Category: SMSNA Patients
Penile Glans Necrosis – A Look into the Rare Condition
Category: SMSNA Patients
Penile glans necrosis is a rare condition which occurs when the tip (glans) of the penis becomes infected, or has reduced blood flow (ischemia), which eventually causes tissue death (necrosis). While it is rare (most infections or ischemia cases are resolved), penile glans necrosis can be devastating or cause significant cosmetic and functional damages to the tip of the penis.
You may be able to recognize the beginnings of penile glans necrosis. The tip of the penis will begin to darken, eventually turning black. Additionally, the tip of the penis may feel painful to the touch, or with urination.
Because it is so rare, there is not a lot of research about penile glans necrosis, and therefore, not much knowledge about effective care. The current solution usually ends with surgery to debride (remove) the necrotic (dead) tissue and avoid further damage. However, there is no official treatment or specific care protocol in existing medical guidelines.
What Causes Penile Glans Necrosis?
Luckily, several urologists (penis doctors) have recently reviewed all penile glans necrosis studies to date in order to provide suggestions for how best to treat the condition. In total, all reviewed papers included 89 patients ranging from 8 days old to 86 years old, with a variety of causes. Researchers did find that the main cause of necrosis was circumcision (61% of cases), which explains the youngest age in the patient group as many western societies normalize circumcision at a young age.
The second most common cause of necrosis was prostatic artery embolization (15%). This is a common surgical procedure that treats enlarged prostates, effectively reducing blood flow to the prostate. Researchers suggest the necrosis may be a result of complications with catheter placement or removal.
While the authors did include fewer cases in this study, penile glans necrosis may be a complication of penile prosthesis placement as well. If this does occur, it may be necessary to remove the device. Additionally, penile glans necrosis may be caused by penile calciphylaxis, which is a rare and often fatal condition. Penile calciphylaxis is primarily related to diabetes and end-stage renal disease. If you have a metabolic condition and notice any signs of necrosis, ulcers, or calcium deposits on your penis, it’s important to seek medical help immediately.
Interestingly, researchers did find a connection with the grade, or level, of ischemia and the success of treatment. Grade A (less severe) ischemia usually had a better treatment outcome than Grade B (more severe). In this case, a good outcome consists of the majority of the penis glans being saved, with minimal girth and length loss.
Potential Treatments and Author Recommendations
The main goal of treatment is to restore blood flow, remove the cause, reduce the chance of blood clots, and improve the oxygen supply (also via blood flow). Most frequently, hyperbaric oxygen therapy (HBOT) was used as a first-line treatment. This involves locking the affected tissue (or full body) in a pure-oxygen tube, which creates an environment that can help improve oxygenation and blood flow.
Additionally, clinicians may add pentoxifylline, which is a type of erectile dysfunction medication and blood thinner. Together, HBOT and pentoxifylline can help minimize ischemia, and potentially restore the ischemic tissue (avoiding necrosis).
The authors recommend a combination of several treatments, depending on how early-on necrosis is brought to them. First, a pentoxifylline dose, the HBOT, then debridement (removal) of necrotic tissues, then a course of antibiotics if any further infections occur, and topical testosterone (usually a gel) in areas with color changes.
Key Takeaways
- Penile glans necrosis is a rare condition, mainly resulting from post-surgery infections or complications, but may also occur with priapism (prolonged erection), sexually transmitted infections (STIs), etc.
- It may present itself as the tip of the penis gradually turning black, with pain in the head with touch or while peeing. Please seek a doctor immediately if this occurs.
- The earlier necrosis is caught, the easier it may be to save.
- Clinicians may recommend a cocktail of treatments including erectile dysfunction medications, HBOT, antibiotics, and surgery to remove the dead or dying tissue (debridement).
- It’s important to pay attention to your body and follow post-surgery instructions to the “T” in order to avoid infection.
References
Buss, H. F., Ferreira, F. T., Giles, T. G., & Giles, T. G. (2025). Systematic review of Penile glans necrosis. The Journal of Sexual Medicine, 22(11), 1978–1991. https://doi.org/10.1093/jsxmed/qdaf251
Pereira, T. A., Osmonov, D., & Bernie, H. L. (2024). Minimizing the risk of penile gangrene in the patient undergoing penile implant surgery. The Journal of Sexual Medicine, 21(9), 749–750. https://doi.org/10.1093/jsxmed/qdae076
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