Anthony Hall - Atlas of Male Genital Dermatology

Anthony Hall

Atlas of Male Genital Dermatology

Anthony Hall

School of Medicine, Deakin University, Geelong, VIC, Australia

Skin and Cancer Foundation Inc, Carlton, VIC, Australia

ISBN 978-3-319-99749-0 e-ISBN 978-3-319-99750-6

https://doi.org/10.1007/978-3-319-99750-6

Library of Congress Control Number: 2018960383

Springer Nature Switzerland AG 2019

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This book is dedicated to my wife, Bronwyn and to our three wonderful children whom we love so dearly.

Preface

The perception of most patients and health professionals is that genital disease is mostly sexually transmissible infections (STIs). This approach leads to a diligent search for a sexually transmissible disease (STD) while the patient is left waiting with anxiety and fears. Once investigations are found to be negative for any sexually transmissible disease, many patients are simply informed they do not have an STD and discharged from care. Often no further treatment or advice is offered. Many patients are left uncertain of their diagnosis with persisting symptoms and some still fear they have cancer.

In reality, most genital disease is skin disease of the male genitalia. Most genital skin disease is either a common inflammatory skin disease involving genitalia, a benign skin disease with predilection for genitalia, or genital dysesthesia. Only a minority of patients with genital skin disease have an STD, and fewer have premalignant or an invasive genital cancer.

Most patients with genital disease are managed well by their family physician, sexual health physician, infectious disease physician, urological surgeon, or gynecologist. This atlas brings the perspective of a dermatologist who specializes in male genital skin diseases.

Managing patients with genital skin disease is both challenging and extremely rewarding. Making the correct diagnosis is fundamental to helping our patients. Hopefully this atlas will aid other health professionals in this field in making a correct diagnosis and offering appropriate treatments for our patients.

Anthony Hall

Geelong, VIC, Australia Carlton, VIC, Australia

Acknowledgements

Thank you to my colleagues and staff at both Baycity Dermatology and the Skin & Cancer Foundation in Victoria and to Grant Weston, Lee Klein, Andre Tournois and Dinesh Vinayagam at Springer Nature for help with this project.

Contents

Most genital disease is disease of genital skin. Many male patients fear their genital skin disease is either a sexually transmissible infection (STI) or a genital cancer. Correctly diagnosing and managing patients with concerns about their genitalia or genital disease takes skill and expertise but can be mastered with practice. Improving management of these patients ameliorates symptoms and alleviates distress, anxiety and often hidden fears.

The anogenital region is the crossroad of four organ systems: skin (the integument), reproductive system, urinary system and alimentary system (gastro-intestinal system or gut). Diseases of male genital skin may be common dermatoses occurring on the genitalia or dermatoses with a predilection for genital skin. Confusion arises with variation of the appearance of genitalia, common anatomic variants, and different presentations of dermatoses of the anogenital region. The presence of a foreskin (prepuce) may alter the appearance of genital skin disease and is associated with a higher likelihood of genital disease. Finally, the appearance of genital disease may be further altered by prescribed or self-prescribed (over-the-counter) treatments.

The glans penis (or simply the glans) may be partially or totally covered by the foreskin (prepuce) in the flaccid (non-erect) state (Figs. ]. The corona of the glans is a circumferential (annular) elevation at the base of the glans, often darker in colour than the rest of the glans. The narrowing at the junction of the glans and the penile shaft is termed the coronal sulcus, neck, or retroglandular sulcus.

Under the foreskin is an intertriginous region known as the preputial recess, balano-preputial recess, retroglandular sulcus , or simply subprepuce (Fig. ). The balano-preputial recess (a potential space) disappears with full erection, when the foreskin becomes continuous with the elongated, erect penile shaft. When the prepuce is retracted in the flaccid state, the skin of the subprepuce appears thinner, partially translucent and more erythematous, with visible superficial blood vessels. Confusion may arise between the normal appearance of the subprepuce and irritant dermatitis. This confusion may be exacerbated by the use of a topical corticosteroid beneath the foreskin, leading to concern of possible corticosteroid atrophy.

Fig. 1.1

Appearance of male genitalia (circumcised)

Fig. 1.2

Appearance of male genitalia (uncircumcised)