Genital skin problems

Introduction

Genital skin problems are very common and can be very itchy or painful, distressing and embarrassing. They can interfere with sexual functioning, self-image and interpersonal relationships. Some genital disorders are contagious, including sexually transmitted diseases.

This page provides links to information On DermNet NZ about skin conditions affecting the genital area.

• Genital itch in males
• Genital pain in males
• Genital itch in females
• Genital pain in females
• Vaginal discharge
• Non-sexually transmitted skin infections affecting genital area (males and females)
• Sexually transmitted infections (males and females)
• Genital skin lesions (males and females)
• Diagnosis of genital conditions
• Treatment of genital conditions

Genital itch in males

• Pruritus ani (itchy anus)
• Balanitis (inflammation of the glans penis in males)
• Dermatitis (eczema), including:
  • Lichen simplex (dermatitis due to localised itch-scratch-itch response and resulting in thickened skin on scrotum)
  • Atopic dermatitis (eczema)
  • Seborrhoeic dermatitis (usually affects scalp as well)
  • Irritant contact dermatitis (from wetness, incontinence, vigorous cleansing) the most common cause of nonspecific balanitis (in males)
  • Intertrigo (in skin folds)
  • Allergic contact dermatitis (most often due to fragrances, preservatives or rubber)

Genital pain in males

• Balanitis (inflammation of the tip of the penis)
• Behcet disease
• Erosive lichen planus (which often also affects the mouth)
• Plasma cell balanitis
• Fixed drug eruption
• Crohn disease, which may cause swelling, ulcers and granulomas
• Pudendal nerve entrapment syndrome
• Dysaesthesia and/or burning discomfort (and less often, itching) of the penis (penodynia) and/or scrotum (scrotodynia) in the absence of a primary skin problem. The affected area is often redder than normal.

Genital itch in females

• Itchy anus (pruritus ani)
• Itchy vulva (pruritus vulvae) in adult women
• Itchy vulva (pruritus vulvae) in prepubertal girls
• Dermatitis (eczema), including:
  • Lichen simplex (dermatitis due to localised itch-scratch-itch response and resulting in thickened skin on labia majora
  • Atopic dermatitis (eczema)
  • Seborrhoeic dermatitis (usually affects scalp as well)
  • Irritant contact dermatitis (from wetness, incontinence, vigorous cleansing) (incontinence-associated dermatitis)
  •  the most common cause of vulvitis
  • Intertrigo (in skin folds)
  • Allergic contact dermatitis (most often due to fragrances, preservatives or rubber)
• Psoriasis (persistent, well-defined, red, scaly or moist patches)
• Lichen sclerosus (white scarred patches)
• Lichen planus

Genital pain in females

• Dyspareunia (painful sex)
• Recurrent fissuring of posterior fourchette
• Atrophic vulvovaginitis
• Non-sexually acquired acute recurrent genital ulceration (complex recurrent aphthous ulceration)
• Non-sexually acquired acute reactive genital ulceration
• Behcet disease
• Erosive lichen planus (which often also affects the mouth)
• Plasma cell vulvitis
• Fixed drug eruption
• Desquamative vaginitis
• Crohn disease, which may cause swelling, ulcers and granulomas
• Pudendal nerve entrapment syndrome
• Spasm in pelvic muscles leading to vaginismus
• When no cause has been found for vulval pain, the term vulvodynia is sometimes used. This has been classified into provoked localised vulvodynia (or vestibulodynia) and generalised spontaneous vulvodynia (dysaesthetic vulvodynia or neuropathic pain).

Vaginal discharge

• Vaginitis
• Vaginal or genital malodour
• Non-sexually transmitted skin infections
• Sexually transmitted infections
• Desquamative vaginitis

Non-sexually transmitted skin infections

Non-venereal skin infections may present in the genital area, presumably because the organisms thrive in warmth and humidity.

Bacterial infection

Bacterial skin infections include:

• Boils (deep infection of hair follicles)
• Folliculitis (surface infection of hair follicles)
• Impetigo (school sores)
• Erythrasma (dry brown patches)
• Cutaneous tuberculosis (rare)
• Bacterial vaginosis (cause of frothy discharge).

Fungal infections

Fungal skin infections include:

• Tinea cruris (Jock itch)
• Vulvovaginal candidiasis (thrush).

Viral infections

Viral skin infections include:

• Genital herpes, the commonest cause of recurrent blisters or sores
• Genital warts, the commonest cause of papules in this region
• Herpes zoster (shingles)
• Molluscum contagiosum.

Infestations

The groin is also a favoured site for some parasitic infestations:

• Pubic lice
• Scabies
• Schistosomiasis
• Amoebiasis
• Filariasis
• Leishmaniasis.

Sexually transmitted infections

Important sexually transmitted infections (STIs) include:

• Syphilis
• Gonorrhoea
• Lymphogranuloma venereum
• Chancroid
• Granuloma inguinale (donovanosis)
• Trichomoniasis
• Genital herpes
• Genital warts
• Molluscum contagiosum.

Genital skin lesions

Non-infectious skin lesions and miscellaneous conditions that are commonly found in the genital area include:

• Vulval skin lesions
• Angiokeratomas (red/purple spots)
• Hidradenitis suppurativa (boil-like lumps in skin folds)
• Hailey Hailey (blisters in skin folds)
• Labial adhesions in prepubertal girls
• Labial adhesions in adults
• Sebaceous adenitis (inflamed papules on labia minora)
• Milia, pilar and epidermal cysts
• Vulval intraepithelial neoplasia or VIN (also called vulval squamous cell carcinoma in situ), which includes Bowenoid papulosis
• Penile intraepithelial neoplasia or PIN (also called penile squamous cell carcinoma in situ, Bowen disease of the penis, erythroplasia of Quyerat)
• Anal intraepithelial neoplasia or AIN (also called anal squamous cell carcinoma in situ)
• Invasive squamous cell carcinoma including vulval cancer and anal cancer (arising from genital warts). Vulval cancer can also arise from lichen sclerosus or lichen planus)
• Extramammary Paget disease
• Genital melanotic macules or melanosis (harmless brown marks in which there is more pigment in the skin cells)
• Mucosal melanoma (a rare form of skin cancer in which there is an uncontrolled proliferation of pigment cells)
• Pearly penile papules
• Peyronie disease, in which a fibrous band appears on the penis.

How are genital disorders diagnosed?

A careful history and full skin examination, including genital skin, are recommended. Tests often include:

• Swabs from the affected skin, urethral or vagina for bacteria, yeast and virus culture
• Blood tests
• Skin biopsy.

How are genital disorders treated?

Treatment depends on the individual condition.

Genital skin is delicate, so treatment must be undertaken gently. Wash once or twice daily with warm water. Avoid soap; a pH balanced non-soap cleanser can be used but should be rinsed off.