Causes of Sexual Conditions
Causes of Sexual Conditions (Diseases Database):
The follow list shows some of the possible medical causes of Sexual Conditions
that are listed by the Diseases Database:
Source: Diseases Database
Sexual Conditions Causes: Book Excerpts
Medications or substances causing Sexual Conditions:
The following drugs, medications, substances or toxins are some of the possible
causes of Sexual Conditions as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
See full list of 34
medications causing Sexual Conditions
Medical news summaries relating to Sexual Conditions:
The following medical news items are relevant to causes of Sexual Conditions:
Related information on causes of Sexual Conditions:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Sexual Conditions may be found in:
Causes of Sexual Conditions: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Sexual Conditions.
Dyspareunia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Definitions
–Sexual pain disorder: Persistent or recurrent genital pain of nonorganic cause associated with sexual stimulation, thus causing personal stress; subcategories include dyspareunia and vaginismus
–Superficial dyspareunia: Pain or dysfunction felt upon initial penetration
–Deep dyspareunia: Pain or dysfunction felt deep within the pelvis during intercourse
–Vaginismus: Painful involuntary spasm of the vagina, preventing intercourse
–Vulvar vestibulitis: A chronic and persistent clinical syndrome characterized by severe pain with vestibular touch or attempted vaginal entry, tenderness in response to pressure within the vulvar vestibule, and physical findings confined to various degrees of vestibular erythema
–Vulvodynia: Chronic vulvar discomfort
(e.g. burning, stinging, irritation, rawness)
-
Neurologic etiologies: Nerve damage or infection, dysesthetic (essential) vulvodynia
-
Gynecologic etiologies: Gynecologic tumors (e.g., vulvar, cervical, uterine, ovarian, or rectal cancer; fibroids), Bartholin's gland inflammation
-
GI: Constipation, irritable bowel syndrome, colitis, diverticulitis, GI tumors (in pelvis)
-
Urinary: Interstitial cystitis, urethritis, urethral diverticulum
-
Infectious: Endometritis, vaginitis, PID, salpingitis, vulvovaginitis, herpes genitalis, post-herpetic neuralgia, Bartholin's abscess
-
Dermatologic etiologies: Vaginal atrophy, lichen sclerosis, Behçet syndrome, contact dermatitis
-
Musculoskeletal: Pelvic floor myopathy, fibromyalgia, levator ani myalgia, dysfunctional vaginismus
-
Endocrine: Estrogen deficiency, endometriosis
-
Psychiatric: Female sexual dysfunction(s)
-
Iatrogenic: Surgical (e.g., pelvic adhesions, episiotomy, strictures), pharmacologic (drying soaps or agents, topical medications, OCPs)
-
Trauma: Vaginal lacerations or ecchymoses
-
Primary pain disorder
-
Severely retroverted uterus
-
Imperforate hymen
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Source: In a Page: Signs and Symptoms, 2004
Vaginal Discharge:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Physiologic
–Many women will have a consistent, slightly clear, non-odor-producing discharge, either midcycle or premenstrually, particularly if they are on oral contraceptives
–A change in odor, consistency, or color of discharge may signify that evaluation is necessary
–Increased discharge is associated with pregnancy
- Sexually transmitted disease
–Trichomonas vaginalis: “Strawberry cervix” with punctate erythema, flagellated oval organisms on wet mount
–Gonorrhea/Chlamydia may be associated with pelvic pain/dysmenorrhea and dyspareunia
- Bacterial vaginosis
–Various organisms and changes in normal flora with a characteristic fishy odor
–Not considered an STD
–Increases the risk of preterm delivery in
pregnant women
- Alteration of normal vaginal flora and/or inflammatory response
–Candida albicans overgrowth is more common with recent antibiotic use, poorly controlled diabetes, and/or pregnancy; presents with intensely pruritic, inflamed, and erythematous introitus
–Doderlein's cytolysis (caused by an
overgrowth of lactobacilli)
-
Atrophic vaginitis
–Common in postmenopausal women, especially those not on HRT
–Poor coital lubrication, dyspareunia
–Dysuria due to atrophic urethral tissue
-
Foreign body vaginitis (e.g., retained tampon)
-
Noninfectious irritant/allergic contact vaginitis (e.g., soaps, feminine pads, perfumes)
-
Cervicitis (usually due to gonorrhea or Chlamydia)
-
Cervical dysplasia, cancer, or polyps
-
Vaginal or vulvar trauma or cancer
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Source: In a Page: Signs and Symptoms, 2004
Genital Skin Lesions:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Herpes simplex virus (HSV-1 and HSV-2) is the most common cause of genital lesions in the U.S.
–Presents with prodromal tingling and genital discomfort before lesions
–Lesions are always painful and appear as grouped vesicles on an erythematous base -
Condyloma acuminatum (“warts,” HPV)
–Etiologic agent is human papilloma virus
–Lesions usually painless and pearly with a smooth surface but may be filiform, fungating, and lobulated
Tinea cruris
–Inguinal erythema with itch or tenderness
–Always spares the scrotum
Candida intertrigo
–Inguinal erythema with itch or tenderness
–Often very red with satellite lesions
–Frequently involves the labia or scrotum Syphilis
–Primary stage: Painless solitary ulcer (chancre) on labia, penis, or oral mucosa that heals in 2–3 weeks
–Secondary stage: Condyloma lata (moist hypertrophic papules on genital and oral regions)
–Tertiary stage: Cardiac, neurologic, and other systemic effects
-
Molluscum contagiosum
–Multiple, very small, painless, flesh-colored nodules with umbilicated centers
-
Chancroid
–Etiologic agent is Haemophilus ducreyi
–Painful, solitary, and erythematous lesions
–May present with dyspareunia and/or dysuria
Erythrasma
Lymphogranuloma venereum
Granuloma inguinale
Behçet syndrome
–Oral and genital ulcers, retinitis, uveitis
Lichen planus
Scabies
Zoon's plasma cell balanitis
Less common etiologies (“zebras”) include inverse psoriasis, seborrheic dermatitis, genital squamous cell carcinoma, extramammary Paget's disease, plaque psoriasis, and fixed drug eruptions
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Vaginal Discharge:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Physiologic leukorrhea
–In newborns for 2–3 weeks, due to maternal estrogen effect, and in pubertal girls
–Discharge typically clear to white, sticky, and
nonirritating
–Newborns may have withdrawal bleeding
- Infections
–Bacterial vaginosis: Previously known as nonspecific vaginitis; polymicrobial in etiology (coliforms, streptococci, Gardnerella); discharge may be gray and malodorous (fishy smell) but generally nonirritating
–Candida: Discharge may be cheesy and white with erythematous, pruritic, irritated vulva; typical discharge is rarely seen in prepubertal children; discharge typically has no odor
–Trichomonas: Discharge may be frothy, malodorous, creamy, green, bloody, or pruritic (or asymptomatic)
–Chlamydia: Commonly asymptomatic or a nonspecific discharge
–Gonorrhea: Infection is commonly asymptomatic or has a gray-white, thick, purulent discharge
–Group A β-hemolytic streptococci:
Discharge may be bloody
–Shigella: Discharge may be bloody
-
Irritation/hygiene
–Due to bubble baths and other chemical irritants, tight clothing, obesity, poor wiping
-
Foreign body
–Commonly includes toilet paper, forgotten tampon
–Discharge is often bloody and malodorous
-
Anatomic
–Ectopic urethra
–Rectovaginal fistula
–Urethral prolapse
-
Urinary tract infection
-
Masturbation
-
Sarcoma botyroides
-
Oral contraceptives (estrogen effect)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
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
(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
Vaginal discharge:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Atrophic vaginitis
With atrophic vaginitis, a thin, scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Bacterial vaginosis
Bacterial vaginosis (formerly called Gardnerella vaginalis and Haemophilus vaginalis) results from an ecozogic disturbance of the vaginal flora. Causing a thin, foul-smelling, green or gray-white discharge, it adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other signs of vaginal irritation may occur but are usually minimal.
Candidiasis
Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine, red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
Chancroid
Chancroid — a rare but highly contagious sexually transmitted disease — produces a mucopurulent, foul-smelling discharge and vulvar lesions that are initially erythematous and later ulcerated. Within 2 to 3 weeks, inguinal lymph nodes (usually unilateral) may become tender and enlarged, with pruritus, suppuration, and spontaneous drainage of nodes. Headache, malaise, and fever to 102.2° F (39° C) are common.
Chlamydial infection
Chlamydial infection causes a yellow, mucopurulent, odorless, or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially following menses. Many women remain asymptomatic.
Endometritis
A scant, serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, lower back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
Genital warts
Genital warts are mosaic, papular vulvar lesions that can cause a profuse, mucopurulent vaginal discharge, which may be foul-smelling if the warts are infected. Patients frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea
Although 80% of women with gonorrhea are asymptomatic, others have a yellow or green, foul-smelling discharge that can be expressed from Bartholin’s or Skene’s ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
Gynecologic cancer
Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul-smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
Herpes simplex (genital)
A copious mucoid discharge results from herpes simplex, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
Trichomoniasis
Trichomoniasis can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; a red, inflamed vagina with tiny petechiae; dysuria and urinary frequency; and dyspareunia, postcoital spotting, menorrhagia, or dysmenorrhea. About 70% of patients are asymptomatic.
Other causes
Contraceptive creams and jellies
Contraceptive creams and jellies can increase vaginal secretions.
Drugs
Drugs that contain estrogen, including hormonal contraceptives, can cause increased mucoid vaginal discharge. Antibiotics, such as tetracycline, may increase the risk of a candidal vaginal infection and discharge.
Radiation therapy
Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Dyspareunia:
Causes
(Professional Guide to Diseases (Eighth Edition))
Physical causes of dyspareunia include an intact hymen; deformities or lesions of the introitus or vagina; marked retroversion of the uterus; genital, rectal, or pelvic scar tissue; acute or chronic infections of the genitourinary tract; and disorders of the surrounding viscera (including residual effects of pelvic inflammatory disease or disease of the adnexal and broad ligaments).
Among the many other possible physical causes are:
❑ endometriosis
❑ benign and malignant growths and tumors
❑ insufficient lubrication
❑ radiation to the area
❑ allergic reactions to diaphragms, condoms, or other contraceptives.
Psychological causes include fear of pain or of injury during intercourse, recollection of a previous painful experience, guilty feelings about sex, fear of pregnancy or of injury to the fetus during pregnancy, anxiety caused by a new sexual partner or technique, and mental or physical fatigue. Men and women can suffer pain in the pelvic area during or soon after sexual intercourse.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Genital herpes:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Genital herpes is usually caused by infection with herpes simplex virus Type 2, but some studies report increasing incidence of infection with herpes simplex virus Type 1. This disease is typically transmitted through sexual intercourse, orogenital sexual activity, kissing, and hand-to-body contact. Pregnant women may transmit the infection to neonates during vaginal delivery if an active infection is present. Such transmitted infection may be localized (for instance, in the eyes) or disseminated and may be associated with central nervous system involvement.
An estimated 86 million people worldwide are thought to have genital herpes.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Genital warts:
Causes
(Professional Guide to Diseases (Eighth Edition))
Infection with one of the more than 70 known strains of HPV causes genital warts, which are transmitted through sexual contact. The warts grow rapidly in the presence of heavy perspiration, poor hygiene, or pregnancy and commonly accompany other genital infections.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Dyspareunia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Allergies
Allergic reactions to diaphragms or condoms may result in dyspareunia.
Atrophic vaginitis
In postmenopausal and breast-feeding women, decreased estrogen secretion may lead to inadequate vaginal lubrication and dyspareunia, which intensifies as intercourse continues. Accompanying signs and symptoms include pruritus, burning, bleeding, and vaginal tenderness. Patients may complain of a watery discharge at the same time that they’re feeling “dry.”
Bartholinitis
This inflammatory disorder may produce throbbing pain accompanied by vulvar tenderness during intercourse. The patient may also complain of pain with walking or sitting. Chronic inflammation causes a purulent discharge from the infected cyst.
Cervicitis
This inflammatory disorder causes pain with deep penetration. It may also cause dull lower abdominal pain, a purulent vaginal discharge, backache, and metrorrhagia.
Condylomata acuminata
These papular, mosaic, warty growths occur on the vulva, vaginal and cervical walls, and perianal area. They may bleed, itch, cause burning or paresthesia in the vaginal introitus, and become tender during and after intercourse. A profuse, odorless vaginal discharge may also occur.
Cystitis
Dyspareunia may occur if the patient has inflammation or infection of the bladder. Associated findings include dysuria; urinary urgency, frequency, or incontinence; pyuria; and, after coitus, hematuria.
Endometriosis
This disorder causes intense pain during deep coital penetration. In addition, aching pain may occur during gentle thrusting or during a pelvic examination. The pain is usually in the lower abdomen or behind the uterus and may be worse on one side. It may be relieved by changing coital positions. Other signs and symptoms include dysmenorrhea, irregular menses, infertility, painful urination or defecation, and rectal bleeding and hematuria during menses. Typically, a tender, fixed adnexal mass is palpable on bimanual examination.
Herpes genitalis
During intercourse, friction against lesions on the labia, vulva, vagina, or perianal skin causes pain and itching. The lesions are fluid-filled and usually painless at first, but may rupture and form shallow, painful ulcers with erythema and edema. Related findings include leukorrhea, fever, malaise, headache, inguinal lymphadenopathy, myalgia, and dysuria.
Occlusive or rigid hymen
Dyspareunia may prevent penetration in this condition.
Ovarian cyst or tumor
In this disorder, lower abdominal pain accompanies deep penetration during intercourse. Other signs and symptoms include chronic lower back pain; a tender, palpable abdominal mass; constipation; urinary frequency; menstrual irregularities; and hirsutism.
Pelvic inflammatory disease
Deep penetration causes severe pain that’s unrelieved by changing coital positions. Uterine tenderness may also occur with gentle thrusting or during a pelvic examination. This disorder also causes fever; malaise; a foul-smelling, purulent vaginal discharge; menorrhagia; dysmenorrhea; a soft, enlarged uterus; severe abdominal pain; nausea and vomiting; cervical motion tenderness; and diarrhea.
Uterine prolapse
Sharp or aching pain occurs when the penis strikes the descended cervix of a patient with uterine prolapse. Other effects are dysmenorrhea, pelvic pressure, leukorrhea, urine retention and urinary incontinence, and chronic lower back pain.
Vaginitis
This infection produces dyspareunia along with vulvar pain, burning, and itching during and for several hours after coitus. These symptoms may be aggravated by sexual arousal aside from intercourse. Vaginal discharge is typical; the type varies with the causative organism. Candida albicans produces a curdlike, odorless to musty-smelling discharge; Trichomonas vaginalis produces a yellow-green, frothy, fish-smelling discharge; bacterial vaginosis and Neisseria gonorrhoeae produce a profuse whitish yellow, foul-smelling discharge. Pruritus and dysuria may also occur.
Other causes
Contraceptive and hygienic products
Some spermicidal jellies, douches, and vaginal creams and deodorants cause irritation and edema, resulting in dyspareunia.
Diaphragms and intrauterine devices
An ill-fitting diaphragm may produce cramps with intercourse. An incorrectly placed intrauterine device may cause dyspareunia during orgasm.
Drugs
Antihistamines, decongestants, and nonsteroidal anti-inflammatory drugs decrease lubrication, resulting in dyspareunia.
Episiotomy
If the episiotomy scar constricts the vaginal introitus or narrows the vaginal barrel, the patient may experience perineal pain with coitus.
Pelvic irradiation
Radiation therapy for pelvic cancer may cause pelvic and vaginal scarring, resulting in dyspareunia.
» 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
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
Vaginal discharge:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Atrophic vaginitis
In this disorder, a scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Bacterial Vaginosis
This infection, caused by Gardnerella vaginalis (formerly called Haemophilus vaginalis), results from an ecozogic disturbance of the vaginal flora. It produces a thin, foul-smelling, green or gray-white discharge that adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other mild signs of vaginal irritation may also occur.
Candidiasis
Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
Chancroid
This rare but highly contagious sexually transmitted disease produces a mucopurulent, foul-smelling discharge and vulvar lesions that are initially erythematous and later ulcerated. Within 2 to 3 weeks, inguinal lymph nodes (usually unilateral) may become tender and enlarged, with pruritus, suppuration, and spontaneous drainage of nodes. Headache, malaise, and a fever as high as 102.2° F (39° C) are common.
Chlamydial infection
This infection causes a yellow, mucopurulent, odorless or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially after menses. Many women, however, remain asymptomatic.
Endometritis
A scant serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, low back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
Genital warts
These mosaic, papular vulvar lesions can cause a profuse mucopurulent vaginal discharge, which may be foul smelling if the warts are infected. Patients commonly complain of burning or paresthesia in the vaginal introitus.
Gonorrhea
Although 80% of women with gonorrhea are asymptomatic, others have a foul-smelling yellow or green discharge that can be expressed from Bartholin’s or Skene’s ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
Gynecologic cancer
Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
Herpes simplex (genital)
A copious mucoid discharge results from this disorder, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
Trichomoniasis
This infection can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; an inflamed, erythematous vagina with tiny petechiae; dysuria and urinary frequency; dyspareunia; postcoital spotting; and menorrhagia or dysmenorrhea. About 70% of patients are asymptomatic.
Other causes
Contraceptive creams and jellies
These products can increase vaginal secretions.
Drugs
Drugs that contain estrogen, including hormonal contraceptives, can cause a mucoid vaginal discharge. Antibiotics such as tetracycline may increase the risk of a candidal vaginal infection and associated discharge.
Radiation therapy
Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal Discharge:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Physiologic discharge
❑ Candida vulvovaginitis
❑ Bacterial vaginosis
❑ Trichomonas vaginitis
❑ Atrophic vaginitis
❑ Irritant dermatitis
❑ Gonorrheal cervicitis
❑ Chlamydial cervicitis
❑ Herpes simplex
❑ Cervical cancer
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Genital Ulcer:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Herpes simplex
❑ Trauma
❑ Syphilis
❑ Fixed drug eruption
❑ Behçet syndrome
❑ Candida balanitis
❑ Granuloma inguinale
❑ Chancroid
❑ Lymphogranuloma venereum
❑ Bowen disease
❑ Carcinoma of the penis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 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
Vaginal discharge:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Atrophic vaginitis
With atrophic vaginitis, a thin, scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Bacterial vaginosis
Bacterial vaginosis results in a thin, foul-smelling, green or gray-white discharge that adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other signs of vaginal irritation may occur but are usually minimal.
Candidiasis
Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine, red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
Chlamydial infection
A chlamydial infection causes a yellow, mucopurulent, odorless, or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially following menses. Many women remain asymptomatic.
Endometritis
A scant, serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, lower back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
Genital warts
Genital warts are mosaic, papular vulvar lesions that can cause a profuse, mucopurulent vaginal discharge, which may be foul-smelling if the warts are infected. Patients with genital warts frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea
Although 80% of women with gonorrhea are asymptomatic, others have a yellow or green, foul-smelling discharge that can be expressed from Bartholin’s or Skene’s ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
Gynecologic cancer
Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul-smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
Herpes simplex (genital)
A copious mucoid discharge results from genital herpes, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
Trichomoniasis
Trichomoniasis can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; a red, inflamed vagina with tiny petechiae; dysuria and urinary frequency; and dyspareunia, postcoital spotting, menorrhagia, or dysmenorrhea. About 70% of patients are asymptomatic.
Other causes
Contraceptive creams and jellies
These products can increase vaginal secretions.
Drugs
Drugs that contain estrogen, including hormonal contraceptives, can cause increased mucoid vaginal discharge. Antibiotics, such as tetracycline, may increase the risk of a candidal vaginal infection and discharge.
Radiation therapy
Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vaginal Discharge:
Principal Causes of Vaginal Discharge
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Prepubertalonset
- Physiologicleukorrhea
- Vulvovaginitis
- Nonspecificcauses
- Specific infections
- Foreign body
- Pubertal and postpubertal onset
- Physiologicleukorrhea
- Vulvovaginitis
- Nonspecificcauses
- Specific infections
- Bacterialvaginosis
- Candida species
- Trichomonas vaginalis
- Herpes simplex virus
- Cervicitis
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Pelvic inflammatory disease
- Foreign body
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
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
Vaginal discharge:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Atrophic vaginitis.With atrophic vaginitis, a thin, scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Bacterial vaginosis.Bacterial vaginosis causes a thin, foul-smelling, green or gray-white discharge, it adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other signs of vaginal irritation may occur but are usually minimal.
Candidiasis.Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine, red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
Chancroid.Chancroid produces a mucopurulent, foul-smelling discharge and vulvar lesions that are initially erythematous and later ulcerated. Within 2 to 3 weeks, inguinal lymph nodes (usually unilateral) may become tender and enlarged, with pruritus, suppuration, and spontaneous drainage of nodes. Headache, malaise, and fever to 102.2° F (39° C) are common.
Chlamydial infection.Chlamydial infection causes a yellow, mucopurulent, odorless, or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially following menses. Many women remain asymptomatic.
Endometritis.A scant, serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, lower back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
Genital warts.Genital warts are mosaic, papular vulvar lesions that can cause a profuse, mucopurulent vaginal discharge, which may be foul-smelling if the warts are infected. Patients frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea.Although 80% of women with gonorrhea are asymptomatic, others have a yellow or green, foul-smelling discharge that can be expressed from Bartholin's or Skene's ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
Gynecologic cancer.Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul-smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
Herpes simplex (genital).A copious mucoid discharge results from genital herpes simplex, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
Trichomoniasis.Trichomoniasis can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; a red, inflamed vagina with tiny petechiae; dysuria and urinary frequency; and dyspareunia, postcoital spotting, menorrhagia, or dysmenorrhea. About 70% of patients are asymptomatic.
Other causes
Contraceptive creams and jellies.Contraceptive creams and jellies increase vaginal secretions.
Drugs.Drugs that contain estrogen, including hormonal contraceptives, can cause increased mucoid vaginal discharge. Antibiotics, such as tetracycline, may increase the risk of a candidal vaginal infection and discharge.
Radiation therapy.Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
» 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.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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