Penis skin: colour, spots and pearly bumps

Darker shades, a ring of tiny bumps around the head and pale dots on the shaft are among the most common worries men bring to a clinic, and almost always perfectly normal

No cock is the colour of the rest of its owner. It is usually darker, sometimes much darker, often patchy, and it can carry little bumps and dots that send men straight to a search engine at two in the morning. Almost all of it is normal.

This chapter is a tour of the harmless stuff: the colour, the pearly bumps around the head and the pale spots on the shaft. They are among the most common reasons men visit a sexual health clinic worried about an infection they do not have.

Four normal looks

Why it is darker

Genital skin is darker than the rest of the body in most men, and the difference grows after puberty. The pigment cells in that skin respond to male hormones: they carry receptors for testosterone, and in the lab testosterone makes them work harder at producing pigment. The result is a shaft, and especially a scrotum, a shade or several darker than the thighs around them.

The colour is rarely even: the shaft can be darker than the head or the other way round. During an erection the head fills with blood and turns redder or more purple. None of this means anything about health or about use, despite what you may have heard about "wear and tear".

Pearly penile papules

These are tiny, smooth, skin-coloured or whitish domes, in one or two neat rows around the rim of the head, sometimes all the way round. They are not warts, not an infection and not contagious. They are simply part of the skin.

They are very common. In a British clinic, 48% of 200 men had them. Most had only a few, under a millimetre each, and only a minority had a full ring of bigger ones. More than a third of the men with papules had worried about them, and about a quarter had felt embarrassed. In 2,613 young circumcised men in Turkey the figure was 17.2%, and in every single one of them the papules sat on the rim of the head.

They come and go with age. In two British groups they were found in 38.3% of men under 25 but only 11.4% of men over 50, and among the younger men they were less common in those who were cut, 26.5%, than in those who were not, 42.4%. In other words, they fade on their own with time. The authors even suggested that uncut men might keep the foreskin rolled back, so that everyday rubbing helps the papules on their way.

Some men have them removed for looks, with a laser. Medically there is no reason to: they do no harm and do not spread.

The real risk is being treated for something you do not have. Papules look enough like genital warts that the Turkish researchers warned that confusing the two leads to unnecessary and even harmful treatments, and asked for better education of both men and doctors. In their sample, only 1.1% of the men with papules actually had the wart virus. Wanting them gone is common, though: in the British clinic, 14% of men with small papules and 75% of those with large ones would have liked them removed.

Fordyce spots

These are small pale or yellowish dots, usually 2 to 3 mm across, on the shaft or the scrotum. They are oil glands sitting in an unusual spot, the same kind that appear on the lips and inside the cheeks.

They are commonly mistaken for a sexually transmitted infection. Popular sources say that most adults have them somewhere, but those counts are mostly for the mouth: how many men have them on the cock has never been properly measured. What is known is that they are harmless. If they bother someone enough, they can be removed: a German team punched them out with a tiny tool in 23 men and saw no recurrence over follow-ups of up to seven years.

Do not confuse them with angiokeratomas: small dark red or purple bumps, mostly on the scrotum, which are also harmless and become more common with age.

When to see a doctor

Papules and Fordyce spots share a few traits: they are small, regular, painless, the same from week to week and usually there for years. That is the reassuring pattern. See a doctor if a spot is new and growing, a patch changes colour or shape, something bleeds, itches or hurts, or you have a sore or a cluster of bumps that appeared after sex. For gay and bi men who get tested regularly, a sexual health clinic is the right place, and the staff there have seen pearly papules more times than they can count.