Causes of Bumps on the Penis, Scrotum, and Groin

Bumps in the groin are worth getting checked out, but not every bump should cause alarm. Genital bumps may come up spontaneously and quickly or they may have a gradual onset. They may be noticeable soon after having sex or may appear after shaving or using a new body wash. There are a variety of benign, normal causes for penile bumps, and there are some that are abnormal.

Normal Bumps (Not Contagious or Dangerous)

Pearly penile papules (PPPs)

Tiny, uniform bumps in a row around the corona (crown) of the penis.^[1] PPPs occur in about 20% of men and have no relationship to warts despite their resemblance. Although they are asymptomatic and do not require treatment, some patients choose to have them removed due to their appearance. Options for removal include surgical excision and a variety of different lasers.^[2,3]

Fordyce spots

Small, flattened white spots on the penis or scrotum, often more noticeable with an erection.^[1] These are sebaceous (oil) glands that may produce a whitish, thick substance when squeezed. Fordyce spots appear in adolescence and are nothing to be concerned about.

Abnormal Bumps

Folliculitis

Look & Feel

Folliculitis presents with occasionally itchy, painful, small red bumps based around hair follicles. They may have pus inside giving them a white-tipped appearance. It occurs on the hair-bearing regions, and can be associated with shaving, moisture, friction, and hygienic practices.

Cause

After shaving, as the hair begins to grow back it can become entrapped, causing ingrown hairs, surrounding inflammation, and bacterial infection.^[4] Folliculitis is usually limited to a few days of symptoms and should resolve if the bumps are kept clean and unbothered. After they resolve, they can leave small dark spots as a result of the inflammation. These dark spots are referred to as post-inflammatory hyperpigmentation and will eventually fade away.

Treatment

Good hygiene is key to preventing folliculitis from progressing. The areas should be washed with soap and water, kept dry, and loose clothing should be worn. If the bumps do not resolve, if they worsen, or continue to occur frequently, a healthcare professional should be contacted for recommendations on antimicrobial washes or antibiotics. Prevention of ingrown hairs is done by avoiding shaving. If shaving cannot be avoided, make sure to shave in the direction of the hair, don’t pull the skin tight while shaving, try to use a new razor each time, and use a good shaving cream. 

Contact Dermatitis

Look & Feel

Contact dermatitis presents with itchy, occasionally painful or burning, widespread red rash or blisters with surrounding redness. It usually occurs after using a new product or medication on the penis or genital region but can also happen with products that have been used for a long time.

Cause

Although contact dermatitis may seem similar to folliculitis, it is a very different condition. Contact dermatitis is divided into two types: allergic and irritant. Allergic contact dermatitis (ACD) is an immune reaction to a substance that comes in direct contact with the skin. Irritant contact dermatitis (ICD) is caused by an irritating substance or hygienic practices that would cause itchy, painful bumps in anyone it touches. ACD is much more common in the genital region than ICD.^[5]

If a product or medication is applied to the genital region, the body may identify a substance it does not like. If this occurs, ACD will develop the subsequent time it comes into contact with the skin. The most common products that cause the itchy, red, bumpy rash are topical medications, like antibiotic ointments or steroids, and products with fragrances.^[5,6] Baby wipes and scented products should be the first things to eliminate from your genital hygiene routine.^[6]

Treatment

For both ICD and ACD, minimizing the products you use should be the first step. Only bland, gentle, fragrance-free products should be used, if any. Excessive washing can worsen both types of contact dermatitis. If ACD is suspected, the product causing the rash should be identified and discontinued. See a healthcare professional to help determine the cause and get treatment. They may recommend patch testing to test for allergies, and they may prescribe topical steroids for symptoms.

Hidradenitis Suppurativa (HS)

Look & Feel

HS usually presents as painful masses that drain pus and form open sores, sinus tracts, and scarring. They are typically located in the genital, perianal, and armpit regions.

Cause

HS is a chronic inflammatory condition affecting the apocrine sweat glands of the body.^[7] Apocrine sweat glands are located in the armpits, groin, genitals, around the anus, and underneath the buttocks and breasts, so HS can present in any of these places. Although HS is three times more common in women, it can occur in men and when it does, it is often more severe.^[8] HS more often affects African Americans.^[8] It is important to recognize HS, because the condition can cause significant discomfort, distress, and scarring.

Treatment

If a patient has any of the symptoms of HS in the body regions described above, they should seek advice from a healthcare professional. There are some lifestyle modifications that can help, such as diet, losing weight, and quitting smoking.^[9] There are many treatment options including antibacterial washes, oral antibiotics, surgery, steroid injections, and immune suppressing medications such as Humira and Remicade.^[8] Due to the complexity of HS treatment, a dermatologist should be consulted to prevent long-term complications.

HPV Bumps: Genital Warts

Look & Feel

Genital warts present as single or multiple, painless, skin-colored bumps. They may be large or small, and smooth or bumpy.

Cause

Human papilloma virus (HPV) is a sexually transmitted infection (STI) that is transmitted by direct contact. The warts are typically painless and do not itch. Once the bumps are identified, a healthcare professional should evaluate the bumps to ensure they are truly genital warts and prescribe the correct therapy.

In addition to genital warts, certain other strains of HPV can cause cervical and anal cancer. The strains that typically cause genital warts are HPV 6 and 11, while the most common strains that cause cervical and anal cancer are HPV 16, 18, 33, and 35.^[10] Genital warts are visible, but cervical and anal cancer may be unnoticeable and asymptomatic until later stages. Just because HPV cannot be seen does not mean it is not there. Prior to engaging in sex, it is best to get tested with your partner, so you do not put yourself or your partner at risk.

Treatment

Treatment is varied and may include imiquimod, liquid nitrogen freezing treatment (cryotherapy), surgical removal or curettage, diode laser ablation, photodynamic therapy, and others.^[11-13] Preventing HPV is even better and can be accomplished with a vaccine—Gardasil-9 or Gardasil-11—that prevents multiple strains of HPV including those that cause genital warts and cervical and anal cancers.^[10]

Warts are contagious, so if you have them you should inform your partner and avoid sexual activity until they are gone. Even after the warts have resolved, they may reoccur as the virus remains within the skin. Condoms can decrease the chance of spreading them through skin-to-skin contact resolution of treatment, but if the area not covered is infected, they may still spread.

Molluscum Contagiosum

Look & Feel

Molluscum presents as single or multiple, painless, waxy, small flesh-colored domes with a central dimple on the top.^[14]

Cause

Molluscum contagiosum (MC) is a very common condition in children and can occur all over their bodies. However, in adults, MC is usually considered an STI.^[14,15] MC is caused by a poxvirus transferred by direct contact with the skin or infected objects (clothing, towels, etc.). In most people, MC will not cause significant symptoms, but in immunocompromised individuals it can cause widespread, difficult-to-treat infection.

Eczema can predispose patients to MC, and scratching can cause secondary infections near molluscum. Overall, in healthy people, the infection will last 6-9 months, but with scratching and constant transfer to objects, it may re-infect the skin, lasting longer.^[16]

Treatment

Molluscum bumps can be frozen by a professional with liquid nitrogen, or they may use other therapies.^[17] Other topical products that can be prescribed by a healthcare professional include: cantharidin, trichloroacetic acid, retinoids, and imiquimod.^[15]

Herpes

Look & Feel

Herpes infections present as multiple, painful, red blisters or open sores.

Cause

Herpes simplex virus (HSV) is another STI. There are two types: HSV-1 and HSV-2.^[18] HSV-1 is typically associated with mouth ulcers or cold sores, while HSV-2 is usually associated with genital herpes. It is possible to have oral herpes from HSV-2 and genital herpes from HSV-1.

Regardless, genital herpes has a common presentation. The first outbreak is often the most severe with the most numerous lesions and may last the longest. During the outbreak, people can experience nausea, fevers, and general fatigue. After resolution of the first outbreak, the virus remains in the body and can cause subsequent outbreaks, which are usually milder and less likely to be accompanied by nausea, fevers, or fatigue. Some people never have a severe first outbreak and never even know they have herpes. Others may experience a severe first outbreak and never have an outbreak again.

Treatment

If there is a question of herpes infection, you should seek help from a healthcare provider. Sometimes HSV infections can be associated with other STIs, and you may need to be tested. Providers may prescribe antiviral medications such as acyclovir or valacyclovir for immediate treatment or as prevention of future recurrences.^[18] Condoms and medications can help prevent the spread of herpes, but the only way to completely avoid transmitting the infection is by avoiding sexual activity, especially when blisters or sores are present.^[18]

What to Do When With a Bump on the Penis, Scrotum, or Groin?

The majority of male genital bumps are easily treated and often resolve on their own. However, if a patient is concerned it could be something more serious, they should consult a healthcare professional. Not only can a provider determine the cause of the genital bumps, but they can provide treatment when necessary. If a patient notices genital bumps, they should keep the area clean and avoid irritating the skin with their hands, sweaty clothes, or new products. If the bumps may be caused by an STI, the patient should avoid sex altogether until they speak with their healthcare provider.