caused by a virus called Molluscum contagiosum which can be transmitted through any skin-skin contact; they are very common in children. Sexually transmitted molluscum are less common and can affect the genitals or any surrounding area including the belly, buttocks and thighs. Molluscum are smooth, firm, round bumps, up to half a centimetre wide, and a range of colours from pearly white to pink or yellow. Their characteristic feature is a small dip in the centre, like tiny doughnuts! There are usually no symptoms, though sometimes molluscum are itchy or uncomfortable and if you touch or squeeze them you can spread them to other bits of the body – shaving or waxing can cause them to spread, so avoid this. Don’t share towels and cover them up when swimming. Molluscum go away within months without any treatment but if they’re causing anxiety or symptoms clinics may offer treatment including cream or solution to apply at home, freezing or cutting them out.
Finally, sebaceous glands can be quite prominent – these are completely normal. They look like raised, skin coloured lumps and if they get infected they look like spots – exactly like spots on the face.
So, although the most likely cause of the bumps on your penis is PPP, pop along to a sexual health clinic where they can examine you. You can have a check up for STI and have the recommended vaccines (HPV, hepatitis A and hepatitis B). And please don’t be embarrassed – looking at genitals in every shape, size and appearance is what sexual health services do!