BXO? Lichen Sclerosus? something fungal? strange HPV? something else?

[coolfrom]

I posted earlier in the FREE section, didn't realize that I needed to post here for an actual Doctor to review my case :)

Here it goes:

I have recently moved to a remote semi-rural area with no real experienced urologist/std expert, thus I must use this forum for my inquiry. I would greatly appreciate your expertise.

I'm a 32yo male. About 8-9 years ago I had phimosis (with some balantitis/smegma) and I underwent circumcision (very happy, great for hygiene and feel clean and dry since then).  

Over the last couple of years I have noticed a little scar-like formation on top of the penis glans. It seems like it has been increasing in circumference over the last 1-2 years (but I have largely ignored it, so I'm not 100% sure whether it has really increased).  It is flat, somewhat shinier than the rest of the glans.  It doesn't feel as smooth as the rest of the glans when I slide my finger on top of it. It doesn't hurt, doesn't itch, doesn't smell.

One year ago, a black tiny dot, about half a millimeter in size appeared on this scar-like formation.  It was flat, but I could barely feel it with my finger if I went over it. I tried squeezing it, and it wouldn't squeeze. So, I left it alone and it went away in about 1 month.  About 45 days ago, same tiny black dot came back, and about 30 days later disappeared.  I took a picture of it:
http://i.imgur.com/pLsBpJM.jpg
http://i.imgur.com/Ha5Shtz.jpg

I can't figure out if this is a very tiny wart? or something fungal? or (i doubt) caused by masturbation?

Here are several more photos of the penis glans today, black dot is gone, but you can see the scar.
http://i.imgur.com/2vVMR0o.png
http://i.imgur.com/1agtQ1s.png
http://i.imgur.com/dQWjBkP.png
http://i.imgur.com/4h9avWo.png
http://i.imgur.com/FcxHzC4.png

If you tell me that there is NO STD or dermatological condition matching this, then could this (if it is a scar) be caused by vigorous masturbation/sex over the years?

Thank you again.

[H. Hunter Handsfield, M.D.]

Sorry.  As I said, we only deal with STDs.  The only conceivable STD that could cause anything consistent with such penile lesions is genital warts or other HPV lesions, which seem unlikely based on your description.  That opinion would not be likely to change even with inspection of the lesions by a non-dermatologist -- and as I said, an online forum should not be considered a substitute for direct health care.  In any case, I have difficulting envisioning a circumstance in which it isn't possible to see a doctor or clinic for 8 months, even in a "remote semi-rural area"; if it's important enough to you, I'm pretty sure you could work it out.

Alternatively, consider contacting your (former?) personal physician and asking for referral to a dermatologist; after a physician-patient relationship has been established, many dermatologists are happy to view photos by email or online.

[coolfrom]

I was hoping those high res images could help to rule out at least some possibilities.  I'll be 8 months till I can see a doctor.

[H. Hunter Handsfield, M.D.]

Welcome to the forum

Unfortunately, I can't help very much.  This is strictly an STD forum, not a venue to attempt to determine the cause of all genital lesions.  In addition, on this forum we don't look at posted clinical photos.  As implied by what I just said, we aren't dermatologists and our view is that examining such photos comes too close to practicing medicine from a distance.  Regardless of the poor availability of certain clinicians in your area, an online forum is never a substitute for direct examination and evaluation by an experienced health care provider and should not be used in that manner (whiich is made clear in MedHelp's disclaimer statement).

All I can say is that from your description, I doubt you have any STD.  Some aspects suggest the possibility of genital warts, and others suggest possible lichen planus.  Beyond that, your own suspicions -- as stated in the title of your question -- all sound like reasonable possibilties.

In short, you should not look at this forum or any online resource as a substitute for direct medical care.  I would advise you find a dermatologist (not a urologist), even if you have to travel some distance for it.

Best wishes--   HHH, MD