Pearly imperfections in the pants

Dear Dr. G,

I am 25 years old and have some kind of skin problem on my glans penis.

I have had the problem since adolescence and doctors have told me these are papules that occur naturally in some men.

Recently, I have become self-conscious, especially when my new girlfriend started asking about this.

On several occasions, she has asked if these unsightly problems at the edges on my glans penis are some kind of sexually transmitted infection.

She is worried these might be genital warts or herpes and I could have caught from a previous relationship.

Naturally, she is reluctant to “go all the way” until I get this skin problem properly diagnosed and resolved.

I confess I may not have been a saint during my university days, but never a reckless risk taker.

What exactly are these pearly papules? Why is it happening to me?

How do I know this is not herpes or genital warts?

And most importantly, how do I get rid of this imperfection in my pants?

Yours truly,
Imperfect Ian

These small, naturally occurring protuberances on the ridge of the human glans penis are commonly known as pearly penile papules (PPP, also scientifically termed as hirsuties coronae glandis or hirsutoid papillomas).

Technically, these are non-pathological and harmless dome-shaped flesh that resembles a ring of pearls and occurs naturally in many men. In fact, most clinicians would consider PPP an anatomical variation of the norm.

The exact purpose and function of the PPP is unknown. It is postulated the papules are the remnant of “penile spines” that are sensitive protrusions in certain species of primates.

The “spines” are believed to generate frictional pleasure in the vagina during penetrative intercourse. It can be said PPP can heighten sexual pleasure and enhance orgasms for female partners – but no study has ever been conducted to compared the sexual performance of men with and without PPP.

Numerous studies, however, have been conducted on the prevalence of PPP. A 1999 study indicated an estimated 8% to 48% of men reported having it to have some degree. Another study also demonstrated higher prevalence of PPP in younger and uncircumcised men.

Overall, PPP was reported to affect 33% of uncircumcised men, as compared to 7% of circumcised males. All the studies seem to indicate the decline in appearance of PPP with advancing age.

Although the papules are thought to be benign in nature and proven to be completely non-contagious, these flesh-coloured lesions are often unsightly, creating anxiety when confused with sexually transmitted infections. PPPs do resemble genital warts, herpes or even syphilis. It is often wise to clear the air with definitive tests to rule out any STIs – providing there was really no guilty past to haunt the present.

When something aesthetically displeasing arises from the pride and joy of the manhood, there will naturally be an abundance of remedies and misinformation about this condition. Sadly, many advertised lotions, potions and operations play on men’s insecurities and the need to cure the imperfection. Many techniques, including the use of lasers, electro-surgery for cauterisation or even cryosurgery have been described to ablate the PPP. Imagine vaporising, electrocuting or even freezing the poor penis to eliminate a benign imperfection that is hardly noticeable! Worse yet, repeated treatments are generally required and the torture begins again.

“This is the very perfection of a man, to find out his own imperfections”, goes a famous quote from Saint Augustine. When it comes to sexual health – especially the possibility of sexually transmitted infections – the emotional fear of our guilty past can dampen the pleasure. As the perfect journey in sex is about trust and respect, it is crucial to clarify past imperfections in order to move forward.

When Dr G is put on the spot, his advice is: “Accepting the beauty of your pearly imperfection is the only way to find the very perfection in the pants!”