Pearly penile papules are common but not commonly seen in a physician's office. These multiple, white, coronal papules are rarely, if ever, the source of a disease but may cause the adolescent and young adult patient some surprise when they are first noticed. "Discovery" may occur after careful self-examination following suspected contact with venereal disease, sexual exposure, masturbation, or other situations that may be associated with anxiety. Frequently, the patient believes that the lesions originated "overnight"; this is never the case and usually represents inaccurate observation.
Lesions of pearly penile papules are characteristic in morphology and locale. They occur exclusively in postpubertal patients. Neinstein and Goldenring1 found pearly penile papules in 23 of 151 (15.2%) boys and men ranging from 11 to 22 years of age. Lesions were not noted in patients less than 14 years old or with a sexual maturity rating less than a Tanner 3. Glicksman and Freeman2 examined 229 men and found these lesions in 45 (20%). There does not appear to be any racial tendency, and whereas one series found a greater percentage in uncircumcised patients,2 a second could not substantiate this possibility.1 Although no surveys have been done in prepubertal patients, it is my clinical impression that these lesions do not occur in this age group.
Giant mesenteric cyst from the small bowel mesentery in a young adult patient