Medical mystery solved: Penis ulcer a delayed reaction to filler for penis enlargement

Doctors in Spain had a medical mystery on their hands when a male patient showed up with a painful ulcer on his penis. But it wasn’t a sexually transmitted infection. A case report in JAMA Dermatology revealed that the problem was a reaction to the injection of an unapproved dermatologic filler. But it took a lot of medical sleuthing to find the cause, and in some parts of the world the problem is growing.The patient, a man in his 30s presented with a painful ulcer on the penile shaft. It had appeared three months earlier, and there were scars from other ulcers. Because his medical history included unprotected sexual intercourse along with complaints of recurrent self-healing penile ulcers the past three months, doctors started testing for a variety of sexually transmitted infections (STIs).He was tested for herpesvirus types 1 and 2, Treponema pallidum, and Chlamydia, as well as bacterial infection. When those came back as negative, more tests were conducted, including for syphilis, HIV and hepatitis C and hepatitis B virus, which also came back negative.A biopsy was then conducted and the sample underwent histopathological study, revealing diffuse dermal hyaline fibrosis with cystic spaces of variable size. According to the paper, it looked like Swiss cheese. There were also spots where the skin had died. The diagnosis was sclerosing lipogranuloma of the penis (SLP).The cause? It turned out that two years earlier the patient had received several injections of kanamycin ointment, which contained paraffin, to help enlarge his penis size.Surgically removing the injected material along with the damaged tissue is the treatment of choice. But removing the injected material is complex, and often requires imaging, multiple procedures as well as reconstructive procedures, the paper said.The patient refused any more treatment or tests.According to the authors, SLP results from a reaction to lipid compounds that are injected for penis enlargement.“The most commonly injected materials include paraffin and silicone (resulting in conditions known as paraffinoma and siliconoma, respectively), followed by olive oil, motor oil, cod liver oil, or vaseline,” they wrote.These are not standard, accepted dermatologic fillers. They noted that “self-injection of kanamycin ointment are almost exclusively reported in Romania,” which is where the patient was originally from.However, the problem is apparently on the rise with reports of an increased incidence in Thailand, Korea and Eastern Europe. It is especially prevalent among incarcerated individuals.The researchers added that “Penile injections are typically administered in a non-standardized manner by nonprofessional individuals or by patients themselves.”A review paper in Sexual Medicine Reviews on penis girth enlargement stated that a common trigger for men undergoing the procedure is penile dysmorphophobic disorder (PDD) which is a severe preoccupation with penis size. And that most men looking for augmentation actually have a normal sized penis.The paper stated “men who perceive their penis to be smaller than average account for as much as 91% of the general population. Because this preconception is further proliferated by mainstream media, men are increasingly seeking medical solutions for ‘inadequate’ size.”When it comes to procedures, there are multiple approaches in the normal medical arena such as soft tissue fillers, surgical procedures and medical implants. But they all have risks and don’t always give the patient what they want.“There are still no accepted standardized methods to determine the physical, clinical, and psychological benefits of these interventions. Furthermore, complications of penile girth enhancement are likely widely underreported.”The authors noted that for patients wanting penile enlargement should first be assessed for PDD.

Medical mystery solved: Penis ulcer a delayed reaction to filler for penis enlargement

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