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Pearly Penile Papules (PPP)

Pearly Penile Papules (PPP) are a common occurrence in young men, and are actually a variation of normal anatomy.

They appear as multiple, distinct growths arranged symmetrically in a circular pattern at the base of the penile head (assuming the penile tip as a triangle where the tip of the penis represents the tip of the triangle).

These papules are usually arranged in 1-3 circular rows, set a couple of millimeters apart.

Symptoms

What are the symptoms of Pearly Penile Papules?

Pearly Penile Papules usually present as small (1–3mm) pearly, dome-shaped bumps that typically appear around or under the corona of the glans (the head of the penis). They may be flesh-coloured, white or yellow and often appear in rows. They are painless and do not cause any adverse effects. They are not itchy and do not cause any penile discharge or smell. They may change over time, and often regress with age.

Many young men present to sexual health clinics with great concern or embarrassment after noticing these penile papules. The attention to these lumps can be drawn during changes of puberty or after a sexual contact, and can knock off the confidence of young men.

Sometimes a patient attends the clinic on multiple occasions to have STI checks to seek reassurance, and it may take a while for the patient to share their concern about PPPs with the nurse or doctor.

If a patient has had a genital examination with their doctor in primary care or in a specialist sexual health clinic, normally the doctors will not mention the presence of Pearly Penile Papules as it is not a specific medical illness and does not require any treatment.

What areas of the penis can Pearly Penile Papules affect?

Normally, Pearly Penile Papules appear right at the edge of the coronal ridge (i.e. the circumference at the base of the glans penis).

They can also appear in more than one row (sometimes as many as 4-5) and where one of the rows becomes more prominent compared to the others. In these situations, the rows of Pearly Penile Papules can also be present on the side wall of glans penis, declining towards coronal sulcus (as shown in the pictures).

What are ectopic Pearly Penile Papules?

Ectopic means “away from the usual site”. When Pearly Penile Papules are present at unusual locations, they are described as ectopic Pearly Penile Papules.

Ectopic PPPs when present are generally present in addition to the typical PPPs.

Examples include:

Ectopic PPP on the glans penis itself

Occasionally the Pearly Penile Papules may appear sporadically on the body of glans penis itself.

Ectopic Pearly Penile Papules on the coronal sulcus

Rarely PPPs may largely be present on the groove of the  coronal sulcus. They can be so numerous and cluster together to give the appearance of an odd skin condition but the true nature of the lesions become quite apparent when the skin is examined after stretching it.

I have some bumps on the side of my frenulum?

Many men have pearly white looking glands, symmetrically placed on both sides of the frenulum. These are called parafrenular glands, and can be treated at the same time as part of PPP treatment. However, some men may have a larger cluster of such glands.

When do Pearly Penile Papules start to appear?

Pearly Penile Papules appear as a part of development of secondary sexual characteristics early during adolescence. As one goes through the years of adolescence, the tiny pearly papules remain tiny in most individuals. However, they grow in others during these years and become conspicuous to become much more noticeable as the years go by, and reach their maximum size by 21 years of age.

Pearly Penile Papules reach a maximum size by the time adulthood has set it, typically 21 years of age. These spots rarely grow any further in size or number after this age.

Pearly Penile Papules tend to recede (become smaller in size) in some individuals in their 50s, presumably due to decline in testosterone level around this time.

What complications can Pearly Penile Papules lead to, if untreated?

There are no complications associated with having Pearly Penile Papules as they are a common and normal part of penile anatomy. They are not associated with sexually transmitted infection, personal hygiene or development of any cancers.

Causes

Who can get Pearly Penile Papules?

Anyone with a penis can have Pearly Penile Papules, however, they are found more commonly in younger people, with the highest incidence found in those aged 20–40. They generally appear after puberty, and may be more common in Black people and those who have not been circumcised.

What causes Pearly Penile Papules?

Pearly Penile Papules are thought to be an embryological remnant of penile spines, which are still present on the penis of some other primates.

Penile spines play an important role in animals such as ducks, where the friction of the spines in the female genital tract is thought to induce ovulation. The papules in humans often secrete an oily substance called sebum, which acts to lubricate the penis.

There is a hypothesis that Pearly Penile Papules play a role in sexual stimulation of the female, however this is yet to be investigated.

Is Pearly Penile Papules infectious?

Pearly Penile Papules are part of the normal anatomy of the penis and are not caused by an infection. PPP is not an indication of poor personal hygiene – a common misconception.

Can I pass on Pearly Penile Papules?

As Pearly Penile Papules are not infectious in origin, they cannot be passed on to anyone else.

Are Pearly Penile Papules an STI?

Pearly Penile Papules are not a sexually transmitted infection and are common in all men regardless of if they are sexually active or not. Sexual activity appears to have no effect on the development, progression or regression of PPP, and they do not increase the risk of contracting an STI.

Diagnosis

Key Information

Routine method of diagnosis

Visual examination under illumination

Distinguishing features

Yes, we provide local anaesthetic before

Next steps

Treatment not medically required

How are Pearly Penile Papules diagnosed?

Pearly Penile Papules are primarily diagnosed based on inspection of the lesions. It is important that examination is undertaken by a clinician experienced in dealing with penile skin conditions so that a correct diagnosis is made (and other possible diagnoses ruled out).

Occasionally PPPs are misdiagnosed as Genital warts, and this results in unnecessary distress, relationship difficulties and unnecessary treatment.

Our approach to  diagnosis includes:

Taking patients concerns seriously
It is important that the patients who have concerns about  or spots on their penis are taken seriously

Unhurried physical examination
Undertaken in a private setting in an unhurried manner

Discuss concerns & anxieties
Concerns and anxieties of patients must be identified during consultation, and the impact of clinical examination, and information available from history by a healthcare professional with expertise in genital health.

Sometimes dermatoscopy can be used to study the lesions in greater detail.

In rare cases where the diagnosis is not clear, a biopsy may be taken off the lesions, which is examined under a microscope. It’s important to see an experienced healthcare professional to rule out other conditions such as sexually transmitted infections, which may require urgent treatment.

What factors can help a correct diagnosis?

Pearly Penile Papules can be misdiagnosed as other conditions such as sexually transmitted infections, skin conditions and other normal conditions. are most commonly misdiagnosed as genital warts or molluscum contagiosum.

The number, size, shape, symmetry as well as pattern of distribution of the lesions are taken into account in making a diagnosis of Pearly Penile Papules.

Pearly Penile Papules tend to be localised to the penile corona, whereas warts and molluscum can affect any part of the genitals. The size of the lesions can also help in the diagnosis; are rarely larger than 1–3mm whereas molluscum lesions are typically 2–5mm in size and genital warts can be variable in size.

Can another condition be mistaken as Pearly Penile Papules?

People with PPP often worry that they have genital warts, and this is the most common misdiagnosis. Other sexually transmitted infections that can be mistakenly diagnosed in a person with PPP include molluscum contagiosum, syphilis and scabies. PPP can also resemble other skin conditions such as folliculitis, an inflammation of the hair follicles; or lichen nitidus, a rare inflammatory skin condition.

PPP can also be mistaken for other variations of normal anatomy, such as the presence of sebaceous glands. Normal sebaceous glands include Tyson’s glands, which appear on either side of the frenulum (the band of tissue connecting the head of the penis to the underside of the shaft), and Fordyce spots, which typically appear along the shaft of the penis. PPP can also be mistaken for skin tags, another normal variation that does not require treatment.

Treatment

As you’ve gathered by now, Pearly Penile Papules are a perfectly normal feature of the body and treatment is not medically required.

However, we have seen many patients for whom life has come to a standstill and it is difficult to build/maintain relationships. In such an event, a simple procedure can help to regain your confidence and rebuild your life.

Learn more about Treatment

Prognosis

What is the long term prognosis for someone who has Pearly Penile Papules?

In many cases, Pearly Penile Papules regress with age, and the incidence of PPP is lower in older people. In most cases however, the papules persist harmlessly, and do not change much over time.

Why can PPP be worrying?

PPPs are an absolutely normal anatomical feature of the human body.

However, many of us do not like their appearance, and can find it difficult to come to terms with them. This can lead to psychological distress, lack of confidence and finding it hard in developing fulfilling relationships. Many patients share with us that it is always in the back of their mind, affecting their focus on studies and work. Many people find it hard to discuss their concerns with anyone, even their doctors.

Many patients have sought help to be told “it is normal”, but this is often not sufficient for them to move on (although it is accurate).

In our clinics, we see men who have discussed their concerns with their parents, and we regularly see some patients accompanied by their mothers.

We like to understand what is the primary concern of our patients seeking treatment for PPPs. In our experience, the underlying reasons tend to be one of the following:

  • A sexual partner has commented
  • That a sexual partner may comment about the appearance
  • That a sexual partner may reject them thinking they have got genital warts
  • In rare cases, PPPs can be really large enough to appear unsightly
  • May remind them of unhappy childhood days and sexual trauma  including coincidence with sexual abuse 
  • Had come to accept them somehow but their concern has resurfaced after separating them from their partner and they are back single again

Do I have to tell my partner I have (or had) Pearly Penile Papules?

PPP is not a sexually transmitted infection so there is no need to inform your partner that you have them. However, PPP are commonly mistaken for an STI such as genital warts, so it may be worth discussing with your partner and reassuring them that it is not an infection and cannot be transmitted to them.

Once treated, am I immune from getting Pearly Penile Papules again?

Recurrence of PPPs is rare, and is a result of the on-going effect of male hormone testosterone. Use of supplemental testosterone can therefore slightly increase the chances of recurrence of PPPs.

Most people who have been successfully treated for PPPs will not get the lesions back. However, in a small minority of individuals, tiny papules may appear over the years. Such recurrences, if bothersome, can be easily treated.

How can I prevent getting Pearly Penile Papules in the future?

Pearly Penile Papules are a part of normal genital anatomy and there is not a way to prevent them from occurring. Most people will develop PPP in their 20’s or 30’s, and it is less likely to develop PPP beyond the age of 40.

There are no lifestyle factors linked to the development of PPP, however maintaining a healthy lifestyle and practicing safe sex are recommended for everyone.

PPP appears to occur less commonly in people who are circumcised, however circumcision will not guarantee PPP will not develop. We do see patients presenting for treatment of PPP despite having had a circumcision in their childhood.

We recommend avoidance of taking testosterone supplements without medical supervision as it can slightly increase the risk of recurrence of PPPs.

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Page reviewed by Dr. Manoj Malu (Clinical Director)

Last reviewed date: 1 April 2022
Next review due: 1 April 2025

Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.

References & Further Reading