Causes of Male sexual conditions
Male sexual conditions Causes: Book Excerpts
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Priapism:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Low-flow, or “ischemic”-type: Corpora cavernosa are rigid; corpora spongiosum and glands are spared; there is decreased venous outflow, sludging, and stasis; painful
–Intracorporeal injection for impotence (most common cause in adults): Papaverine, prostaglandin E1, phentolamine, phenoxybenzamine
–Sickle cell disease (most common cause in
children)
–Leukemia
–Penile infiltration with solid tumors
(bladder cancer, prostate cancer)
–Prescription drugs: Trazodone,
chlorpromazine, sildenafil
–Illicit drugs: Marijuana, crack cocaine
–Idiopathic
–Other (e.g., total parenteral nutrition,
dialysis, vasculitis)
-
High-flow: Caused by increased arterial blood flow due to arterial-cavernosal shunt; whole penis is rigid; not usually painful
–Groin or straddle injury
–Cocaine
-
Less common etiologies
–Post-spinal cord trauma or injury to the medulla (clinically similar to high-flow priapism)
–Polycythemia
–Thalassemia
–Fabry's disease
–May occur in clitoris as well as penis
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Scrotal Swelling:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Hydrocele
–Fluid surrounding the testicle
–Typically seen in infancy
–Results from remnant of testicular descent from the abdomen through the inguinal canal into the scrotum
–May be communicating or noncommunicating; communicating hydroceles have retained patency of the tract of descent, and noncommunicating hydroceles do not
–Communicating hydroceles may be reducible and are likely to fluctuate in size depending on the amount of fluid within the scrotal sac; crying or any increase in intra-abdominal pressure results in an increase in size
–Usually is noncommunicating; i.e., not reducible, and does not change in size with crying
–Testes may be difficult to palpate because surrounded by the hydrocele
- Hernia
–Protrusion of a loop of bowel into the scrotum
–Direct hernias represent a channel directly through the musculature of the pelvic floor; indirect hernias have proceeded through the inguinal canal
–Usually painless unless incarcerated
–Usually reducible and changes in size with changes in intra-abdominal pressure
–Testes usually palpable below the hernia
-
Varicocele
–A collection of dilated veins in the scrotum
–Usually painless, but patients may complain
of heaviness
-
Edema
–Generalized edema often is accompanied by scrotal edema
-
Tumor
–Presents as painless nodule on testes
–May be accompanied by sexual precocity or
gynecomastia secondary to hormone production by the tumor
-
Leukemia
–Patients may present with unilateral scrotal swelling (common site for relapse)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Impotence:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Central nervous system disorders
Spinal cord lesions from trauma produce sudden impotence
A complete lesion above S2 (upper motor neuron lesion) disrupts descending motor tracts to the genital area, causing a loss of voluntary erectile control but not of reflex erection and reflex ejaculation. However, a complete lesion in the lumbosacral spinal cord (lower motor neuron lesion) causes a loss of reflex ejaculation and reflex erection. Spinal cord tumors and degenerative diseases of the brain and spinal cord (such as multiple sclerosis and amyotrophic lateral sclerosis) cause progressive impotence.
Endocrine disorders
Hypogonadism from testicular or pituitary dysfunction may lead to impotence from a deficient secretion of androgens (primarily testosterone)
Adrenocortical and thyroid dysfunction and chronic hepatic disease may also cause impotence because these organs play a role (although minor) in sex hormone regulation.
Penile disorders
With Peyronie’s disease, the penis is bent, making erection painful and penetration difficult and eventually impossible
Phimosis prevents erection until circumcision releases the constricted foreskin. Other inflammatory, infectious, or destructive diseases of the penis may also cause impotence.
Psychological distress
Impotence can result from diverse psychological causes, including depression, performance anxiety, memories of previous traumatic sexual experiences, moral or religious conflicts, and troubled emotional or sexual relationships.
Other causes
Alcohol and drugs
Alcoholism and drug abuse are associated with impotence, as are many prescription drugs, especially antihypertensives. (See Drugs that may cause impotence, page 352.)
Surgery
Surgical injury to the penis, bladder neck, urinary sphincter, rectum, or perineum can cause impotence, as can injury to local nerves or blood vessels.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Priapism:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Penile cancer
Cancer that exerts pressure on the corpora cavernosa can cause priapism. Usually, the first sign is a painless ulcerative lesion or an enlarging warty growth on the glans or foreskin, which may be accompanied by localized pain, a foul-smelling discharge from the prepuce, a firm lump near the glans, and lymphadenopathy. Later findings include bleeding, dysuria, urine retention, and bladder distention. Phimosis and poor hygiene have been linked to the development of penile cancer.
Sickle cell anemia
With sickle cell anemia, painful priapism can occur without warning, usually on awakening. The patient may have a history of priapism, impaired growth and development, and an increased susceptibility to infection. Related findings include tachycardia, pallor, weakness, hepatomegaly, dyspnea, joint swelling, joint or bone aching, chest pain, fatigue, murmurs, leg ulcers and, possibly, jaundice and gross hematuria.
With sickle cell crisis, signs and symptoms of sickle cell anemia may worsen and others, such as abdominal pain and a low-grade fever, may appear.
Spinal cord injury
With spinal cord injury, the patient may be unaware of the onset of priapism. Related effects depend on the extent and level of injury and may include autonomic signs such as bradycardia.
Stroke
A stroke may cause priapism, but sensory loss and aphasia may prevent the patient from noticing or describing it. Other findings depend on the stroke’s location and extent, but may include contralateral hemiplegia, seizures, a headache, dysarthria, dysphagia, ataxia, apraxia, and agnosia. Visual deficits include homonymous hemianopsia, blurring, decreased acuity, and diplopia. Urine retention or incontinence, fecal incontinence, constipation, and vomiting may also occur.
Other causes
Drugs
Priapism can result from the use of a phenothiazine, thioridazine, trazodone, an androgenic steroid, an anticoagulant, or an antihypertensive. It may also occur after an intracorporeal injection of papaverine, a common treatment for impotence.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Scrotal swelling:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Epididymal cysts
Located in the head of the epididymis, epididymal cysts produce painless scrotal swelling.
Epididymitis
Key features of inflammation are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have a high fever, malaise, an urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Hydrocele
Fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Idiopathic scrotal edema
Swelling occurs quickly with idiopathic scrotal edema and usually disappears within 24 hours. The affected testicle is pink.
Orchitis (acute)
Mumps, syphilis, or tuberculosis may precipitate orchitis, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; a fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Scrotal trauma
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
Spermatocele
Spermatocele is a usually painless cystic mass that lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Testicular torsion
Most common before puberty, testicular torsion is a urologic emergency that causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Testicular tumor
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of a hydatid of Morgagni
Torsion of this small, pea-sized cyst severs its blood supply, causing a hard, painful swelling on the testicle’s upper pole.
Other causes
Surgery
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Genital lesions in the male:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Balanitis and balanoposthitis
Typically, balanitis (glans infection) and posthitis (prepuce infection) occur together (balanoposthitis), causing painful ulceration on the glans, foreskin, or penile shaft. Ulceration is usually preceded by 2 to 3 days of prepuce irritation and soreness, followed by a foul discharge and edema. The patient may then develop features of acute infection, such as a fever with chills, malaise, and dysuria. Without treatment, the ulcers may deepen and multiply. Eventually, the entire penis and scrotum may become gangrenous, resulting in life-threatening sepsis.
Bowen’s disease
Bowen’s disease is a painless, premalignant lesion that commonly occurs on the penis or scrotum, but may also appear elsewhere. It appears as a brownish red, raised, scaly, indurated plaque with well-defined borders, which may ulcerate at its center.
Chancroid
Chancroid is an STD that’s characterized by the eruption of one or more lesions, usually on the groin, inner thigh, or penis. Within 24 hours, the lesion changes from a reddened area to a small papule. (A similar papule may erupt on the tongue, lip, breast, or umbilicus.) It then becomes an inflamed pustule that rapidly ulcerates. This painful — and usually deep — ulcer bleeds easily and commonly has a purulent gray or yellow exudate covering its base. Rarely more than 2 cm in diameter, it’s typically irregular in shape. The inguinal lymph nodes also enlarge, become very tender, and may drain pus.
Folliculitis and furunculosis
Hair follicle infection may cause red, sharply pointed lesions that are tender and swollen with central pustules. If folliculitis progresses to furunculosis, these lesions become hard, painful nodules that may gradually enlarge and rupture, discharging pus and necrotic material. Rupture relieves the pain, but erythema and edema may persist for days or weeks.
Genital herpes
Caused by herpesvirus type 1 or 2, genital herpes is an STD that produces fluid-filled vesicles on the glans penis, foreskin, or penile shaft and, occasionally, on the mouth or anus. Usually painless at first, these vesicles may rupture and become extensive, shallow, painful ulcers accompanied by redness, marked edema, and tender, inguinal lymph nodes. Other findings may include a fever, malaise, and dysuria. If the vesicles recur in the same area, the patient usually feels localized numbness and tingling before they erupt. Associated inflammation is typically less marked.
Genital warts
Most common in sexually active males, genital warts initially develop on the subpreputial sac or urethral meatus, and less commonly on the penile shaft; they then spread to the perineum and perianal area. These painless warts start as tiny red or pink swellings that may grow to 4" (10 cm) and become pedunculated. Multiple swellings are common, giving the warts a cauliflower appearance. Infected warts are also malodorous.
Leukoplakia
Leukoplakia is a precancerous disorder that’s characterized by white, scaly patches on the glans and prepuce accompanied by skin thickening and occasionally fissures.
Pediculosis pubis
Pediculosis pubis is a parasitic infestation that’s characterized by erythematous, itching papules in the pubic area and around the anus, abdomen, and thigh. Inspection may detect grayish white specks (lice eggs) attached to hair shafts. Skin irritation from scratching in these areas is common.
Penile cancer
Penile cancer usually produces a painless, enlarging wartlike lesion on the glans or foreskin. However, if the foreskin becomes unretractable, the patient may experience localized pain. Examination may reveal a foul-smelling discharge from the prepuce, a firm lump in the glans, and enlarged lymph nodes. Late signs and symptoms may include dysuria, pain, bleeding from the lesion, and urine retention and bladder distention associated with urinary tract obstruction.
Scabies
Mites that burrow under the skin in scabies may cause crusted lesions or large papules on the glans and shaft of the penis and on the scrotum. Lesions may also occur on the wrists, elbows, axillae, and waist. They’re usually raised, threadlike, and 1 to 10 cm long and have a swollen nodule or red papule that contains the mite. Nocturnal itching is typical and commonly causes excoriation.
Syphilis
Two to four weeks after exposure to the spirochete Treponema pallidum, one or more primary lesions, or chancres, may erupt on the genitalia; occasionally, they also erupt elsewhere on the body, typically on the mouth or perianal area. The chancre usually starts as a small, red, fluid-filled papule and then erodes to form a painless, firm, indurated, shallow ulcer with a clear base and a scant, yellow serous discharge or, less commonly, a hard papule. This lesion gradually involutes and disappears. Painless, unilateral regional lymphadenopathy is also typical.
Tinea cruris
Also called jock itch, tinea cruris is a superficial fungal infection that usually causes sharply defined, slightly raised, scaling patches on the inner thigh or groin (typically bilaterally) and, less commonly, on the scrotum and penis. Pruritus may be severe.
Urticaria
Urticaria is a common allergic reaction that’s characterized by intensely pruritic hives, which may appear on the genitalia, especially on the foreskin or shaft of the penis. These distinct, raised, evanescent wheals are surrounded by an erythematous flare.
Other causes
Drugs
Phenolphthalein, barbiturates, and certain broad-spectrum antibiotics, such as tetracycline and sulfonamides, may cause a fixed drug eruption and a genital lesion.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Impotence:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Central nervous system disorders
Spinal cord lesions from trauma produce sudden impotence. A complete lesion above S2 (upper-motor-neuron lesion) disrupts descending motor tracts to the genital area, causing loss of voluntary erectile control but not of reflex erection and reflex ejaculation. However, a complete lesion in the lumbosacral spinal cord (lower-motor-neuron lesion) causes loss of reflex ejaculation and reflex erection. Spinal cord tumors and degenerative diseases of the brain and spinal cord (such as multiple sclerosis and amyotrophic lateral sclerosis) cause progressive impotence.
Endocrine disorders
Hypogonadism from testicular or pituitary dysfunction may lead to impotence from deficient secretion of androgens (primarily testosterone). Adrenocortical and thyroid dysfunction and chronic hepatic disease may also cause impotence because these organs play a role (although minor) in sex hormone regulation.
Penile disorders
With Peyronie’s disease, the penis is bent, making erection painful and penetration difficult and eventually impossible. Phimosis prevents erection until circumcision releases constricted foreskin. Other inflammatory, infectious, or destructive diseases of the penis may also cause impotence.
Peripheral neuropathy
Systemic diseases, such as chronic renal failure and diabetes mellitus, can cause progressive impotence if the patient develops peripheral neuropathy. This condition affects about 50% of males with diabetes. Associated signs and symptoms of diabetic neuropathy include bladder distention with overflow incontinence, orthostatic hypotension, syncope, paresthesia and other sensory disturbances, muscle weakness, and leg atrophy.
Psychological distress
Impotence can result from diverse psychological causes, including depression, performance anxiety, memories of previous traumatic sexual experiences, moral or religious conflicts, and troubled emotional or sexual relationships.
Trauma
Traumatic injury involving the penis, urethra, prostate, perineum, or pelvis may cause sudden impotence due to structural alteration, nerve damage, or interrupted blood supply.
Vascular disorders
Various vascular disorders can cause impotence. These include advanced arteriosclerosis affecting both major and peripheral blood vessels, Leriche’s syndrome (slowly developing occlusion of the terminal abdominal aorta), and arteriosclerosis, thrombosis, or embolization of smaller vessels supplying the penis.
Other causes
Alcohol and drugs
Alcoholism and drug abuse are associated with impotence, as are many prescription drugs, especially antihypertensives. (See Drugs that may cause impotence.)
Surgery
Surgical injury to the penis, bladder neck, urinary sphincter, rectum, or perineum can cause impotence, as can injury to local nerves or blood vessels.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Priapism:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Granulocytic leukemia (chronic)
Priapism is an uncommon sign of this disorder. More characteristic signs and symptoms include fatigue, weakness, malaise, lymphadenopathy, pallor, dyspnea, tachycardia, and bleeding tendencies. Hepatosplenomegaly, bone tenderness, low-grade fever, weight loss, and anorexia may also occur.
Penile cancer
Cancer that exerts pressure on the corpora cavernosa can cause priapism. Usually, the first sign is a painless ulcerative lesion or an enlarging warty growth on the glans or foreskin, which may be accompanied by localized pain, a foul-smelling discharge from the prepuce, a firm lump near the glans, and lymphadenopathy. Later findings include bleeding, dysuria, urine retention, and bladder distention. Phimosis and poor hygiene have been linked to the development of penile cancer.
Penile trauma
Priapism can occur with other signs and symptoms of injury, such as bruising, abrasions, swelling, pain, and hematuria.
Sickle cell anemia
With this congenital disorder, painful priapism can occur without warning, usually on awakening. The patient may have a history of priapism, impaired growth and development, and increased susceptibility to infection. Related findings include tachycardia, pallor, weakness, hepatomegaly, dyspnea, joint swelling, joint or bone aching, chest pain, fatigue, murmurs, leg ulcers and, possibly, jaundice and gross hematuria.
With sickle cell crisis, signs and symptoms of sickle cell anemia may worsen and others, such as abdominal pain and low-grade fever, may appear.
Spinal cord injury
With this condition, the patient may be unaware of the onset of priapism. Related effects depend on the extent and level of injury and may include autonomic signs, such as bradycardia.
Stroke
A stroke may cause priapism, but sensory loss and aphasia may prevent the patient from noticing or describing it. Other findings depend on the stroke location and extent but may include contralateral hemiplegia, seizures, headache, dysarthria, dysphagia, ataxia, apraxia, and agnosia. Visual deficits include homonymous hemianopsia, blurring, decreased acuity, and diplopia. Urine retention or incontinence, fecal incontinence, constipation, and vomiting may also occur.
Thrombocytopenia
This disorder uncommonly produces priapism. More typical characteristics include blood-filled bullae in the mouth and local bleeding, such as epistaxis, ecchymosis, and hematuria. Central nervous system bleeding may cause decreased level of consciousness. Fatigue, weakness, and lethargy may occur.
Other causes
Drugs
Priapism can result from the use of a phenothiazine, thioridazine, trazodone, an androgenic steroid, an anticoagulant, or an antihypertensive.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Scrotal swelling:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Elephantiasis of the scrotum
With this disorder (common in some tropical countries), infection by a filaria worm obstructs lymphatic drainage, causing chronic gross scrotal edema and pain. Associated findings include other areas of pitting and, eventually, brawny edema (especially the legs), thickened subcutaneous tissue, hyperkeratosis, and skin fissures.
Epididymal cysts
Located in the head of the epididymis, these cysts produce painless scrotal swelling.
Epididymal tuberculosis
This disorder produces an enlarged scrotal mass separated from the testicle. Other findings include palpable beading along the vas deferens, induration of the prostate or seminal vesicles, and pus or tubercle bacilli in the urine.
Epididymitis
Key features of inflammation are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have high fever, malaise, urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Gumma
This rare, painless nodule—usually associated with benign tertiary syphilis—can affect any bone or organ. If it affects the testicle, it causes edema.
Hernia
Herniation of bowel into the scrotum can cause swelling and a soft or unusually firm scrotum. Occasionally, bowel sounds can be auscultated in the scrotum.
Hydrocele
Fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Idiopathic scrotal edema
Swelling occurs quickly with this disorder and usually disappears within 24 hours. The affected testicle is pink.
Orchitis (acute)
Mumps, syphilis, or tuberculosis may precipitate this disorder, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Scrotal burns
Burns cause swelling within 24 hours of injury. Depending on the burn’s severity, associated findings may include severe pain, erythema, chafing, tissue sloughing, and maceration with a weeping exudate.
Scrotal trauma
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
Spermatocele
This usually painless cystic mass lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Testicular torsion
Most common before puberty, this urologic emergency causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Testicular tumor
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of a hydatid of Morgagni
Torsion of this small, pea-sized cyst severs its blood supply, causing a hard, painful swelling on the testicle’s upper pole.
Other causes
Surgery
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Genital lesions in the male:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Balanitis and balanoposthitis
Typically, balanitis (glans infection) and posthitis (prepuce infection) occur together (balanoposthitis), causing painful ulceration on the glans, foreskin, or penile shaft. Ulceration is usually preceded by 2 to 3 days of prepuce irritation and soreness, followed by a foul discharge and edema. The patient may then develop features of acute infection, such as fever with chills, malaise, and dysuria. Without treatment, the ulcers may deepen and multiply. Eventually, the entire penis and scrotum may become gangrenous, resulting in life-threatening sepsis.
Bowen’s disease
This painless, premalignant lesion usually occurs on the penis or scrotum but may appear elsewhere. It appears as a brownish red, raised, scaly, indurated, well-defined plaque, which may have an ulcerated center.
Candidiasis
When this infection involves the anogenital area, it produces erythematous, weepy, circumscribed lesions, usually under the prepuce. Vesicles and pustules may also develop.
Chancroid
This STD is characterized by the eruption of one or more lesions, usually on the groin, inner thigh, or penis. Within 24 hours, the lesion changes from a reddened area to a small papule. (A similar papule may erupt on the tongue, lip, breast, or umbilicus.) It then becomes an inflamed pustule that rapidly ulcerates. This painful—and usually deep—ulcer bleeds easily and commonly has a purulent gray or yellow exudate covering its base. Rarely more than 2 cm in diameter, it’s typically irregular in shape. The inguinal lymph nodes also enlarge, become very tender, and may drain pus.
Erythroplasia of Queyrat
This premalignant lesion is a form of Bowen’s disease that appears exclusively under the foreskin of an uncircumcised penis. It typically appears as a red, raised, well-defined, velvety, indurated plaque, which may have an ulcerated center.
Folliculitis and furunculosis
Hair follicle infection may cause red, sharply pointed, tender and swollen lesions with central pustules. If folliculitis progresses to furunculosis, these lesions become hard, painful nodules that may gradually enlarge and rupture, discharging pus and necrotic material. Rupture relieves the pain, but erythema and edema may persist for days or weeks.
Fournier’s gangrene
In this life-threatening form of cellulitis, the scrotum suddenly becomes tense, swollen, painful, red, warm, and glossy. As gangrene develops, the scrotum also becomes moist. Fever and malaise may accompany these scrotal changes.
Genital herpes
Caused by herpesvirus type I or II, this STD produces fluid-filled vesicles on the glans penis, foreskin, or penile shaft and, occasionally, on the mouth or anus. Usually painless at first, these vesicles may rupture and become extensive, shallow, painful ulcers accompanied by redness, marked edema, and tender, inguinal lymph nodes. Other findings may include fever, malaise, and dysuria. If the vesicles recur in the same area, the patient usually feels localized numbness and tingling before they erupt. Associated inflammation is typically less marked.
Genital warts
Most common in sexually active males, genital warts initially develop on the subpreputial sac, urethral meatus or, less commonly, the penile shaft and then spread to the perineum and the perianal area. These painless warts start as tiny red or pink swellings that may grow to 10 cm and become pedunculated. Multiple swellings are common, giving the warts a cauliflower-like appearance. Infected warts are also malodorous.
Granuloma inguinale
Initially, this rare, chronic STD causes a single painless macule or papule on the external genitalia that ulcerates and becomes a raised, beefy red lesion with a granulated, friable border. Later, other painless lesions may erupt and blend together on the glans penis, foreskin, or penile shaft. Lesions may also develop on the nose, mouth, or pharynx. Eventually, these lesions become infected, malodorous, and painful and may be accompanied by fever, weight loss, malaise, and signs of anemia such as weakness. Later, they’re marked by fibrosis, keloidal scarring, and depigmentation.
Leukoplakia
This precancerous disorder is characterized by white, scaly patches on the glans and prepuce accompanied by skin thickening and occasionally fissures.
Lichen planus
Small, shiny, polygonal, violet papules develop on the glans penis in this disorder. These papules are less than 3 cm in diameter and have white, lacy, milky striations. They may be linear or coalesce into plaques. Occasionally, oral lesions precede genital lesions; lesions may also appear on the lower back, ankles, and lower legs. Accompanying findings may include pruritus, distorted nails, and alopecia.
Lymphogranuloma venereum
One to three weeks after sexual exposure, this STD may produce a penile erosion or papule that heals rapidly and spontaneously; in fact, it often goes unnoticed. A few days or weeks later, the inguinal and subinguinal nodes enlarge, becoming painful, fluctuant masses. If these nodes become infected, they rupture and form sinus tracts, discharging a thick, yellow, granular secretion. Eventually, a scar or chronic indurated mass forms in the inguinal area. Systemic signs and symptoms include a rash, fever with chills, headache, migratory joint and muscle pain, malaise, and weight loss.
Pediculosis pubis
This parasitic infestation is characterized by erythematous, pruritic papules in the pubic area and around the anus, abdomen, and thigh. Inspection may detect grayish white specks (lice eggs) attached to hair shafts. Skin irritation from scratching in these areas is common.
Penile cancer
This cancer usually produces a painless, enlarging wartlike lesion on the glans or foreskin. The patient may experience localized pain, however, if the foreskin becomes unretractable. Examination may reveal a foul-smelling discharge from the prepuce, a firm lump in the glans, and enlarged lymph nodes. Late signs and symptoms may include dysuria, pain, bleeding from the lesion, and urine retention and bladder distention associated with obstruction of the urinary tract.
Psoriasis
Red, raised, scaly plaques typically affect the scalp, chest, knees, elbows, and lower back. When they occur on the groin or on the shaft and glans of the penis, the plaques are usually redder; on an uncircumcised penis, the characteristic silver scales are absent. The patient commonly reports itching and, possibly, pain from dry, cracked, encrusted lesions. Nail pitting and joint stiffness may also occur.
Scabies
In this disorder, mites that burrow under the skin may cause crusted lesions or large papules on the glans and shaft of the penis and on the scrotum. Lesions may also occur on the wrists, elbows, axillae, and waist. They’re usually raised, threadlike, and 1 to 10 cm long and have a swollen nodule or red papule that contains the mite. Nocturnal pruritus is typical and commonly causes excoriation.
Seborrheic dermatitis
Initially, this disorder causes erythematous, dry or moist, greasy, scaling papules with yellow crusts that enlarge to form annular plaques. These pruritic plaques may affect the glans and shaft of the penis, scrotum, and groin as well as the scalp, chest, eyebrows, back, axillae, and umbilicus.
Syphilis
Two to four weeks after exposure to the spirochete Treponema pallidum, one or more primary lesions, or chancres, may erupt on the genitalia; occasionally, they also erupt elsewhere on the body, typically on the mouth or perianal area. The chancre usually starts as a small, red, fluid-filled papule and then erodes to form a painless, firm, indurated, shallow ulcer with a clear base and a scant yellow serous discharge or, less commonly, a hard papule. This lesion gradually involutes and disappears. Painless, unilateral regional lymphadenopathy is also typical.
Tinea cruris
Also called “jock itch,” this superficial fungal infection usually causes sharply defined, slightly raised, scaling patches on the inner thigh or groin (often bilaterally) and, less commonly, on the scrotum and penis. Pruritus may be severe.
Urticaria
This common allergic reaction is characterized by intensely pruritic hives, which may appear on the genitalia, especially on the foreskin or shaft of the penis. These distinct, raised, evanescent wheals are surrounded by an erythematous flare.
Other causes
Drugs
Barbiturates and certain broad-spectrum antibiotics, such as tetracycline and sulfonamides, may cause a fixed drug eruption and a genital lesion.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Scrotal Pain/Swelling:
Differential Overview
(Field Guide to Bedside Diagnosis)
Pain Predominant
❑ Epididymitis
❑ Testicular torsion
❑ Prostatitis
❑ Referred pain
❑ Trauma
❑ Orchitis
❑ Torsion of the appendix testis
❑ Inguinal hernia/incarcerated
Swelling Predominant
❑ Varicocele
❑ Inguinal hernia
❑ Hydrocele
❑ Spermatocele
❑ Sebaceous cyst
❑ Testicular cancer
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Scrotal swelling:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Elephantiasis of the scrotum
With elephantiasis of the scrotum (common in some tropical countries), infection by a filaria worm obstructs lymphatic drainage, causing chronic gross scrotal edema and pain. Associated findings include other areas of pitting and, eventually, brawny edema (especially the legs), thickened subcutaneous tissue, hyperkeratosis, and skin fissures.
Epididymal cysts
.Located in the head of the epididymis, these cysts produce painless scrotal swelling.
Epididymal tuberculosis
Epididymal tuberculosis produces an enlarged scrotal mass separated from the testicle. Other findings include palpable beading along the vas deferens, induration of the prostate or seminal vesicles, and pus or tubercle bacilli in urine.
Epididymitis
Key features of inflammation are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have high fever, malaise, urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Gumma
Gumma is a rare, painless nodule — usually associated with benign tertiary syphilis — that can affect any bone or organ. If it affects the testicle, it causes edema.
Hernia
Herniation of bowel into the scrotum can cause swelling and a soft or unusually firm scrotum. Occasionally, bowel sounds can be auscultated in the scrotum.
Hydrocele
Fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Idiopathic scrotal edema
Swelling occurs quickly with idiopathic scrotal edema and usually disappears within 24 hours. The affected testicle is pink.
Orchitis (acute)
Mumps, syphilis, or tuberculosis may precipitate acute orchitis, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum accompanied by fever of up to 104° F (40° C), chills, lower abdominal pain, nausea, vomiting, and extreme weakness. Urinary signs are usually absent.
Scrotal burns
Burns cause swelling within 24 hours of injury. Depending on the burn’s severity, associated findings may include severe pain, erythema, chafing, tissue sloughing, and maceration with a weeping exudate.
Scrotal trauma
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
Spermatocele
This usually painless cystic mass lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Testicular torsion
Most common between ages 12 and 25 years, testicular torsion — a urologic emergency — causes scrotal swelling with sudden, severe pain and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Testicular tumor
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of a hydatid of Morgagni
Torsion of a hydatid of Morgagni — a small, pea-sized cyst — severs its blood supply, causing hard, painful swelling on the testicle’s upper pole.
Other causes
Surgery
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Scrotal swelling:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Epididymal cysts
Located in the head of the epididymis, epididymal cysts produce painless scrotal swelling. Most men, however, are asymptomatic and discover the cyst on self-examination.
Epididymitis
Key features of epididymitis are inflammation, pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have high fever, malaise, urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Hernia
Herniation of bowel into the scrotum can cause swelling and a soft or unusually firm scrotum. Occasionally, bowel sounds can be auscultated in the scrotum. If bowel obstruction occurs, anorexia, nausea, vomiting, and reduced bowel sounds may occur.
Hydrocele
With hydrocele, fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Orchitis (acute)
Mumps, syphilis, or tuberculosis may precipitate acute orchitis, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Scrotal trauma
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish. Nausea, vomiting, and difficulty urinating might also occur.
Spermatocele
A spermatocele, a usually painless cystic mass, lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Testicular torsion
Most common before puberty, testicular torsion is a urologic emergency that causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. Testicular torsion may also cause nausea and vomiting.
Testicular tumor
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum. With ureteral obstruction, the patient may have urinary complaints.
Other causes
Surgery
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Genital lesions in the male:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Balanitis and balanoposthitis
Typically, balanitis (glans infection) and posthitis (prepuce infection) occur together (balanoposthitis), causing painful ulceration on the glans, foreskin, or penile shaft. Ulceration is usually preceded by 2 to 3 days of prepuce irritation and soreness, followed by a foul discharge and edema. The patient may then develop features of acute infection, such as fever with chills, malaise, and dysuria. Without treatment, the ulcers may deepen and multiply. Eventually, the entire penis and scrotum may become gangrenous, resulting in life-threatening sepsis.
Bowen’s disease
Bowen’s disease, a painless, premalignant lesion, commonly occurs on the penis or scrotum but may also appear elsewhere. It appears as a brownish red, raised, scaly, indurated plaque with well-defined borders, which may ulcerate at its center. When lesions appear on the glans penis, it’s called Queyrat’s erythroplasia.
Candidiasis
When candidiasis involves the anogenital area, it produces erythematous, weepy, circumscribed lesions that usually appear under the prepuce. Vesicles and pustules may also develop.
Chancroid
Chancroid is an STD that’s characterized by the eruption of one or more lesions, usually on the groin, inner thigh, or penis. Within 24 hours, the lesion changes from a reddened area to a small papule. (A similar papule may erupt on the tongue, lip, breast, or umbilicus.) It then becomes an inflamed pustule that rapidly ulcerates. This painful — and usually deep — ulcer bleeds easily and often has a purulent gray or yellow exudate covering its base. Rarely more than ¾";(2 cm) in diameter, it’s typically irregular in shape. The inguinal lymph nodes also enlarge, become very tender, and may drain pus.
Folliculitis and furunculosis
Folliculitis (hair follicle infection) may cause red, sharply pointed lesions that are tender and swollen with central pustules. If folliculitis progresses to furunculosis, these lesions become hard, painful nodules that may gradually enlarge and rupture, discharging pus and necrotic material. Rupture relieves the pain, but erythema and edema may persist for days or weeks.
Genital herpes
An STD, genital herpes produces fluid-filled vesicles on the glans penis, foreskin, or penile shaft and, occasionally, on the mouth or anus. Usually painless at first, these vesicles may rupture and become extensive, shallow, painful ulcers accompanied by redness, marked edema, and tender, inguinal lymph nodes. Other findings may include fever, malaise, and dysuria. If the vesicles recur in the same area, the patient usually feels localized numbness and tingling before they erupt. Associated inflammation is typically less marked.
Genital warts
Most common in sexually active males, genital warts initially develop on the subpreputial sac or urethral meatus (less commonly, on the penile shaft); they then spread to the perineum and the perianal area. These painless warts start as tiny red or pink swellings that may grow to 4";(10.2 cm) and become pedunculated. Multiple swellings are common, giving the warts a cauliflower appearance. Infected warts are also malodorous.
Lichen planus
With lichen planus, small, polygonal, violet papules develop on the glans penis. These papules are shiny and less than 1¼";(3.2 cm) in diameter and have white, lacy, milky striations. They may be linear or coalesce into plaques. Occasionally, oral lesions precede genital lesions. Also, lesions may affect the lower back, ankles, and lower legs. Accompanying findings may include pruritus, distorted nails, and alopecia.
Pediculosis pubis
Pediculosis pubis, a parasitic infestation, is characterized by erythematous, itching papules in the pubic area and around the anus, abdomen, and thigh. Inspection may detect grayish white specks (lice eggs) attached to hair shafts. Skin irritation from scratching in these areas is common.
Psoriasis
With psoriasis, red, raised, scaly plaques typically affect the scalp, chest, knees, elbows, and lower back. When they occur on the groin or on the shaft and glans of the penis, the plaques are usually redder; on an uncircumcised penis, the characteristic silver scales are absent. The patient commonly reports itching; pain from dry, cracked, encrusted lesions occasionally occurs. Nail pitting and joint stiffness may also occur.
Scabies
Scabies are mites that burrow under the skin and may cause crusted lesions or large papules on the glans and shaft of the penis and on the scrotum. Lesions may also occur on the wrists, elbows, axillae, and waist. They’re usually raised, threadlike, ⅜" to 4";(1 to 10 cm) long, and have a swollen nodule or red papule that contains the mite. Nocturnal itching is typical and commonly causes excoriation.
Seborrheic dermatitis
Initially, seborrheic dermatitis causes erythematous, dry or moist greasy scaling papules, and yellow crusts that enlarge to form annular plaques. These itchy plaques may affect the glans and shaft of the penis, scrotum, and groin as well as the scalp, chest, eyebrows, back, axillae, and umbilicus.
Syphilis
Two to four weeks after exposure to the spirochete Treponema pallidum (syphilis), one or more primary lesions, or chancres, may erupt on the genitalia; occasionally, they also erupt elsewhere on the body, typically on the mouth or perianal area. The chancre usually starts as a small, red, fluid-filled papule and then erodes to form a painless, firm, indurated, shallow ulcer with a clear base and a scant, yellow serous discharge or, less commonly, a hard papule. This lesion gradually involutes and disappears. Painless, unilateral regional lymphadenopathy is also typical.
Tinea cruris
Also called jock itch, tinea cruris is a superficial fungal infection that usually causes sharply defined, slightly raised, scaling patches on the inner thigh or groin (often bilaterally) and, less commonly, on the scrotum and penis. Pruritus may be severe.
Urticaria
Urticaria is a common allergic reaction that’s characterized by intensely pruritic hives, which may appear on the genitalia, especially on the foreskin or shaft of the penis. These distinct, raised, evanescent wheals are surrounded by an erythematous flare.
Other causes
Drugs
Phenolphthalein, barbiturates, and certain broad-spectrum antibiotics, such as tetracycline and sulfonamides, may cause a fixed drug eruption and a genital lesion.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Impotence:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Central nervous system disorders.Spinal cord lesions from trauma produce sudden impotence. A complete lesion above S2 (upper motor neuron lesion) disrupts descending motor tracts to the genital area, causing a loss of voluntary erectile control but not of reflex erection and reflex ejaculation. However, a complete lesion in the lumbosacral spinal cord (lower motor neuron lesion) causes a loss of reflex ejaculation and reflex erection. Spinal cord tumors and degenerative diseases of the brain and spinal cord (such as multiple sclerosis and amyotrophic lateral sclerosis) cause progressive impotence.
Endocrine disorders.Hypogonadism from testicular or pituitary dysfunction may lead to impotence from a deficient secretion of androgens (primarily testosterone). Adrenocortical and thyroid dysfunction and chronic hepatic disease may also cause impotence because these organs play a role (although minor) in sex hormone regulation.
Penile disorders.With Peyronie's disease, the penis is bent, making erection painful and penetration difficult and eventually impossible. Phimosis prevents erection until circumcision releases the constricted foreskin. Other inflammatory, infectious, or destructive diseases of the penis may also cause impotence.
Psychological distress.Impotence can result from diverse psychological causes, including depression, performance anxiety, memories of previous traumatic sexual experiences, moral or religious conflicts, and troubled emotional or sexual relationships.
Other causes
Alcohol and drugs.Alcoholism and drug abuse are associated with impotence, as are many prescription drugs, especially antihypertensives. (See Drugs that may cause impotence.)
Surgery.Surgical injury to the penis, bladder neck, urinary sphincter, rectum, or perineum can cause impotence, as can injury to local nerves or blood vessels.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Priapism:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Penile cancer.Cancer that exerts pressure on the corpora cavernosa can cause priapism. Usually, the first sign is a painless ulcerative lesion or an enlarging warty growth on the glans or foreskin, which may be accompanied by localized pain, a foul-smelling discharge from the prepuce, a firm lump near the glans, and lymphadenopathy. Later findings include bleeding, dysuria, urine retention, and bladder distention. Phimosis and poor hygiene have been linked to the development of penile cancer.
Sickle cell anemia.With sickle cell anemia, painful priapism can occur without warning, usually on awakening. The patient may have a history of priapism, impaired growth and development, and an increased susceptibility to infection. Related findings include tachycardia, pallor, weakness, hepatomegaly, dyspnea, joint swelling, joint or bone aching, chest pain, fatigue, murmurs, leg ulcers and, possibly, jaundice and gross hematuria.
With sickle cell crisis, signs and symptoms of sickle cell anemia may worsen and others, such as abdominal pain and a low-grade fever, may appear.
Spinal cord injury.With spinal cord injury, the patient may be unaware of the onset of priapism. Related effects depend on the extent and level of injury and may include autonomic signs such as bradycardia.
Stroke.A stroke may cause priapism, but sensory loss and aphasia may prevent the patient from noticing or describing it. Other findings depend on the stroke's location and extent, but may include contralateral hemiplegia, seizures, headache, dysarthria, dysphagia, ataxia, apraxia, and agnosia. Visual deficits include homonymous hemianopsia, blurring, decreased acuity, and diplopia. Urine retention or incontinence, fecal incontinence, constipation, and vomiting may also occur.
Other causes
Drugs.Priapism can result from the use of a phenothiazine, thioridazine, trazodone, an androgenic steroid, an anticoagulant, or an antihypertensive. It may also occur after an intracorporeal injection of papaverine, a common treatment for impotence, or phosphodiesterase inhibitors (used with ED).
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Scrotal swelling:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Epididymal cysts. Located in the head of the epididymis, epididymal cysts produce painless scrotal swelling.
Epididymitis.Key features of epididymitis are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have a high fever, malaise, a urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Hydrocele.With a hydrocele, fluid accumulation produces gradual scrotal swelling that's usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Idiopathic scrotal edema.Swelling occurs quickly with idiopathic scrotal edema and usually disappears within 24 hours. The affected testicle is pink.
Orchitis (acute).Mumps, syphilis, or tuberculosis may precipitate orchitis, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; a fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Scrotal trauma.Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
Spermatocele.Spermatocele is a usually painless cystic mass that lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it's movable and may be transilluminated.
Testicular torsion.Most common before puberty, testicular torsion is a urologic emergency that causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Testicular tumor.Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of a hydatid of Morgagni.Torsion of this small, pea-size cyst severs its blood supply, causing a hard, painful swelling on the testicle's upper pole.
Other causes
Surgery.An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Genital lesions, male:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Balanitis and balanoposthitis.Typically, balanitis (glans infection) and posthitis (prepuce infection) occur together (balanoposthitis), causing painful ulceration on the glans, foreskin, or penile shaft. Ulceration is usually preceded by 2 to 3 days of prepuce irritation and soreness, followed by a foul discharge and edema. The patient may then develop features of acute infection, such as a fever with chills, malaise, and dysuria. Without treatment, the ulcers may deepen and multiply. Eventually, the entire penis and scrotum may become gangrenous, resulting in life-threatening sepsis.
Bowen's disease.Bowen's disease is a painless, premalignant lesion that commonly occurs on the penis or scrotum, but may also appear elsewhere. It appears as a brownish red, raised, scaly, indurated plaque with well-defined borders, which may ulcerate at its center.
Chancroid.Chancroid is an STD that's characterized by the eruption of one or more lesions, usually on the groin, inner thigh, or penis. Within 24 hours, the lesion changes from a reddened area to a small papule. (A similar papule may erupt on the tongue, lip, breast, or umbilicus.) It then becomes an inflamed pustule that rapidly ulcerates. This painful—and usually deep—ulcer bleeds easily and commonly has a purulent gray or yellow exudate covering its base. Rarely more than 2 cm in diameter, it's typically irregular in shape. The inguinal lymph nodes also enlarge, become very tender, and may drain pus.
Folliculitis and furunculosis.Hair follicle infection may cause red, sharply pointed lesions that are tender and swollen with central pustules. If folliculitis progresses to furunculosis, these lesions become hard, painful nodules that may gradually enlarge and rupture, discharging pus and necrotic material. Rupture relieves the pain, but erythema and edema may persist for days or weeks.
Genital herpes.Caused by herpesvirus type 1 or 2, genital herpes is an STD that produces fluid-filled vesicles on the glans penis, foreskin, or penile shaft and, occasionally, on the mouth or anus. Usually painless at first, these vesicles may rupture and become extensive, shallow, painful ulcers accompanied by redness, marked edema, and tender, inguinal lymph nodes. Other findings may include a fever, malaise, and dysuria. If the vesicles recur in the same area, the patient usually feels localized numbness and tingling before they erupt. Associated inflammation is typically less marked.
Genital warts.Most common in sexually active males, genital warts initially develop on the subpreputial sac or urethral meatus, and less commonly on the penile shaft; they then spread to the perineum and perianal area. These painless warts start as tiny red or pink swellings that may grow to 10.2 cm and become pedunculated. Multiple swellings are common, giving the warts a cauliflower appearance. Infected warts are also malodorous.
Leukoplakia.Leukoplakia is a precancerous disorder that's characterized by white, scaly patches on the glans and prepuce accompanied by skin thickening and occasionally fissures.
Pediculosis pubis.Pediculosis pubis is a parasitic infestation that's characterized by erythematous, itching papules in the pubic area and around the anus, abdomen, and thigh. Inspection may detect grayish white specks (lice eggs) attached to hair shafts. Skin irritation from scratching in these areas is common.
Penile cancer.Penile cancer usually produces a painless, enlarging wartlike lesion on the glans or foreskin. However, if the foreskin becomes unretractable, the patient may experience localized pain. Examination may reveal a foul-smelling discharge from the prepuce, a firm lump in the glans, and enlarged lymph nodes. Late signs and symptoms may include dysuria, pain, bleeding from the lesion, and urine retention and bladder distention associated with urinary tract obstruction.
Scabies.Mites that burrow under the skin in scabies may cause crusted lesions or large papules on the glans and shaft of the penis and on the scrotum. Lesions may also occur on the wrists, elbows, axillae, and waist. They're usually raised, threadlike, and 1 to 10 cm long and have a swollen nodule or red papule that contains the mite. Nocturnal itching is typical and commonly causes excoriation.
Syphilis.Two to four weeks after exposure to the spirochete Treponema pallidum, one or more primary lesions, or chancres, may erupt on the genitalia; occasionally, they also erupt elsewhere on the body, typically on the mouth or perianal area. The chancre usually starts as a small, red, fluid-filled papule and then erodes to form a painless, firm, indurated, shallow ulcer with a clear base and a scant, yellow serous discharge or, less commonly, a hard papule. This lesion gradually involutes and disappears. Painless, unilateral regional lymphadenopathy is also typical.
Tinea cruris.Also called jock itch, tinea cruris is a superficial fungal infection that usually causes sharply defined, slightly raised, scaling patches on the inner thigh or groin (typically bilaterally) and, less commonly, on the scrotum and penis. Pruritus may be severe.
Urticaria.Urticaria is a common allergic reaction that's characterized by intensely pruritic hives, which may appear on the genitalia, especially on the foreskin or shaft of the penis. These distinct, raised, evanescent wheals are surrounded by an erythematous flare.
Other causes
Drugs.Barbiturates, and certain broad-spectrum antibiotics, such as tetracycline and sulfonamides, may cause a fixed drug eruption and a genital lesion.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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