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Dermatology/Strange veins in penis with pain

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Right side
Right side  

Left side
Left side  
Hi, I'm an 18 year old with an uncut penis. Basically I've had this problem with my penis for quite some time now, however only now is it starting to get quite painful and uncomfortable on occasion but sometimes there is no pain at all. The pain is in the right hand side of my penis just below the glans. The veins seem to have all swelled up and deformed, with redness and red spider veins too. in the same place on my left side the veins look normal and there is no pain at all.

I'd basically just like to know what the problem could be and if there is any treatment for it. I've attached picture too, one on the left and one on the right of the penis.

Thanks

Answer
Thrombosis of the dorsal vein of the penis is a rare disorder that tends to affect males in the age range of 21Ė70 years old. Correctly diagnosing this benign condition is imperative so that the physician can allay the patientís fears of having a sexually transmitted disease, erectile dysfunction, or cancer.

Many predisposing factors can lead to the development of thrombosis of the dorsal vein of the penis. These factors all relate back to Virchows traid of vessel wall damage, stasis, and a hypercoagulable state.The reported causal factors comprise traumatisms, excessive sexual activity, prolonged sexual abstinence, local or distant infectious processes, venous obstruction secondary to bladder distension, pelvic tumors, disseminated pancreatic adenocarcinoma or constrictive elements used in certain sexual practices, and the abuse of certain intravenous drugs.

Penile Mondorís Disease can be diagnosed from medical history and a physical examination. The patient consistently presents with a rope-like cord on the dorsum of the penis. The cord is a thrombosed dorsal vein, which has become thickened and adherent to the overlying skin. Often, the lesion will extend superiorly into the suprapubic area. The vein may appear to be swollen and erythematous. The patient will report having a significant amount of pain, which can be either episodic or constant. In some cases, affected patients can also present irritative micturition syndrome.

Superficial thrombophlebitis of the dorsal vein of the penis can be divided into three clinical stages: acute, subacute, and re-permeabilized. The acute stage tends to manifest in males in the range of 20 to 40 years old and typically manifests in the 24 hours following prolonged sexual activity, possibly secondary to vascular endothelial trauma.

Sclerosing lymphangitis and peyronies disease both need to be considered in the differential diagnosis of a painful, fibrotic lesion of the penis; however, Sclerosing lymphangitis is characterized by thickened and dilated lymphatic vessels whose morphology is serpiginous. Peyronies disease results from a thickening of the tunica albugenia and presents as a well-defined fibrotic plaque on the penis.

If doubt persists even after taking the medical history and performing the physical examination, consider ultrasonography. If the vein appears noncompressible, this is consistent with the diagnosis of venous thrombosis.

Several methods of treating superficial thrombophlebitis of the dorsal vein of the penis have been proposed, none of which has been shown to significantly decrease duration. Anticoagulation with aspirin, heparin, or other antiplatelet agents will not expedite healing and is not necessary to prevent additional thrombosis. Currently, treatment is palliative for most patients. However, antibiotic therapy should be administered when cellulitis is suspected and vein stripping may be necessary for severe, persistent cases of Mondorís Disease.An injection of 0.5% bupivacaine hydrochloride subcutaneously in the region surrounding the affected vein has provided relief to patients who are in acute pain. Care should be taken to avoid injecting patients who have signs of infection, as this may exacerbate their condition. In the subacute and chronic stages, anti-inflammatory drugs and local heparin containing creams can be prescribed as was done in our case.

Most cases resolve within 4 to 6 weeks, with re-permeabilization in 9 weeks. In persistent cases, surgery may prove necessary with a thrombectomy or resection of the superficial dorsal vein.
See you doctor for treatment.

Dermatology

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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