1. Defect And Excess Of Formation

The penis may be smaller than usual, whilst the remainder of the sexual organs are normal, or themselves imperfectly developed, or it may present some further anomalies depending upon an arrest of development; in the latter case it is reduced in length, as is the case in hypospadiasis and hermaphrodisia; the penis then bears a resemblance to the clitoris.

Fissures of the penis, or rather of the urethra, which sometimes extend to the glans, and to the penis itself, are important. They are termed hypospadiasis and epispadiasis, the former of which is by far the most common. Both present various degrees, but the first is particularly liable to variations. We here find the fissure affecting a greater or less extent of the urethra from the glans backwards, or even involving the entire penis together with the scrotum; the penis remains in a corresponding state of imperfect development as to size and form; the prepuce is also fissured and small, the glans divided; in higher degrees, the smallness of the organ, the total absence of foreskin, the retraction of the scrotal fissure, and the imperforate condition, induce a resemblance to the clitoris; and mistake as to the sex of the individual will be the more likely to occur if the scrotal fissure leads to a cul-de-sac simulating the vaginal passage. Epispadiasis is a very unusual occurrence, and is either limited to the glans or extends over the entire urethra; in the latter case it is complicated with eversion of the bladder (fissure of bladder).

Excess of development, except as more or less remarkable enlargement of the penis, is very rare; the few observations recorded of two perfect penes placed beside or above one another are not to be credited.

2. Deviations Of Size

Atrophy of the penis, accompanied by obliteration of the tissue of the glans and the corpora cavernosa, deserves notice; it is probably always associated with atrophy of the testicles.

An apparent diminution of the penis is presented in the retracted state, induced by large scrotal herniae, sarcocele, hydrocele, oedema of the scrotum, etc, in consequence of the relaxation and advance of the common integument.

3. Diseases Of The Tissues

They affect the glans and the corpora cavernosa of the penis.

We meet with mechanical hyperaemia of all the spongy tissues as an accompaniment of most of the advanced stages of organic heart diseases; we find a similar tumefaction of these parts in cases of asphyxia, especially when produced by strangulation.

Inflammation of the cutaneous investment of the glans, which is generally complicated with inflammation of the internal lamina of the foreskin, gives rise to excoriation, exudation of coagulable lymph, adhesion of the prepuce to the glans, suppuration, and ulceration; when chronic, it induces exuberant formation of epidermis, and if the deeper parts of the parenchyma of the glans are involved, obliteration, cartilaginous induration, and atrophy follow. Inflammation of the coronal follicles induces increased secretion of a fluid, corroding smegma, and follicular ulceration. Ulcers of a specific character present deep, white, striated, more or less hard, cartilaginous cicatrices, which vary according to the size of the ulcerated surface, and the intensity of the surrounding reaction.

Inflammation of the corpora cavernosa, though of rare occurrence, is brought on by contusions or by gonorrhceal metastases; it occasionally terminates in obliteration of the cells, and, by means of the inflammatory product, in the conversion of the latter into a cellulo-fibrous cicatrix; the uniform turgescence of the penis in erection is thus permanently impeded.

Among the morbid growths, we have to notice the warts occurring on the glans, and carcinoma, and carcinomatous ulcers on the glans and the corpora cavernosa; the former occur frequently, the latter very rarely. Cancer appears chiefly to assume the medullary form; it gives rise to considerable malformation and enlargement, and to ulcerative destruction of the penis.

We find an anomaly in the secretion occurring in the shape of abundant discharge of sebaceous matter, which, in the case of phimosis or a neglect of cleanliness, accumulates on the glans and round the corona in the shape of lamellae and tubercular masses, and, after long stagnation and decomposition, brings on inflammation, excoriation, and ulceration, or becomes inspissated, so as to form calculous concretions (calculi glandis).