MEN'S HEALTH MATTERS:The inflammation may be caused by any of the common conditions which can affect the skin
Q I have had a red rash on the top of my penis for the last two years, which comes and goes. I have been to see my doctor and I have been treated with an antifungal cream. This does clear it up, but once I stop it, it recurs. I am worried that I have got a resistant infection.
A It is very unlikely you have a resistant infection, but I would advise you discuss this with your doctor and if necessary be referred to an appropriate specialist.
This may be a condition called balanitis, which is inflammation of the glans or head or the penis. Red or pink patches on the glans are not uncommon and there can be associated tenderness, oozing, discomfort and itching.
Inflammation of the skin on the penis can be caused by any of the common conditions which can affect the skin elsewhere on the body, such as eczema, psoriasis, allergy, lichen planus etc. There are also some skin conditions which affect just the skin of the genitals. An example of this is plasma cell balanitis. Your doctor or dermatologist should look for signs of skin disease elsewhere and this may give a clue as to the diagnosis.
There is a form of balanitis, which is called non-specific, when no other cause is found. It is thought it may possibly be an irritant reaction to the normal bugs that are found in small numbers on normal skin.
Non-specific balanitis nearly always affects uncircumcised men as the foreskin keeps the area moist and this permits the bugs to grow. There are, however, other factors. Infrequent washing or over frequent washing, some irritants such as creams, lubricants can play a role.
Treatment will depend on whether there is an associated skin or systemic disease. Occasionally a biopsy or sample of the skin may need to be taken to confirm a diagnosis.
Personal hygiene is also very important and the aim is to keep the head of the penis and the foreskin clean and dry. Daily showering with particular attention to cleaning the glans, washing with warm water, avoiding using soap in the area using a non-soap cleanser such as aqueous cream instead.
After showering, dry the area and make sure the head of the penis is completely dry before replacing the foreskin. Prescription treatments include topical antifungals, antibiotics or antiseptics. A mild topical steroid may be used on its own or in conjunction with one of these. If the problem persists it may be useful to request a referral to a genitourinary physician, an urologist or a dermatologist.
Q My husband is a teacher and has noticed that his voice has become hoarse recently. He was seen by a specialist and was told that he has vocal cord nodules. What does this mean and how can it be treated?
A When we speak, air from our lungs travels up through the trachea (windpipe) and into the larynx (voice-box), which houses our vocal cords. Our vocal cords, which are two delicate muscles, vibrate to create sound which is then shaped into different sounds in the mouth.
Voice disorders including vocal cord nodules, may develop if interference with this normal vocal mechanism occurs. Vocal nodules can develop in people with vocally demanding occupations, eg teachers, singers, and coaches.
If hoarseness persists for more than two or three weeks, it is advisable to make an appointment with your GP.
Vocal cord nodules are benign (non-cancerous), localised growths that occur on the vocal cords. Vocal misuse/abuse is a common cause for nodules, eg prolonged loud talking or shouting, singing inappropriately or speaking with an unnatural pitch.
One or both cords may be involved, vary in size and may re-occur if the vocally abusive behaviours persist. Symptoms include a slowly developing hoarseness, a breathy voice, reduced vocal range and vocal fatigue.
Initially a full examination by an ear, nose and throat (ENT) specialist is required to diagnose the presence of vocal cord nodules. A referral is then usually made to the speech and language therapist for further assessment and treatment of this voice disorder.
In voice therapy, assessment includes obtaining a case history and looking at different vocal parameters including respiration, phonation and resonance. Therapy involves eliminating the behaviours that caused the nodules. This may include, identifying and eliminating negative vocal habits, relaxation techniques to eliminate tension, optimising breathing to support the voice as well as specific vocal exercises to strengthen or modify vocal use.
Nodules usually regress through voice therapy with a speech and language therapist in the majority of cases.
In rare cases, surgery may be required if voice therapy is ineffective.
Ways to prevent vocal cord nodules include:
Avoid screaming and consistent loud talking.
Avoid consistent throat clearing.
Not whispering or speaking at a higher or lower pitch than is natural.
Avoid singing if not properly trained.
Relax your head and neck area.
Get your indigestion treated since heartburn/reflux can damage your voice.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Patrick Ormond, consultant dermatologist and dermatological surgeon, St James's Hospital, Dublin and Valerie Flood, senior speech and language therapist, St James's Hospital