I’m Embarrassed About a Penile Lesion — What Happens During the Examination?
Finding a new sore, lump, red patch or other change on the penis can be worrying. For many men, the thought of having it examined can feel almost as uncomfortable as the lesion itself.
If you feel embarrassed, you are not unusual. Studies of men diagnosed with penile cancer have found that embarrassment is one of the reasons some people delay seeking medical attention.[1,2] The important point is that a penile lesion does not automatically mean penile cancer. Many penile skin changes are caused by benign, inflammatory or infectious conditions.[3]
The purpose of an examination is simply to work out what the lesion is and whether any further investigation is required.
What is a penile lesion?
“Penile lesion” is a broad medical term. It can describe almost any abnormal area involving the skin of the penis, foreskin or glans.
This might include:
a red or irritated patch
a white patch
an ulcer or sore
a small lump or growth
thickened skin
cracking or bleeding
a wart-like area
persistent inflammation
a change beneath the foreskin
a lesion that does not seem to heal
There are many possible causes. These include inflammatory skin conditions such as lichen sclerosus, infections, benign skin conditions, penile intraepithelial neoplasia (PeIN) and, much less commonly, invasive penile cancer.[3,4]
Appearance alone does not always reliably distinguish these conditions, which is why examination — and occasionally biopsy — can be useful.
What happens before the examination?
The consultation normally begins with a conversation while you are fully clothed.
You may be asked:
when you first noticed the lesion
whether it has changed in size or appearance
whether it is painful or itchy
whether there has been bleeding or discharge
whether the foreskin has become tighter
whether urination has changed
whether you have previously been treated with creams or antibiotics
whether you have had previous penile or foreskin surgery
whether you have a history of genital skin conditions
about relevant sexual or infection history where appropriate
These questions help narrow down the possible causes.
There is no need to feel that you have to diagnose the problem yourself before attending.
What actually happens during the penile examination?
For most penile lesions, examination is straightforward.
Current European Association of Urology guidance recommends careful inspection and palpation of the penis when assessing a suspicious penile lesion.[4]
1. The penis is inspected
You will usually be asked to lower your clothing sufficiently for the genital area to be examined.
The clinician may look at the:
penile shaft
glans or head of the penis
foreskin
area beneath the foreskin, where it can be comfortably retracted
urethral opening
surrounding genital skin
The examination is focused on the medical problem. Exposure should be limited to what is necessary for an appropriate assessment.
If you have a tight or scarred foreskin, it should not be forcibly retracted simply to complete the examination. Foreskin scarring may itself provide useful information about the underlying condition.
You can read more about assessment of significant foreskin problems on the Complex Circumcision & Foreskin Problems page.
2. The lesion is examined closely
The clinician will assess features such as its:
position
size
colour
surface
borders
thickness
firmness
ulceration or bleeding
relationship to nearby structures
These features can help distinguish inflammatory or benign conditions from lesions that need further investigation.[3,4]
3. The area may be gently inspected
Palpation simply means gently feeling the abnormal area.
This can provide information about whether a lesion is confined to the surface or whether there appears to be deeper thickening or firmness beneath it.
Physical examination remains an important part of assessing the local extent of penile tumours. Imaging is generally reserved for situations where additional information about deeper involvement is needed.[4-6]
4. The groins may also be examined
If a lesion appears suspicious for penile cancer, the lymph nodes in both groins may be examined.
This involves gently feeling the groin on each side for enlarged or abnormal lymph nodes. Examination of both groins forms part of guideline-recommended assessment when penile cancer is suspected.[4]
This does not mean that your clinician thinks the cancer has spread. It is simply an appropriate part of assessing certain penile lesions.
Will I need a biopsy?
Not every penile lesion needs a biopsy.
Some conditions have a typical appearance and can be managed or monitored without immediately taking a tissue sample.
A biopsy becomes more important when:
the diagnosis is uncertain
the lesion has unusual or suspicious features
a persistent lesion has not responded as expected
penile intraepithelial neoplasia or cancer needs to be excluded
the result will influence the choice of treatment.[3,4]
A biopsy removes a small piece of tissue so that a pathologist can examine the cells under a microscope.
Depending on the size and location of the lesion, this may be performed using local anaesthetic or as a short procedure in theatre.
Importantly, being advised to have a biopsy does not mean that you definitely have cancer. Biopsy is often the most reliable way to distinguish between conditions that can look similar during examination.
Will I need a scan?
Usually not at the first assessment of a simple penile skin lesion.
Clinical examination is often sufficient to decide what should happen next.[4,6]
If penile cancer is subsequently diagnosed, or if the depth of a suspicious lesion cannot be determined adequately on examination, additional investigations may sometimes include penile ultrasound or MRI.
MRI can be particularly useful where there is uncertainty about deeper invasion or when planning penile-preserving surgery.[4,7]
For more detailed information, see Penile Cancer: Symptoms, Diagnosis & Treatment.
What if the lesion is hidden beneath a tight foreskin?
This is an important situation.
Penile lesions can sometimes be partly or completely hidden by phimosis, where the foreskin cannot be comfortably retracted.[4]
The clinician will assess:
the degree of foreskin narrowing
whether there is scarring
whether lichen sclerosus may be present
whether there is discharge or bleeding beneath the foreskin
whether the underlying lesion can be adequately assessed
In some situations, treatment of the foreskin — including circumcision — may be part of establishing the diagnosis or treating the condition. This decision depends on the individual examination and should not be assumed before assessment.
Could it just be an infection or skin condition?
Yes.
Many penile lesions are benign, inflammatory or infectious rather than cancerous.[3]
Possible causes include balanitis, dermatitis, benign anatomical variants, infections and chronic inflammatory conditions such as lichen sclerosus.
However, inflammatory, premalignant and malignant penile lesions can occasionally resemble one another.[3,8]
For that reason, a persistent abnormality that keeps recurring, does not heal or does not respond as expected should generally be assessed rather than repeatedly self-treated without a clear diagnosis.
Do I need to shave before the appointment?
No special preparation is usually necessary.
Normal washing is sufficient. There is generally no reason to shave specifically for a penile examination.
If you have previous biopsy results, pathology reports, photographs showing how the lesion has changed, or details of creams or treatments you have already tried, these may be helpful.
You can also review what to bring to your appointment.
Can I ask for a chaperone?
Yes. Intimate examinations should be approached professionally, with explanation and consent.
If you would feel more comfortable with a chaperone present, you can ask about this. You can also tell the clinician that you are anxious or embarrassed before the examination begins.
If something is uncomfortable, you can ask for the examination to stop.
Can I just send a photograph instead?
A photograph can sometimes provide useful preliminary information, particularly if a lesion changes or disappears intermittently.
However, photographs cannot reliably assess features such as firmness, depth, foreskin scarring or groin lymph nodes. They also cannot replace a biopsy when tissue diagnosis is required.
A persistent or concerning penile lesion therefore usually requires direct clinical assessment.
When should a penile lesion be assessed?
Consider medical assessment if you develop:
a persistent penile sore or ulcer
a new lump or growth
unexplained bleeding
progressive thickening
a persistent red or white area
discharge from beneath the foreskin
a lesion that continues despite treatment
progressive tightening or scarring of the foreskin
a new lump in the groin associated with a penile lesion
These symptoms still do not necessarily mean cancer.
The reason for assessment is to establish the diagnosis rather than guess from appearance alone.
What happens after the examination?
There are several possible outcomes.
The lesion appears benign
You may simply need reassurance, observation or management of a benign skin condition.
An inflammatory or infectious condition is suspected
Further tests or appropriate treatment may be discussed depending on the likely diagnosis.
Lichen sclerosus or significant scarring is suspected
Assessment may need to consider not only the penile skin but also the foreskin, urethral opening and urinary symptoms.
Read more about male genital lichen sclerosus.
The diagnosis remains uncertain
A biopsy may be recommended.
The lesion is suspicious for penile cancer
A biopsy is generally required to establish the diagnosis and guide further treatment planning.[4]
If cancer is confirmed, treatment depends on the precise type, position, size and depth of the tumour. Modern penile cancer management considers cancer control alongside preservation of penile tissue and function whenever oncologically appropriate.[4]
More information is available through the Penile & Testicular Cancer service.
Embarrassment is common — but the examination is medical
Penile problems are understandably private.
Research has specifically identified embarrassment as a reason some men postpone assessment of penile abnormalities.[1,2]
For a urologist, however, examination of the penis and genital skin is simply part of routine clinical practice.
You do not need to know whether the lesion is serious before arranging an appointment, and you do not need to find the right words to describe it. Saying “I have noticed a change on my penis and I would like it checked” is enough.
Concerned about a penile lesion?
If you have a persistent penile sore, lump, ulcer, area of bleeding, foreskin change or other lesion that has not resolved, an individual assessment can help determine what it represents and whether observation, further investigation or treatment is appropriate.
Dr Jack Crozier's practice includes penile cancer, genital skin disease and penile, genital and urinary reconstruction in Brisbane.
Frequently Asked Questions
Does a penile lesion mean cancer?
No. Many penile lesions are benign, inflammatory or infectious. Examination helps determine which conditions need further investigation.[3]
Will the doctor examine my whole penis?
The penis, glans, foreskin and surrounding relevant areas may be inspected to properly assess a lesion. If cancer is suspected, the groin lymph nodes may also be examined.[4]
Is a penile examination painful?
Visual examination should not be painful. A lesion may be gently palpated. If an area is already inflamed or tender, tell the clinician before it is examined.
Does every penile lesion need a biopsy?
No. Biopsy is generally considered when the diagnosis is unclear, cancer or precancer needs to be excluded, or the result is needed to plan treatment.[3,4]
Does having a biopsy mean the doctor thinks I have cancer?
Not necessarily. Different inflammatory, benign and precancerous conditions can resemble one another. A biopsy may simply be the most reliable way of establishing the diagnosis.
Should I be embarrassed about showing a penile lesion to a urologist?
Feeling embarrassed is common, but penile and genital examination is a routine part of urological practice. The examination has a medical purpose: determining what the lesion is and what, if anything, needs to happen next.
References
Skeppner E, Andersson SO, Johansson JE, Windahl T. Initial symptoms and delay in patients with penile carcinoma. Scand J Urol Nephrol. 2012;46(5):319-25. doi:10.3109/00365599.2012.677473.
Gao W, Song LB, Yang J, Song NH, Wu XF, Song NJ, et al. Risk factors and negative consequences of patient's delay for penile carcinoma. World J Surg Oncol. 2016;14:124. doi:10.1186/s12957-016-0863-z.
Chipollini J, Harb De la Rosa A, Azizi M, Shayegan B, Zorn KC, Spiess PE. Patient presentation, differential diagnosis, and management of penile lesions. Can Urol Assoc J. 2019;13(2 Suppl 1):S2-S8. doi:10.5489/cuaj.5712.
European Association of Urology, American Society of Clinical Oncology. EAU-ASCO Penile Cancer Guidelines. Presented at the EAU Annual Congress London 2026. Arnhem: EAU Guidelines Office; 2026.
Lont AP, Besnard APE, Gallee MPW, van Tinteren H, Horenblas S. A comparison of physical examination and imaging in determining the extent of primary penile carcinoma. BJU Int. 2003;91(6):493-5. doi:10.1046/j.1464-410X.2003.04119.x.
Bozzini G, Provenzano M, Romero Otero J, Margreiter M, Garcia Cruz E, Osmolorskij B, et al. Role of penile Doppler US in the preoperative assessment of penile squamous cell carcinoma patients: results from a large prospective multicenter European study. Urology. 2016;90:131-5. doi:10.1016/j.urology.2016.01.003.
Krishna S, Schieda N, Kulkarni GS, Shanbhogue K, Baroni RH, Woo S. Diagnostic accuracy of MRI in local staging (T category) of penile cancer and the value of artificial erection: a systematic review and meta-analysis. AJR Am J Roentgenol. 2022;219(1):28-36. doi:10.2214/AJR.21.27063.
Shabbir M, Minhas S, Muneer A. Diagnosis and management of premalignant penile lesions. Ther Adv Urol. 2011;3(3):151-8. doi:10.1177/1756287211412657.
Medical Disclaimer
This article provides general educational information only and is not a substitute for individual medical advice, examination, diagnosis or treatment. Penile lesions can have many different causes, and their appearance alone may not establish a diagnosis. If you have a new, persistent or changing penile lesion, discuss it with an appropriately qualified healthcare professional. Seek urgent medical assessment for severe pain, significant bleeding, rapidly progressive swelling, difficulty passing urine or other acute symptoms.
