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The incidence and prevalence of male genital dermatoses are not known with accuracy, but most, like sexually transmitted diseases, are more common and more severe in the uncircumcised; these include psoriasis, seborrheic dermatitis, and lichen planus (LP).1 The global prevalence of circumcision is estimated at 25%–33% and in the United States, 85%.1–5 Religious and cultural practices and medical intervention account for these rates. Circumcision has been adopted as a measure to reduce human immunodeficiency virus (HIV) transmission.6–17 Neonatal circumcision is a topic that evokes controversy, but some benefits are accepted (Table 77-1).1,2,3,10,18–41 Although there is little evidence of significant adverse effects on health and psychosexual function, circumcision can have side effects and complications, especially when performed “ritually.”3,5,17–19,42–47 Although views of circumcision range from prophylaxis to child abuse, the rational stance is that nontherapeutic circumcision of male infants should be left to parental discretion.3,48–50
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Etiologic and pathogenetic factors have to be understood in relationship to structure, function, and microecology.3 Obviously the genital area differs between the sexes, but it also provides a good example of regional human variation.
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Although the whole organ of the skin is concerned with sexual expression and activity, the penis is the male structure most intimately involved in sexual intercourse. It is also the conduit for urinary excretion. The scrotum is the extracorporeal sack that maintains the testes at the ideal temperature for spermatogenesis. The essential structures of the penis and its important landmarks are illustrated in Figure 77-1...