You have noticed small papules lined up in a row along the edge of the glans. The first thought is usually the worst one: a venereal disease. The second: who to tell.
So let's start with the answer you came here for. If these are pearly penile papules, this is not a disease at all — it is a physiological feature of the skin of the penis. They are not contagious, they are not sexually transmitted and they do not require treatment.
The rest of this article is here so that you know how to recognise them and how they differ from lesions that really do need to be shown to a doctor.
What pearly penile papules actually are
In English, pearly penile papules or hirsutoid papillomas of the penis, in Latin papillomatosis coronae penis (PPP for short). There are several names, but behind each of them lies the same thing: a completely physiological change that is not a sign of any disease whatsoever.
Their formation has nothing to do with sexual activity. Nor with hygiene. The causes are still unknown — it is assumed that they are simply a natural product of the penile epithelium, an anatomical variant of the skin of the penis.
They occur in 14 to 48 percent of men — the range is wide because it depends on the population studied. The data on who is affected more often is inconsistent — some studies describe them as more common in uncircumcised men, others the other way round; a higher frequency has also been described in men with a darker complexion. There are, however, no grounds for treating removal of the foreskin as a way of getting rid of the papules.
They most often appear around the age of 20 to 30, although it happens that someone notices them for the first time only after fifty. They become less and less common with age.
What they look like and how they feel
Small papules — dome-shaped or elongated, ranging in size from 0.5 to 4 mm. Flesh-coloured or pearly, with a shiny surface.
They resemble small pimples, but that resemblance is misleading: nothing oozes out of them. Under the finger they feel like fine grains or semolina.
They are usually located at the base of the glans, in the so-called coronal sulcus, in one or several rows. On the glans they usually occur in large numbers and form a kind of ring. They increase in size during an erection.
They are painless. Many men do not notice them at all.
This is the most important part: what they can be confused with
This is exactly why you found this article. Lesions in the intimate area always require differential diagnosis, and before diagnosing pearly penile papules all similar-looking eruptions must be taken into account.
The most important distinction concerns condylomata acuminata, or genital warts — and it is particularly important in men who are already sexually active.
- Cause. Pearly penile papules — a physiological product of the penile epithelium, an anatomical variant. Genital warts — infection with the human papillomavirus (HPV 6, 11).
- Contagiousness. Pearly penile papules — no, they are not sexually transmitted. Genital warts — yes, they are a sexually transmitted disease.
- Appearance. Pearly penile papules — small dome-shaped or elongated papules, 0.5–4 mm, flesh-coloured or pearly, shiny. Genital warts — pedunculated papules with a “cauliflower” shape.
- Location. Pearly penile papules — the base of the glans (coronal sulcus), in one or several rows, often forming a ring. Genital warts — most often the shaft of the penis, also the coronal sulcus, the frenulum and the inner surface of the foreskin.
- Do they require treatment. Pearly penile papules — no; they are removed for aesthetic reasons only. Genital warts — yes, they require treatment.
So the difference is fundamental. Pearly penile papules are an anatomical feature you simply live with. Condylomata acuminata are the result of a viral infection and a matter for a doctor — not least because they concern more than just you.
If you have any doubt about which of these descriptions matches what you see — do not decide it yourself. That is what a doctor is for — and it is an ordinary diagnostic appointment, just like any other.
Pearly papules are not the only change on the penis that can be mistaken for genital warts. The second one is Fordyce spots — small, yellowish papules most often visible on the shaft of the penis. These are ordinary sebaceous glands located where they are not normally found. Like pearly papules they are completely benign, they are not contagious and they do not require treatment. If what you can see is on the shaft and not on the rim of the glans, that still does not mean it is genital warts.
And do pearly papules occur in women?
No. Pearly penile papules can occur only in men.
This matters, because it can be the source of a dangerous misunderstanding. In women there is a separate but very similar finding: vestibular papillomatosis. These are small, soft, skin-coloured or pink projections arranged symmetrically in the vaginal vestibule or on the inner side of the labia minora. Just like pearly papules in men, it is a variant of anatomy and not a disease — it has nothing to do with the HPV virus, it is not contagious and it does not require treatment. It is, however, sometimes mistaken for genital warts, and that is a mistake with serious consequences: it leads to unnecessary tests, unnecessary procedures and to a diagnosis of a sexually transmitted disease that was never there. The difference is visible to a doctor: in papillomatosis each projection grows from its own separate base, whereas in genital warts the projections merge into a common one. Do show a lesion in the intimate area to a doctor — but do not assume in advance that it is warts.
What you must not do
Pearly penile papules must not be rubbed, squeezed or scratched.
Attempts to get rid of them with your own hands have absolutely no effect — but they can lead to irritation of the skin and mucous membranes, wound infection and inflammation of the lesions.
Over-the-counter preparations advertised as a way of making these lesions go away have no documented effect. Their efficacy is doubtful at best.
Do they need to be removed
No, they do not.
Pearly penile papules do not require treatment. They do not affect your sex life and they do not increase the risk of malignant tumours. They do rarely resolve on their own, but that is no reason to do anything about them.
There are, however, two reasons why men decide to have a procedure.
The first is how you feel. The papules can lower self-esteem and cause a sense of shame — and that is reason enough to talk to someone about it.
The second is practical: more smegma — the secretion that collects under the foreskin — usually gathers where they occur. With inadequate hygiene this can cause an unpleasant smell.
What removal methods are available
The procedures differ in how they are performed, in price and in indications. The method is chosen by a specialist after diagnosing the lesions, also taking the patient's expectations into account.
- Plasma or CO₂ laser. After an anaesthetic cream is applied, a fine beam “burns off” the papules point by point and they vaporise. A simple, quick and effective method that gives a good aesthetic result and spares the surrounding tissue as much as possible. Healing takes about a week; there is slight swelling and quickly healing scabs. As with any procedure in this area there is a small risk of a scar and of a temporary change in the colour of the skin — which is why, with a lesion that causes no problems, the decision about treatment is entirely yours.
- Cryosurgery. Freezing the lesions with liquid nitrogen, after which the papules flake off. The procedure is short, needs no stitches and the skin heals on its own.
After the procedure you must observe temporary sexual abstinence, so as not to cause complications while the area heals. Proper hygiene and care of the intimate area also matter.
Finally: this is not what you are afraid of
If you have noticed pearly papules on yourself, statistically the most likely explanation is the least dangerous one — an anatomical variant that between a dozen or so percent and nearly half of men live with.
But do not guess. Show the lesion to a dermatologist. An experienced eye distinguishes pearly penile papules from condylomata acuminata with great accuracy, and the appointment takes a few minutes.
One more thing, to take away any worry about the appointment itself: the diagnosis usually requires neither a biopsy nor testing for HPV. The doctor looks at the lesion, with a dermatoscope if needed, and that is usually enough — the arrangement of the papules and the way they grow are characteristic for both of these conditions. It does happen, though, that condylomata and pearly papules coexist in the same person, which is why the whole area is examined, not only what is bothering you.
If, after the diagnosis, you decide you want to get rid of the papules — the doctor will advise which method will be best in your case. And if you decide to leave them alone, that is a perfectly correct decision too.
In our clinics we remove pearly penile papules using a non-surgical method — the procedure costs 1000 zł and takes a dozen or so minutes.
This article was prepared by Anna Grodecka, MD.