Ask Dr. H: 'Retractile penis' not uncommon

Question:

We have an 11-year-old great-grandson. His penis keeps "going in/retracting." The urologist says he will outgrow it. His parents say it is getting worse, and he actually has to pull it out to urinate. What do you suggest?

Answer: Your great-grandson has a fairly common condition called "retractile penis." It happens to varying degrees in most men when the penis is flaccid as a result of cold temperatures, anxiety, and obesity. And it is not uncommon in circumcised boys prior to puberty.

In your great-grandchild's situation, the flaccid penis is retracting beneath the fat pad that overlies the pubic bone. Bands of connective tissue are acting like rubber bands to retract the penis inward. The good news is that this clears up for most children as they proceed through puberty. A very small percentage of them will eventually require surgery to loosen up the connective-tissue "rubber bands."

In obese men, a large pubic fat pad hides the flaccid penis and creates a retractile appearance. When the retractile penis becomes engorged with blood in the erect state, the penis is usually of normal size and appearance.

I'd suggest patience, with periodic checkups by his physician; the overwhelming odds are that he'll be fine.

nolead begins

Q:

A while back, you wrote about the best ways to get rid of toenail fungus. You recommended taking pills for three to four months, which I know can cause side effects like liver injury. You mentioned Vicks VapoRub as a home remedy, but did not recommend it. Why not? I've tried it and I know it works. And it's much safer than pills.

A: While a three- to four-month course of an antifungal pill like Sporanox or Lamisil has been found in published studies to cure toenail fungus in more than 60 percent of cases, it can be expensive and does carry a small risk of liver toxicity. The prescription topical antifungal nail lacquer Penlac has a published cure rate of 34 percent. I did not recommend Vicks VapoRub in my previous article because it was an untested home remedy.

A physician making recommendations to a large audience must be cautious about unproven and unconventional treatments. That said, you'll be pleased to learn that there is now research, albeit limited, that affirms the safety and modest effectiveness of Vicks VapoRub in the treatment of toenail fungus.

A very small study published in the January-February issue of the Journal of the American Board of Family Medicine showed that Vicks VapoRub is a safe, inexpensive, and modestly effective (28 percent cure rate) alternative to prescription treatments for toenail fungus when applied once a day for 48 weeks. There were just 18 participants; 10 showed partial clearance, and five were considered cured at 48 weeks. Interestingly, all 18 reported that they were "satisfied" or "very satisfied" with the appearance of their toenail.

Although its efficacy is far less than that of antifungal tablets, it appears to be a safe alternative that I can now recommend.