The appearance of white spots on the foreskin when retracted can be concerning. Many causes, however, are common, harmless anatomical features that require no medical intervention. Understanding the specific characteristics, location, and associated symptoms of these spots helps distinguish between a normal variation and a condition requiring professional attention.
Benign and Anatomical Explanations
The most frequent causes for white spots are normal penile structures that become more visible under the foreskin. Pearly Penile Papules (PPP) are common findings, appearing as small, dome-shaped, or thread-like bumps. These papules typically arrange themselves in rows around the corona of the glans penis. PPP are a normal anatomical variant, are not contagious, and are unrelated to hygiene or sexual activity.
Another common feature is the presence of sebaceous glands, sometimes called Tyson’s glands, which are modified oil-producing glands. These glands are generally found near the frenulum, the band of tissue under the glans, and appear as small, yellowish or white bumps.
A third explanation is smegma, a natural, thick, cheese-like substance that collects under the foreskin. Smegma is a combination of shed skin cells, fatty oils, and moisture. If not washed away regularly, this material accumulates, appearing as white lumps or a thick white coating. Gentle, daily hygiene, involving retracting the foreskin and washing with warm water, prevents this accumulation.
White Spots Caused by Infections
Infectious causes of white spots are often accompanied by other symptoms indicating an active problem. Candidiasis, a yeast infection or thrush, is a frequent fungal cause of balanitis (inflammation of the glans and foreskin). This infection manifests as thick, white, lumpy patches or discharge under the foreskin. Associated symptoms include intense itching, redness, a burning sensation, and possible pain during urination or sex.
The Human Papillomavirus (HPV) causes genital warts, which may appear as white or whitish-grey spots or growths. These lesions are raised, often irregular, and can have a rough, bumpy, or “cauliflower-like” texture. Genital warts are sexually transmitted and may be solitary or appear in clusters anywhere on the penis, including the foreskin.
Molluscum contagiosum is another viral infection resulting in small, raised bumps that can be white or flesh-colored. These papules are distinctively dome-shaped with a small central indentation, known as umbilication. In adults, they are often transmitted through intimate skin-to-skin contact.
Inflammatory and Chronic Skin Conditions
Certain inflammatory and chronic skin disorders can also cause white spots or patches on the foreskin. Lichen Sclerosus (LS) is a chronic inflammatory condition primarily affecting the genital area. LS presents as thin, whitish, wrinkled patches of skin on the foreskin and glans. Untreated, the resulting inflammation and scarring can lead to progressive tightening of the foreskin, a condition called phimosis, making retraction difficult or impossible.
Non-infectious balanitis, caused by conditions like psoriasis or eczema, can also lead to white patches. These chronic inflammatory diseases can affect the genital skin, causing localized inflammation and discolored patches. These conditions involve persistent inflammation and changes in skin texture, distinguishing them from benign anatomical features.
Signs That Require Medical Evaluation
Any new or persistent change on the foreskin warrants a professional medical evaluation to ensure an accurate diagnosis. Consultation is necessary if the white spots are accompanied by:
- Pain, tenderness, or a noticeable burning sensation.
- Abnormal discharge, especially if it is purulent, foul-smelling, or associated with a fever.
- Significant skin texture changes, such as thickening, hardening, cracking, or the formation of ulcers or sores.
- Tightening of the foreskin that makes retraction painful or impossible (potentially indicating Lichen Sclerosus or severe balanitis).
Any suspicion of a sexually transmitted infection, or changes that persist despite improved hygiene, should prompt a visit to a general practitioner or dermatologist.