Diseases and Disorders of the Male Genitalia at a Glance
- Men with genital skin problems can present to physicians who are not trained or experienced in the diagnosis and management of these problems.
- Skin problems of the male genitalia may be any of the following:
- Normal variants.
- Manifestations of sexually transmitted diseases.
- Dermatoses that may be generalized or found at extragenital sites but that have a predilection for the genitalia.
- Dermatoses that are specific to the genitalia.
- Much dermatologic disease of the male organ can be linked to the causes or consequences of preputial dysfunction.
- The guiding philosophy behind diagnosis and management is to exclude sexually transmitted disease and to minimize or abolish sexual and urinary dysfunction and the risk of cancer of the penis.
- Circumcision is controversial, but it is indispensable in the management of some diseases of the penis and foreskin.
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
Table 77-1 Benefits of Circumcision |Favorite Table|Download (.pdf)
Table 77-1 Benefits of Circumcision
Reduced or abolished risk of penile cancer
Decreased risk of cervical cancer in partners
Protection from sexually transmitted infections, including human immunodeficiency virus infection (controversial)
Reduced risk of urinary tract infections (controversial)
Reduced risk of inflammatory genital skin diseases
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.
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...