Circumcision and disorders of penis
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Circumcision is the most commonly performed operation in males and is among the oldest - it is believed to have probably originated 15,000 years ago. It was initially performed for religious, ritual or cultural reasons and did not become 'medicalised' until the nineteenth century. Medical indications for circumcisions are few and can be divided into absolute and relative. The absolute indication for circumcision is phimosis secondary to Balanitis xerotica obliterans, which is identical to vulval lichen sclerosis et atrophicus. Circumcision is contraindicated in conditions such as hypospadias, chordee, penoscrotal fusion, buried penis, micropenis, bleeding disorders and megameatus intact prepuce variant of hypospadias. Other complications following circumcision can be skin related, major penile injury or trauma to the glans and urethral meatus. Concealed or buried penis appears small and is secondary to inadequate attachment of the dartos or spermatic fascia to the deeper Buck's fascia.
Problems with the foreskin
Manu Shah, Ariyaratne de Silva in The Male Genitalia, 2018
The function of the foreskin is to protect the glans penis. However, on occasions it may become diseased. Phimosis is a clinical sign and not a diagnosis. It may be a normal finding in boys but usually signifies a specific disease in men. Men may experience a variety of other problems associated with the foreskin. A long foreskin is prone to cause symptoms of dribbling. Lichen sclerosus is also known by other names: lichen sclerosus et atrophicus and balanitis xerotica obliterans (BXO). There are a large number of symptoms that may be associated with lichen sclerosus. Men often present with symptoms of phimosis. Retracting the foreskin may be difficult due to scarring or adhesions. Many cases of lichen sclerosus can be diagnosed clinically. However, co-existing disease such as Zoon's balanitis or infective balanitis is not uncommon and this may complicate diagnosis. There are both medical and surgical treatments for lichen sclerosus. In most cases ultrapotent topical steroids will improve symptoms.
Genital
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
Genital injury in boys caused by physical or sexual abuse is often unrecognised. Any unexplained penile burn, bruising, incised wound and laceration should raise suspicions of child abuse. Children suffering from child abuse may present with symptoms not related directly to their genitalia, example sleep disturbance, behaviour changes, phobias, anorexia, poor school performance and social withdrawal. Swelling of the groin in infants and young children is common and usually noticed by the mother while giving the child a bath. Groin pain often accompanies groin swelling, is caused by a tear or rupture to any adductor thigh muscles following trauma, and produces sudden sharp pain in the thigh. Risk factors for hernia incarceration include female gender, femoral hernia, and groin hernia. Lichen sclerosus is characterised by a sharply demarcated area of hypopigmentation around the vulva and the perianal area. It is associated with intense itching and bleeds easily with normal toilet activities such as genital wiping.
Combined therapy in vulvar lichen sclerosus: does topical tretinoin improve the efficacy of mometasone furoate?
Published in Journal of Dermatological Treatment, 2017
Alessandro Borghi, Sara Minghetti, Giulia Toni, Annarosa Virgili, Monica Corazza
Abstrract Purpose: To assess efficacy and safety profile of combining a potent corticosteroid with a retinoid in the treatment of vulvar lichen sclerosus (VLS). Methods: We retrospectively compared 21 VLS patients treated with tretinoin (T) in short-contact therapy and mometasone furoate (MMF) (group A) and 20 treated with cold cream (CC) and MMF (group B) for 5 consecutive days/week for 12 weeks. The efficacy parameters were the response rate, the percentage of patients achieving an improvement from baseline of ≥75% in subjective and objective scores and the mean reduction in subjective and objective scores. Results: Thirteen patients (75.2%) were considered as responders in group A and 15 (78.9%) in group B; 50% and 61.1% of patients in group A and 100% and 63.1% in group B achieved an improvement of at least 75% in subjective and objective scores, respectively. The scheme combining MMF and CC was better tolerated than the combination of MMF and T. Conclusions: The combination with a topical retinoid did not enhance the effectiveness of a potent corticosteroid in the treatment of VLS. Either the scarce efficacy of the short-contact therapy regimen or a less favorable safety profile of such combination may account for these findings.
Prevention, identification and treatment of vulvar squamous (pre)malignancies: a review focusing on quality of care
Published in Expert Review of Anticancer Therapy, 2013
Loes CG van den Einden, Irene AM van der Avoort, Joanne A de Hullu
Vulvar squamous cell carcinoma, its precursor lesions (usual and differentiated vulvar intraepithelial neoplasia) and lichen sclerosus are rare diseases that may have a large impact on the lives of affected women and their partners. Proper identification is vital, but the lesions are sometimes difficult to diagnose because of their rarity and variety of symptoms. High quality of care and proper treatment is important in order to minimize the morbidity and mortality caused by these lesions. This review gives an outline of the latest insights regarding the current evidence in this area and unresolved issues. Additionally, it highlights the improvements that should be made in order to optimize prevention and identification of (pre-)malignant vulvar lesions and to increase the quality of care for these patients.
Lichen sclerosus in women: a review
Published in Climacteric, 2017
F. R. Pérez-López, P. Vieira-Baptista
Female lichen sclerosus is a chronic inflammatory dermatitis, with a predilection for the anogenital area, which in some cases can become seriously distorted (atrophy of the labia minora, phimosis, introital stenosis, etc.). Most cases are diagnosed in postmenopausal women, but it can affect women of any age. Lichen sclerosus is usually a pruriginous condition, although it can also be asymptomatic. It is associated with an increased risk of vulvar cancer, even though it is not a premalignant condition itself. The true precursor of cancer associated with lichen sclerosus is vulvar intraepithelial neoplasia, differentiated type. The diagnosis is usually clinical, but in some cases a biopsy can be performed, especially to exclude vulvar intraepithelial neoplasia or cancer. The treatment of lichen sclerosus aims at controlling the symptoms, stopping further scarring and distortion and reducing the risk of cancer. The gold standard in treatment is ultra-potent topical steroids (clobetasol propionate). Second-line treatments include calcineurin inhibitors, retinoids, and immunosuppressors. Surgery is used only for the treatment of complications associated with lichen sclerosus. Follow-up must be kept indefinitely.
Related Knowledge Centers
- Genitalia
- Infectious Disease
- Lichen Planus
- Autoimmune Disease
- Vulvar Lichen Sclerosus
- Balanitis Xerotica Obliterans
- Lichenoid Eruptions