Brief Answer:
Possible vascular compromise

Detailed Answer:
Thank you for your return inquiry. In general, the color of blue, purple, or some mix thereof over a part of the body whether it be the lips, the fingers, the toes, or in this case, the penis almost always suggests a compromised blood supply. Sometimes, when that happens there is pain involved because it is a sudden or dramatic loss of circulation to the appendage or body part.

Other times, pain may not be produced if the loss of blood volume occurs slowly enough to allow for some type of compensatory response by the body in order to restore the blood flow in some other way. In this case your son is not suffering from pain.

Now the cause is another story and should be looked for. Sometimes weather changes (especially extreme cold) is the culprit because significant contraction or constriction of the surface blood vessels occurs which reduces the circulating blood volume to the surface structures of the skin and to a certain extent muscles. This in turn reduces oxygen being supplied which then, believed the reason why the color blue predominates since this represents relatively oxygen deficient blood in that area due to the process of constricting the vessels which also causes a buildup of carbon dioxide which accumulates in the tissues since the caliber of the blood vessels are reduced and therefore, transporting away the CO2 in the local area becomes hampered.

Aside from temperature there are things such as physical obstructions to blood flow as tight clothing, tight clothing accessories around a limb or part of the body such as bands, wrist watches, wristbands, extremely tight shoes or boots, ligatures that are left on for prolonged periods of time, etc. I'm assuming that's not the case with your son.

Finally, other pathological reasons fro compromised blood supply such as poor circulation due to just plain old POOR CIRCULATION. Now, in his case since we are suspecting that he may actually possess an anatomic issue involving his spinal cord as in spina bifida occulta then, I would propose that the circulatory pattern which is dictated by his autonomic nervous system that supplies the penis is compromised or aberrant due to the pathology of the cord itself. It may therefore, be true that specific autonomic ganglia or nerves that supply that area of the body which controls blood circulation can be compromised by the congenital and anatomical defect. Thus, the penis becomes discolored due to autonomic dysfunction locally caused by an abnormal spinal cord anatomy and affectation of spinal nerves responsible for the autonomic nervous system. In fact, what is known as the CRANIOSACRAL OUTFLOW which is where autonomic function nerves primarily are concentrated in the nervous system and control many automatic functions of the body in the head, the gut, and the pelvic structures is totally consistent with what could be happening in your son's case.

My recommendation is that he be first examined by his doctor to rule out any of the physical causes that mentioned above for blood flow obstruction. After that workup has been exhausted and he's been found to be without physical reasons or metabolic reasons to have blood flow reduction of that nature then, I believe consideration needs to be given to some type of autonomic dysfunction that supplies the vascular flow to the penis. I would check out an U/S Doppler for flow to the penile structure and then, look to see if any congenital anomalies either of the nerve supply or of the blood vessels themselves explain what may be going on in this child.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them when completed.

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