Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Dear Dr Margaret, I've got this lump on my...

We've had loads of feedback from people using the site - and we read and take notice of every message. (One result is our new design - less orange and, we hope, easier to navigate.) We want to receive your problems to help us decide on new topics for the site. Unfortunately I cannot send you an individual reply, and I can only deal with a few topics in this 'A Problem Shared' spot.

Some problems are particularly difficult for me to answer. These are queries about lumps and bumps and skin problems in the genital area. For example, here are two problems I've recently received.

Dear Dr Margaret
I've had a vein (or what I think is a vein) in my penis staying permanently hard for the last two weeks now. No pain (yet), just wondering what it is all about. Is it a symptom of something and can I get it to go away? It does begin to get sore during sexual activity though. It's the vein that runs halfway up the penis on the right hand side.

Dear Dr Margaret
I'm 23 years old and for the past 7 years the head of my penis has seemed very dry and cracked. It looks bad when erect, like cracks all over the head, and it's very sensitive and I also have little white bumps, kinda like little dots, on the side edge of my penis and they are very sensitive when I touch them. I've been looking all over the net, and all I've seen was go to your family doctor, no-one really states what the problem is or the cure. Please answer because I'm really embarrassed to go to a doctor.

These two problems are both from men, but we get many similar queries from women. I'll try to explain why it would be difficult, if not impossible, for me to answer them.

In medical school, we were taught to diagnose lumps and bumps and skin problems by listening to what the patient said and then asking additional questions. Then we would look at the position of the abnormal area, its colour, size and shape, its consistency and the surrounding skin. We might need to examine other parts of the body. And only after all that might we be able to make a diagnosis.

So I can't make a proper diagnosis of a problem sent in by e-mail. The best I can do is to suggest some possibilities, but I could easily be wrong in your particular case.

For example, when I read the first problem I wondered if it might be a lymphocele. This is a harmless, cord-like swelling due to blockage of the lymphatic channels in the penis. Sometimes it follows prolonged or especially energetic intercourse or masturbation. But it usually goes away in a few days, and my correspondent says he has had it for 2 weeks. Also, a lymphocele is usually cross-wise at the end of the penis, near the base of the foreskin.

So then I wondered if it might be a very early stage of Peyronie's disease, which may cause a tender lump on the shaft. But the truth is that I cannot be sure what it is. So the sensible thing is for him to get it properly checked by a doctor.

The same applies to the second problem. The cracked skin on the head of the penis could be a form of balanitis but no doctor could properly diagnose the white dots without examining them. So he also needs a real check - searching the Net won't provide a reliable answer.

But what if you're too embarrassed to see your doctor, like the second questioner? My view is that people worry too much about what their doctor will think of them. Your doctor is there to provide a service for you, which is to diagnose and treat your medical problems. And what is an embarrassing problem to you is simply a medical problem to your doctor. Remember that anything you discuss with your GP, and any treatment you have, stays confidential, even if you are a teenager. If you really don't want to see your GP, in the UK you can always go to a genito-urinary medicine clinic. The number will be in your phone book or find your nearest clinic in the check up section of www.lovelife.uk.com. The staff at these clinics are famously nice and they can diagnose any genital problem. The clinic will not send a report to your GP unless you give permission. If you want to know what it's like to visit a clinic, look at the 'virtual visit' on www.wellsafe.org

Posted 31 July 2001