Chapter 32: Skin Diseases of the Genitals and Perineum

INTRODUCTION TO CHAPTER

A stroll down the pharmacy aisle is proof enough that genital symptoms plague our society. Many patients will go to great lengths to solve genital symptoms on their own, whether motivated by embarrassment, lack of access to medical care, or uncertainty as to which medical professional is best suited to treat the problem. This often leads to a delay in care and sometimes more than one cause of their symptoms by the time care is obtained. In fact, 1 in 6 women will experience an untreated vulvovaginal discomfort in their lifetime.¹ The following chapter will review the most common causes of genital complaints with some early intervention recommendations.

ANATOMY

Prior to reviewing the main causes of symptoms and disease, it is important to review normal genital anatomy which is also highlighted in the figures below. Knowing normal genital anatomy can help the clinician identify abnormalities as well as communicate to other specialties the location of concern.

The external component of female genitalia is called the vulva (Figure 32-1). The labia majus extends bilaterally from the mons to the perineum at the fourchette and is a hair bearing area. Between the labia majus are two labia minus which extend from the clitoral hood to just anterior to the labia majus insertion. Between the labia majus and labia minus is the interlabial sulcus. The labia minora can vary significantly in size and whether it extends beyond the labia majora externally. The clitoral hood when retracted will expose the clitoris. The area inside the labia minora is called the vestibule within which one will find the urethral orifice, trigone area, and the vaginal opening.

Penile anatomy consists of two main sections: the shaft and then distally the glans (Figure 32-2). The cone like glans contains the slit like urethral opening. The glans is separated from the shaft by the corona which in uncircumcised men is covered by the prepuce or foreskin. The concavity between the corona and the shaft is the sulcus.

CATEGORIES OF DISEASE

Skin diseases of the genitals and perineum can be classified into five broad categories:

• Dermatitis

  • Irritant contact dermatitis and allergic contact dermatitis

  • Lichen simplex chronicus

• Papulosquamous disorders

  • Psoriasis

  • Lichen planus

  • Lichen sclerosus

• Infection

  • Fungal

    • Candidiasis

    • Tinea cruris

  • Bacterial

    • Erythrasma

    • Folliculitis

    • Hidradenitis

    • Perianal streptococcal disease

    • Syphilis

  • Viral

    • Herpes simplex

    • Molluscum

    • Human papillomavirus

• Cancerous and precancerous tumors

  • Squamous cell carcinoma

  • Melanoma

  • Extramammary paget's disease

• Dysesthesias/Genital pain syndromes

  • Vulvodynia

  • Scrotodynia

    ...