Penile and testicular cancer awareness

Unlike breast, cervical and colorectal cancer, there are currently no screening tests that have been shown to improve outcomes for penile or testicular cancer in people at average risk. Therefore, early detection relies on recognising possible symptoms and changes affecting the penis or testicles, such as persistent lumps, swelling, sores, skin changes, bleeding or other unusual symptoms.

In some situations, such a history of undescended testicles (cryptorchidism) or a strong family history of testicular cancer, your healthcare provider may recommend regular testicular self-examination.

Certain infections and conditions that affect the immune system can increase the risk of penile cancer.

One of the main risk factors is persistent infection with certain high-risk types of human papillomavirus (HPV), a very common virus that can be transmitted through sexual contact. Approximately 40–50% of penile cancers are linked to HPV infection, while the remaining cases are associated with other risk factors, such as chronic inflammatory conditions affecting the penis.

HPV can be passed between partners regardless of gender and sexual orientation, including through vaginal, anal, or oral sex, genital skin-to-skin contact, or by sharing sex toys. HPV is so common that more than 80% of sexually active people will acquire an HPV infection at some point in their lives. In most people, the infection clears on its own. In a small proportion of people, the infection persists and can contribute to the development of penile cancer over many years.

People with a weakened immune system, including people living with HIV or those receiving long-term immunosuppressive treatment, are less likely to clear HPV infections naturally. As a result, they have a higher risk of persistent HPV infection and HPV-related cancers, including penile cancer.

The good news is that many HPV-related cancers can be prevented through HPV vaccination.

Important to know:

• Condoms reduce the risk of HPV transmission but do not provide complete protection. This is because HPV is transmitted through intimate skin-to-skin contact, including areas that are not covered by a condom. 
• The HPV vaccine protects against many HPV types that can cause penile cancer. However, the vaccination does not cover all HPV types. For this reason, it is important to seek medical advice if you notice any unusual symptoms, even if you have been vaccinated.

HPV vaccination protects against the high-risk HPV types responsible for most cervical cancers and many cancers of the anus, vulva, vagina, penis, and oropharynx (back of the throat, including the base of the tongue and tonsils). It also protects against the low-risk HPV types that cause most genital warts.

Vaccination is recommended from the age of 9 and is most effective before exposure to HPV, although it can still provide benefits later in life. In Belgium, people who were not vaccinated earlier can still receive the vaccine up to age 30. 

For more information on HPV vaccination, see the dedicated section.

Some types of gender-affirming surgery involve the construction of a neopenis and/or neoscrotum.

As a neoscrotum does not contain testicular tissue, there is no risk of testicular cancer itself. However, the newly created genital tissues may rarely develop cancers of the skin or mucosa. Some of these cancers are associated with persistent HPV infection. 

As with penile and testicular cancer in AMAB people, there are no established screening tests and early detection relies on recognising suspicious changes or sypmtoms and seeking medical advice if these occur.

Some types of gender-affirming surgery, particularly those involving the creation of a neovagina and/or neovulva, often involve the removal of the penis and/or testicles. However, surgical procedures may vary and not everyone undergoes the same operations. 

If the penis has been removed, there is no longer a risk of penile cancer. If both testicles have been removed, there is no longer a risk of testicular cancer. However, the newly created genital tissues may rarely develop cancers of the skin or mucosa. Some of these cancers are associated with persistent HPV infection. 

For more information, see Vaginal and vulvar cancer awareness.