The important thing to note here is...
Means that pearly penile papules have blood vessels inside them.
These blood vessels are fragile and are easily damaged.
Damage to these delicate blood vessels can trigger inflammation & cause penile tissue scarring.
Means that pearly penile papules also have dense fibrous tissue inside them.
This fibrotic tissue is clumped up into a tough mass that is difficult to breakdown.
Getting to these fibrotic clumps is not easy because it requires you to go deep past the delicate penile surface.
On the one hand you want to get to the tough fibrous tissue deep inside each papule and break it down effectively
On the other hand you want to do this without damaging the delicate blood vessels below or irritating the sensitive penile surface above