I have seen how profound the effects of erectile dysfunction and penile curvature can be on a man’s quality of life. Indeed, the penis holds a unique place in the male psyche, influencing all kinds of behavior like no other organ. Robin Williams probably said it best: “God gave man both a penis and a brain, but unfortunately not enough blood supply to run both at the same time.” But there’s one penis problem that out-haunts any other that men may have by a long shot: penis cancer. And what’s most concerning is that rates of penile cancer may be increasing.

Penile cancer typically presents as a painless, nonhealing sore or growth on the penis. Sores can be a reddish, velvety rash or be small, crusty bumps that may bleed. Growths are usually flat and bluish/brown in color. Neither respond to antibiotics or topical steroids. There may also be bleeding from the penis (sometimes from under the foreskin) or or thickening of the foreskin that makes it difficult to draw it back behind the penis (phimosis). Penile cancer can be life threatening, but it can also be treated. The rub here is that curing penile cancer typically involves its amputation, a procedure with a psychosexual impact that has no equal.

Bulging Statistics

Penile cancer is rare in the US, occurring in fewer than 1:100,000 men. However, it is more common in Africa, Asia, and South America. For the past half-century, penile cancer rates were falling… that is, until the third millennium. Recent data from England, Denmark, and the Netherlands, countries whose rates of penile cancer have traditionally mirrored that of the US, now show 20-30% increases in penile cancer diagnoses over the last 30 years. More concerning is what’s happening in Brazil where penis cancer rates are double that of the US and rising. In fact, Brazil reported more than 6,500 penile amputations over the last 10 years, which is an average of 2 per day!

Known Risk Factors

So, what drives the development of this unmentionable cancer? Known risk factors for penile cancer include being uncircumcised and having poor penile hygiene, multiple sexual partners, and a history of genital warts or other sexually transmitted diseases. Tobacco use, advanced age, phimosis and other inflammatory conditions of the penis, and UV light treatment for skin conditions have also been linked to penile cancer.

One risk factor that has recently come to light is infection with human papillomavirus (HPV), the virus linked to genital warts and cervical cancer. Importantly, there are “low risk” forms of HPV (types 6 and 11) that cause genital warts but are not a risk factor for penile cancer. There are also high-risk variants (types 16-65) that are associated with both cervical and penile cancers. It may not be coincidental that HPV DNA is found in 20% of penile cancer cells and, by some estimates, 60-80% of penile cancers are now thought to be HPV-related.

Minding the Missile: Preventative Measures

So, how do we stop the dreaded progression of penile cancer? The key is to reduce risk. Here’s what you should think about:

• If you are not cut, make sure your personal hygiene is up to snuff with daily penile cleaning with the skin retracted. The risk of penile cancer in uncircumcised men with good hygiene is no different than circumcised men.
• If you are uncut and unclean, consider circumcision. A recent meta-analysis of over 24,000 men found a 33% reduction in HPV infection in circumcised vs. uncircumcised men
• Protect your sex! Use barrier contraceptives consistently to reduce the risk of STDs. The STDs that run most with HPV are herpes simplex type 2 and chlamydia trachomatis.
• Consider getting the HPV vaccine. In 2018 the FDA approved the expanded use of the GARDASIL 9 vaccine to include men and women ages 27 to 45. The vaccine protects against nine types of HPV and can prevent genital warts, cervical cancer, and likely penile cancer.
• Trim the number of sexual partners, alcohol use, and smoking. All of these have been associated with increased male HPV infection.

Ben Franklin once said that “an ounce of prevention is worth a pound of cure.” And believe me, when it comes to penile cancer, that “pound” of cure is one whole ton of trouble. Take the preventative ounce and take it regularly so that you will have no regrets.