Topics still taboo

Penile cosmetology. Products for local use.

Sofia SPANOPOULOU, MD.

Henri Mondor Hospital. Créteil

Introduction

Many men feel a lack of harmony when it comes to their genitals. The size and functionality of the penis is closely related to l΄estime and sexual identity.

Male genital surgery and aesthetic medicine have been in great progress since the 1970s, based on the need to correct physical deficiencies and deformities that cause significant psychological stress. The growing interest of the scientific community has led to effective management of conditions and diseases.

There are also a wide variety of local products that can be used safely in situations such as : erectile dysfunction, balanitis, eczema, l΄ premature ejaculation, lubrication, scarring.


Erectile Dysfunction

It is a very common multifactorial disorder with a profound impact on the quality of sexual life of patients and their partners (1) . Oral drug therapy with phosphodiesterase 5 (PDE 5) is the first-line treatment. Alprostadil, a prostaglandin, has been used for years in the form of urethral rods or intra cavernous injections and is now available as a cream (Vitaros® /Virirec®) (2) It induces relaxation of vascular smooth muscles and triggers erection.

Clinical efficacy in Phase II and III trials showed efficacy up to 83% with the 300 μg dose. It has been reported that microcirculation improves rapidly, leading to full erection in 10-12 minutes and penetration within 5-30 min (3).

Alprostadil cream could be a first-line treatment for patients who have contraindications to using oral therapy (beta-blocker therapy, antihypertensive drugs and/or nitrates) or for those who cannot tolerate its systemic side effects. The study showed that there were no significant side effects(4) .

Balanite

Balanitis is a common and treatable condition, which is associated with pain and inflammation of the penile gland and is most common in uncircumcised men. Treatment often includes antibiotics, antifungal creams, improved personal hygiene and in some cases, circumcision.   

If the cause of balanitis is a yeast infection (Candida), treatment includes local therapies such as Clotrimazole (Desenex®), Miconazole (Monazol®) or Imidazole (Canesten®) to treat the infection (5). The patient should apply the cream to the gland and foreskin. Risk factors for contracting a yeast infection are diabetes, obesity and immunosuppression. Symptomatic treatment includes daily local hygiene, use of mild soaps and drying the area. The sexual partner should also be treated to avoid reinfection.

Eczema 

There are different types of eczema that can affect the genital area, including atopic eczema, seborrheic dermatitis, allergic contact dermatitis and irritant contact dermatitis. Genital eczema frequently affects the penis, scrotum, groin and perianal area.

Treatment is with local agents and includes emollients and steroid creams or ointments (mometasone furoate 0.1 %).

Topical steroids can be used safely in the genital area as long as they are prescribed appropriately. The skin on the genital area absorbs topical steroids more quickly and therefore should be used with caution. Usually, treatment is 1 application per day for 3 months.

Topical ointment-based treatments contain fewer potential allergens than creams and because they are greasy, they spread easily and are well absorbed. However, creams are easier to spread on hairy skin. When using a topical steroid, leave a 20-30 minute gap between its application and an emollient to avoid diluting it. It doesn't matter which one is applied first. (7.8.9)

Lubricants

Personal lubricants are specialized products that reduce friction, pain and discomfort during sexual activity. There are many types available and everyone will have their own preference.

  • Water-based lubricants are water soluble and are most commonly used. They have a tendency to dry out upon use, so reapply or use a little water to reactivate them.

  • Silicone-based lubricants usually contain less than four components and do not contain water. Silicone lubricants have a different feel than water-based lubricants and work longer.

Healing

The penis is a very sensitive organ with only a thin layer of skin that makes it prone to cuts and injuries. Rubbing, scratching and simple accidents can all lead to the formation of a wound. 25 % of people who treat their pubic hair are injured in the process (10). Prolonged and repetitive physical activities or the penis rubbing against other parts of the body or tight clothing (running, jogging, sexual activity, masturbation) can lead to skin irritation or scarring.

Treatment of minor injuries includes washing the area with mild soap and moisturizing the penis. A study of children and adults with intimate irritation or diaper rash showed the effectiveness of using healing creams (Avène Cicalfate® +).  The patients noted the alleviation of the discomfort sensation from the first application and the drugs noted the restorative effectiveness after 2 days of use. The proposed treatment includes 2 applications per day for 3 weeks. The study also reported the effectiveness of the use for surgical scars, with a significant improvement in the appearance of the scars at D22.

Penis enlargement lotions

Penis enlargement lotions usually contain herbs, hormones and vitamins which, according to their promoters, help to increase the size of the penis. However, these products can be marketed directly to consumers without any studies proving their effectiveness.   According to some researchers, these products may contain traces of lead, pesticides and may be harmful.

 Premature ejaculation

Premature ejaculation is the most common sexual dysfunction in men. It is a condition for which there are oral treatments (serotonin reuptake inhibitors (SSRIs) and lidocaine-containing topicals. Given that increased glandular sensitivity is implicated in premature ejaculation, it seems reasonable that reducing sensitivity could have a delaying effect.

The cream and the spray have the same mechanism of action, by reducing the sensitivity of the penis, the sexual intercourse is prolonged.

  • Lidocaine cream (EMLA) is designed to be applied to the tip of the penis. Often, lidocaine cream contains a mixture of lidocaine and prilocaine that has been shown to increase the average pre-ejaculation period by 8.7 minutes (+/-1.7 min) (11) . When applied 30 minutes before sexual activity it gives the best result. The cream is inexpensive and easily accessible with a prescription.

  • Lidocaine spray can also be used on the tip of the penis but also in the scrotal area. The application should be done 10-15 minutes before the sexual act and has been proven to increase the intravaginal ejaculation latency time (IVELT) from 84 seconds to 11 minutes and 22 seconds (12) . Before any type of treatment, the patient should seek medical advice for proper diagnosis and behavioral techniques.

Hair removal

The depilation of the lower abdomen and the sex seduces more and more men for its hygienic, aesthetic side, to reduce the smell or after the request of the partner. There are different methods (laser, hot wax, electric razor, epilator, depilatory cream) depending on skin type, hair type and budget.

  1. For hot wax There are no contraindications for the intimate area, but the technique is best performed in an institute by an experienced beautician. Before hair removal, an anesthetic cream can be used and afterwards it is advisable to use a soothing and moisturizing cream.
  2. For the depilatory cream It is necessary to respect the time according to the indications which vary according to the zones to avoid chemical burns. The depilatory cream must not be applied on the genitals, the glans, the anal margin and the mucous membranes.

Discussion

There are countless products available on the market and many promise unrealistic results.  Before using them, a clinical diagnosis by a specialized physician is necessary who can offer a wide range of treatments depending on the patient's needs.

Clinical trials will continue to find new treatments. There are non-invasive ways to improve the functionality of the male sex, the quality of life and the self-confidence that this implies for the patients. The management of male genital conditions is no longer a taboo and the patient's ally in the search for solutions is his doctor.