Perineum Research Articles

Regenerative therapies in lichen sclerosus genitalis patients and possible efficacy in preventing squamous cell carcinoma development: a long-term follow-up pilot study

Lichen sclerosus (LS) is a chronic scleroatrophic dermatosis of unknown etiology that usually affects the anogenital area and occasionally the extragenital sites, which has no definitive cure. LS patients are at higher risk of developing squamous cell carcinoma (SCC) in their lifetime compared to the general population. Through a retrospective study, we evaluated the impact of regenerative medicinebased therapies on SCC onset in the context of genital LS. LS patients treated in our institute from March 2013 to December 2022 were reviewed. A total of 319 patients, including 34 treated with adipose-derived stem cells (ADSCs) graft, 31 treated with ADSCs graft and PRP, and 254 treated with platelet-rich plasma (PRP) were identified. In parallel, data extracted from the histologic institutional database searching for SCC in the anogenital area were matched to surgical records. None of the 319 LS patients developed skin SCC in the anogenital area. Our data suggest that cellular and acellular therapies achieving therapeutic control prevent continuous tissue remodeling and its evolution and, therefore, neoplastic degeneration. Regenerative approaches are considered a valid strategy for treating LS patients symptomatic despite prolonged first-line medical treatment. Studying genital carcinogenesis of LS cases, we reported for the first time a protective role of PRP, ADSCs, and combined therapies. Thus, in terms of cancer prevention, we propose that regenerative therapies ameliorating disease control of non-responders to conventional therapy represent an important innovative tool.

Understanding and Managing Vulvar Psoriasis in Girls: Findings From a Cohort Study.

Pediatric vulvar psoriasis in girls is under-recognized and under-treated due to its nonspecific clinical appearance. This paper aims to describe the signs and symptoms of pediatric vulvar psoriasis and treatment strategies used by our group. A retrospective cohort study was undertaken at a private pediatric dermatology referral practice from January 2016 to December 2022. Clinical data were prospectively collected and recorded in an online patient database. Treatment regimens were individualized and titrated to clinical response. In 100 girls with vulvar psoriasis, the most common presentation was an erythematous vulvar eruption (97%) which was well-demarcated in 52% of children and appeared as a plaque in one-fourth. The perianal skin was involved in 48% of cases. Extragenital psoriasis was present in 69% of patients. Most children responded to initial induction treatment with moderate-potency topical corticosteroid ointment followed by maintenance with topical tar solution. Systemic treatment was not required for purely vulvar psoriasis compared with 3% of children with extragenital psoriasis. Vulvar psoriasis in girls presents as a chronic erythematous vulvitis, with perianal involvement inhalfthecases,but without vaginitis. It is a remitting and relapsing skin condition that requires long-term topical management.

Role of C-Reactive Protein/Lymphocyte and Neutrophil/Lymphocyte Ratios in Predicting Mortality in Patients with Fournier’s Gangrene

Background and objectives Fournier’s gangrene (FG) is a polymicrobial-induced necrotizing fasciitis that affects the deep and superficial tissues of the perineal, perianal, scrotal, and genital regions. This study aimed to investigate the role of C-reactive protein (CRP)/lymphocyte and neutrophil/lymphocyte ratios, which are objective markers of inflammatory response, in predicting mortality in patients with FG. Patients and methods Seventy-one patients who underwent surgery for FG between 2019 and 2023 were evaluated retrospectively. Demographic and clinical characteristics, laboratory results, the FG severity index (FGSI) score, and the CRP/lymphocyte and neutrophil/lymphocyte ratios were analyzed for the patient groups with and without in-hospital mortality. Results The characteristics of the patients with and without mortality were compared. A total of 71 patients, 51 (71.8%) males and 20 (28.2%) females, were evaluated. Eight patients died during treatment. The median age was 67 (56–86) years in the mortality group and 58 (27–82) years in the non-mortality group. Statistically significant differences were observed between the two groups in terms of age, lymphocyte count, CRP/lymphocyte, neutrophil/lymphocyte, potassium, blood urea nitrogen, and FSGI. In the receiver operating characteristic analysis of the CRP/lymphocyte and neutrophil/lymphocyte ratios, the cutoff values were calculated as 183.3 and 19.93, respectively. By comparing the data between the mortality and non-mortality groups, the sensitivity and specificity rates of these ratios were also determined. Conclusion The CRP/lymphocyte and neutrophil/lymphocyte ratios may be important parameters in predicting mortality in patients with FG.

The Effectiveness Of Pregnant Exercise In Squat Position With Perineal Rupture In Maternity Mothers At TPMB Siti Salmah In 2022

Background : In the majority of first-time births, perineal tears last for some time. Unexpected tension that occurs in the head or body of the hatchlings causes tears in the skin and perineal tissue Writing Purpose: to determine the Effectiveness of Pregnant Squat Exercise with Perineal Rupture in Maternity Mothers at TPMB Siti Salmah Year 2022 Research Methods: this type of quantitative research uses an experimental design (quasi-experimental) ) with the Nonrandomized Control Group Pretest Posttest Design. The total population of this study was 30 mothers giving birth at TPMB Sti Salmah divided into 15 intervention groups and 15 control groups. Research Results: The results of the independent sample test obtained Asymp. Sig (2 – Sided) has a value of 0.001, because 0.001 <0.05, the hypothesis is accepted. This means that there is a difference between doing pregnancy exercise in the squat position and not doing pregnancy exercise in the squat position on the incidence of perineal rupture in pregnant women so that it can be concluded that there is effectiveness of pregnancy exercise in the squat position with perineal rupture in maternity mothers at TPMB Siti Salmah in 2022 Conclusions and Suggestions: Expected results this research allows midwives to do pregnancy exercises in a squatting position. This research will also serve as a guide for its implementation, making it easier for patients, especially pregnant women, to prepare for delivery to prevent perineal rupture.

Variant anatomy of the iliac veins and presence of two venous rings around the arteries in the pelvis.

Internal iliac vein drains the pelvic viscera, gluteal region, and the perineal region. Knowledge of its variations is of importance to radiologists, gynecologists, and orthopedic surgeons. We found one of the rare variations of the internal iliac vein during our cadaveric dissections. The right internal iliac vein had anterior and posterior trunks. The anterior trunk joined the external iliac vein to form the common iliac vein. The posterior trunk terminated into the common iliac vein. There was abroad communication between anterior and posterior trunks. Further, there were two venous rings formed by the tributaries of the internal iliac veins. One of them surrounded the superior gluteal artery and the other surrounded the internal pudendal and inferior gluteal arteries. Here, we discuss the clinical importance of the case.

Fournier's Gangrene and Sodium-Glucose Cotransporter 2 Inhibitor Use: A Report of Two Cases.

Necrotizing fasciitis is a serious infection that requires prompt surgical excision and broad spectrum antibiotics. Fournier's gangrene (FG) is a type of necrotizing fasciitis that specifically affects the perineal, scrotal, and genital region. FG is a known adverse outcome of the class of medications known as sodium-glucose cotransporter 2 (SGLT2) inhibitors. This class of drugs is most commonly use to treat diabetes, but recently it's use has expanded to include those with heart failure, regardless of whether they have diabetes. With the increased use of SGLT2 inhibitors, the incidence of FG may increase as well. We present 2 case reports of patients who experienced FG while on SGLT2 inhibitor therapy.

The Perianal Mirage: Case of Primary Perianal Paget’s Disease

Background: Paget’s disease is rare and arises from the apocrine glands of skin. Perianal Paget’s disease is very rare form of extramammary Paget’s disease. Method and Results: Patient presented with complaints of perianal itching which on examination had patchy depigmented nodular skin in perianal region. Biopsy showed Paget’s cells, and immunohistochemical staining was positive for CK7, CEA and GCDFP-15, confirming the diagnosis of primary perianal Paget’s disease. Further, patient was staged and was planned for surgery and underwent wide local excision of perianal skin preserving internal and external anal sphincters. Reconstruction of the defect was completed with a local flap. Conclusions: Surgery remains most effective and only curative option for perianal Paget’s disease. As it is a rare disease, a high degree of suspicion is required for early diagnosis and treatment.

Ultrasound combined with DSA-guided pulsed radiofrequency for perineal herpes zoster pain management: clinical outcomes and complications.

Herpes zoster (HZ) in the perineal area is a rare disease. There are limited treatment options for this disease. This study aimed to assess the efficacy of ultrasound combined with digital subtraction angiography (DSA)-guided pulsed radiofrequency (PRF) for perineal herpes zoster-related pain. Two hundred and twelve patients with perineal HZ were enrolled at the pain department. From January 1, 2018 to December 30, 2019, patients with HZ in the perineal area were treated with PRF under DSA guidance, and from January 1, 2020 to October 30, 2023, patients with HZ in the perineal area were treated with PRF under ultrasound combined with DSA guidance. The included patients were divided into two groups: DSA group and ultrasound + DSA group. The visual analog scale (VAS), central sensitization inventory (CSI), sleep quality scores (SQS), the 36-Item Short Form Health Survey questionnaire (SF-36) at baseline and after the PRF treatment were analyzed to evaluate clinical efficacy. The mean VAS scores, CSI scores, SQS, and SF-36 scores were statistically significantly lower after treatment compared to baseline (p < 0.001). There was no significant change in VAS scores, CSI scores, SQS, and SF-36 scores between the DSA group and the ultrasound + DSA group (p > 0.05). The time it took from the start of the puncture to the successful puncture was significantly shorter in the ultrasound + DSA group compared to the DSA group (41.2 ± 21.2 vs. 48.1 ± 20.3, p = 0.035). The ultrasound + DSA group had a higher percentage of satisfaction with the procedure than the DSA group (90/99, 90.9% vs. 62/78, 79.5%, p = 0.030). A total of 27 postoperative complications occurred. The incidence of puncture site hematoma was significantly higher in the DSA group (10/78, 12.8%) than that in the ultrasound + DSA group (4/99, 4.0%) (p = 0.032). PRF can reduce pain from HZ in the perineal region, alleviate central sensitization, enhance sleep quality, and improve overall quality of life. When PRF is performed under ultrasound guidance combined with DSA, it shortens the puncture time and reduces the risk of hematoma formation at the puncture site, making it the recommended method for clinical use.

Influence of experimental conditions on some in-vitro biomechanical properties of the sow’s perineum

The aim of this work was to develop an experimental protocol that takes into account the influence of experimental conditions on these perineal tissues, before determining their mechanical properties. Samples of each perineal tissue layer were obtained from the skin, the vagina, the external anal sphincter (EAS), the internal anal sphincter (IAS) and anal mucosa of freshly dead sows. They were tested in quasi-static uniaxial tension using the Mach-1 testing machine. Stress-strain curves of each perineal tissue layer before the first damage for each sow were obtained and modeled by hyperelastic laws described by three coefficients: C1, C2, and C3 (Yeoh model). The influence of sample preparation conditions such as tissue freezing, hygrometry and sample orientation were evaluated, and the conditions under which the tests were performed such as the displacement velocity during testing were also evaluated by analysing C1-coefficient. This study suggested that sample preparation conditions such as tissue freezing for 24 h, storage in cellophane paper for two hours and the strain rate did not statistically affect the C1-hyperelastic coefficient for each perineal layer (p > 0.05). Samples should not be stored in saline for 2 h (p < 0.05). Sample orientation did not influence C1-hyperelastic coefficient (p > 0.05). This experimental protocol could be used to study in vitro biomechanical properties of perineal tissues in order to better understand perineal tears during delivery.

Transperineal Ultrasound In Clinically Diagnosed FistulaIn Ano Cases - A Cross-Sectional Study In A Tertiary Care Center

Fistula-in-ano (FIA) is a chronic and often recurrent anorectal condition characterized by an abnormal communication between the rectum or anal canal and the perianal skin. Accurate diagnosis and management of FIA remain challenging due to the complexity of fistula tracts and potential complications. Traditional diagnostic methods like clinical examination and fistulography are commonly employed, but these methods often lack detailed visualization of the fistulous tracts. In recent years, transperineal ultrasound (TPUS) has emerged as a non-invasive, radiation-free, and cost-effective tool in the assessment of FIA. This study aims to review the role of transperineal ultrasonography in the assessment of fistula-in-ano, with respect to its current techniques, advantages, clinical applications, and future directions.

Negative Pressure Wound Therapy With Instillation as an Early Intervention for Extensive Wounds From Necrotizing Fasciitis: A Case Study.

Ms. S was a 50-year-old woman hospitalized with necrotizing fasciitis from a labial abscess. After several surgical interventions wound debridements were performed consecutively for 6days. She was left with extensive full thickness tissue destruction of her abdomen, bilateral groin areas, and complete displacement of skin over her mons pubis. Wounds related to necrotizing fasciitis can be especially challenging to manage, especially when the perineal region is involved. Due to the location of such wounds, it can be difficult to maintain dressings, including negative pressure wound therapy with instillation devices (NPWTi). Ms. S. also had a history of uncontrolled diabetes mellitus, which can hinder wound healing. The Wound, Ostomy and Continence (WOC) nurse was consulted on day 6 of Ms. S's admission, for application of NPWTi. Complex NPWTi dressings were completed in the operating room (OR), 2 times weekly for 2weeks. When Ms. S was transferred from the intensive care unit to the surgical unit, NPWT dressings with instillation were used but later converted to standard NPWT, changed twice weekly by the WOC nurse. Dressings were changed at the bedside until day 29 of her admission. The management of Ms. S's extensive wounds was successful, and her wounds were closed by plastic surgery on day 29 of her admission. Ms. S was the first patient at our hospital with extensive wounds from necrotizing fasciitis to undergo surgical closure of her wounds during the same hospital admission.

Essential Considerations for Radiologists in Diagnosing Hidradenitis Suppurativa.

Hidradenitis suppurativa, also referred to as inverse acne, manifests as a persistent inflammatory skin disorder characterized by lesions such as deep nodules, abscesses, sinus tracts, and fibrotic scars. These manifestations predominantly occur in skin folds and intertriginous areas, notably in the axillary, inguinal, perianal, perineal, and inframammary regions. Due to similarities with other conditions in its initial stages, accurate diagnosis of hidradenitis suppurativa is often delayed, sometimes spanning several years. Diagnosis relies on identifying specific morphologic features (such as deep, inflamed, and painful nodules; sinus tracts; and scars), considering the affected sites (skin folds and areas with apocrine glands), and recognizing the chronic nature of the condition (persistent course with periods of exacerbation and remission). There are no definitive biologic or pathologic diagnostic tests, and biopsy of the affected area is not necessary. Treatment varies based on severity and may include topical and systemic antibiotics, hormonal therapy, immunomodulators, and surgery. Due to associated pain, increased site sensitivity, secretion drainage, odor, and scarring, this condition can have a negative psychosocial impact. Imaging studies, including high-frequency US and MRI with subsequent three-dimensional reconstruction, serve as valuable tools for precise staging, monitoring disease activity, and preoperative assessment. Currently, high-frequency US stands as the preferred method, incorporating sonographic classifications, while MRI and thee-dimensional imaging represent an emerging and promising approach. Imaging helps identify the extent of sinus tracts, assess involvement dimensions in advanced disease stages, and monitor proposed treatments. ©RSNA, 2024 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Enhanced Recovery Protocol Decreases Postoperative Opioid Use after Penile Inversion Vaginoplasty.

Penile inversion vaginoplasty (PIV) entails considerable soft-tissue dissection to the perineal region and involves complex tissue rearrangement. This study examines the role of an enhanced recovery after surgery (ERAS) pathway after PIV in reducing opioid use and controlling postoperative pain. A retrospective study of 50 transfemale patients who underwent PIV at a single institution from June 2021 to January 2023 was completed. The study compared 2 groups of patients who were given different postoperative pain management regimens: group A received standard postoperative analgesics and group B received ERAS. Variables such as postoperative pain scores on the numeric pain rating scale (0-10), use of opioid medication, length of hospital stay, and patient comorbidities were recorded and compared across the 2 groups. The average hospital stay length was 4.92 (±0.85) days. Group A had a slightly longer average stay compared with group B. The average pain level in both groups was 4.25 (SD ±1.51). Group A exhibited a slightly higher average pain level of 4.31 (±1.53), whereas group B exhibited 4.16 (SD±1.51) (P = 0.77). Although pain levels did not significantly vary between the 2 groups, there was a statistically significant decrease in the amount of opioid medication used in group B with a P value of 0.009. ERAS protocol is effective in decreasing opioid usage in the immediate postoperative setting after PIV.

Management of Lichen Sclerosus and Related Comorbidities at a Tertiary Referral Center: Beyond Topical Steroids.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital area, with potential systemic implications. Our aim was to elucidate its clinical characteristics and management strategies. We conducted a retrospective observational study on adult patients with LS referred to our center between January 2022 and December 2023. Forty-six adult subjects affected with LS were enrolled in the present study. The majority of patients presented with genital involvement, but a significant subset also exhibited extragenital LS and concomitant immune-mediated disorders. Common symptoms included itching, soreness, and dyspareunia, with characteristic skin findings of erythema and atrophy. Topical corticosteroids were the mainstay of therapy, complemented by alternative treatments in refractory cases. Alternative therapeutic approaches, such as PRP (platelet rich plasma) or ADSC (adipose-tissue derived stromal/stem cell)-based strategies, were effectively employed in refractory cases, in the absence of major adverse events. Our findings underscore the importance of alternative approaches in the management of LS and highlight the need for further research to elucidate its pathogenesis and optimize therapeutic interventions.

A rare case of postoperative Fournier's gangrene after a hemorrhoidectomy

Fournier’s gangrene (FG) is a severe and fulminant necrotizing fasciitis of the perineal, genital, and perianal regions. Extensive postoperative infections after anorectal surgeries are rare, and the development of FG after hemorrhoid surgery is extremely rare. We present the case of a 68-year-old diabetic male found to have a severe necrotizing infection of the perianal and perineal region eight days after a hemorrhoidectomy. His hospital course was complicated by septic shock, acute kidney injury, respiratory failure, and multiple strokes. The purpose of this case is to increase awareness of extensive necrotizing infections such as FG, complicating a hemorrhoidectomy, albeit rarely, especially in patients with comorbidities such as diabetes mellitus.

Staged operations of acquired lymphangiectasia of the vulva: 10 cases clinical analysis

Objective: To investigate the characteristics, diagnosis and therapeutic effect of acquired lymphangiectasia of the vulva (ALV). Methods: A retrospective analysis of clinicopathological and follow-up data was conducted on the patients treated in Capital Medical University Affiliated Beijing Shijitan Hospital due to female ALV from July 2009 to July 2023. The patients who completed the staged operations [partial labiectomy and reconstruction + thoracic ductplasty and (or) perineal lymphovenous anastomosis] were included in the study and followed up. The improvement of perineal swelling, blister range, fluid leakage volume and frequency were evaluated through outpatient visits by the symptom rating scale of ALV (hereinafter referred to as the symptom rating scale) before and after surgery. Results: A total of 48 patients were treated due to ALV from July 2009 to July 2023, of which 98% (47/48) were postoperative pelvic malignant tumors and 94% (45/48) had a history of radiotherapy. A total of 10 patients with ALV who completed the staged operations were included in this study. (1) Clinical characteristics and diagnosis: 10 patients had a median age of 60 years old (50, 63 years old ). The median duration from cervical cancer surgery and radiation therapy to vulvar swelling was 1.5 years (0.0, 2.0 years), and the median duration from vulvar swelling to blister formation and leakage was 0.0 years (0.0, 4.8 years). Seven patients (7/10) had a history of recurrent erysipelas; 7 patients (7/10) had the most severe symptom (widespread blisters, persistent fluid leakage, and large amount of fluid leakage); noncontrast magnetic resonance lymphography (NCMRL) showed edema signals in the perineal region of all the patients, and increase of agent in the perineal region was observed in lymphoscintigram (LS). (2) Surgical treatment and postoperative pathological examination: of the 10 ALV patients who completed staged surgical treatment, 6 cases (6/10) were diagnosed with thoracic duct outlet obstruction and underwent thoracic ductplasty and partial labiectomy and reconstruction. Perineal lymphovenous anastomosis and partial labiectomy and reconstruction were performed in 4 cases (4/10) without thoracic duct outlet obstruction. Postoperative routine pathological examination of 10 patients (10/10) showed dermal papilla lymphangiectasia. Immunohistochemical tests were performed on 5 patients, all of which were positive for D2-40 and negative for CD34. (3) Efficacy: 8 patients completed the postoperative follow-up, and the median follow-up time was 31.0 months (17.5, 78.3 months). The perineal swelling and the blister fluid leakage were all significantly improved after the staged operations. All indexes of the symptom rating scale, including the degree of perineal swelling, blister range, fluid leakage volume and frequency, were significantly improved in 8 follow-up patients, and 3 (3/8) of them were cured; the median symptom score decreased significantly from 11.0 before surgery to 3.0 after surgery (P<0.001). The incidence of erysipelas was significantly reduced from 7/10 before surgery to 2/8 after surgery (P=0.035). Conclusions: The main causes of female ALV are pelvic tumor surgery and radiotherapy. The clinical diagnosis is made from relevant medical history, clinical manifestations, LS and magnetic resonance imaging. The diagnosis is confirmed by histopathological findings. Pathological results show lymphangiectasia in the dermal papilla, and immunohistochemical staining show positive for D2-40 and negative for CD34. The effect of staged surgery on ALV is remarkable and even cured, and could effectively reduce the incidence of erysipelas.

Phyllodes - like Tumor of the Anogenital Mammary - like Glands – A Rare Entity

Abstract Introduction/Objective Phyllodes tumor (PT), a biphasic fibroepithelial tumor typically found in the breast, is an exceedingly rare finding outside the mammary gland, with only about 160 cases reported to date. We describe a rare case of PT arising from anogenital mammary-like glands (AGMLG). Methods/Case Report A 68-year-old woman presented with a small perianal mass that was incidentally detected during hemorrhoidectomy procedure. It appeared as a pedunculated olive-sized mass on the perianal skin. A papillectomy was performed, and upon sectioning, a solid-cystic lesion measuring 2.0 x 1.4 x 0.9 cm was observed. Microscopic examination revealed a biphasic pattern comprising of glandular epithelium and a stromal component, with a predominance of the latter and together they formed leaf-like slits. These spaces were lined by a bilayered epithelium consisting of secretory (apocrine)-type cells and myoepithelial cells resembling mammary glandular epithelia. Focal clusters of benign glands, morphologically consistent with AGMLGs, were identified at the periphery of the tumor. Immunohistochemically, epithelial components reacted positively for GATA3, mammoglobin, CK7, estrogen receptor and progesterone receptor, while the myoepithelial cells were highlighted by calponin and p63. The AGMLGs in the periphery also stained for GATA3, estrogen receptor and progesterone receptor. The mitotic rate was low (1 to 2 per 50 high-power fields), without atypical mitoses. The lesion was diagnosed as a benign PT. Results (if a Case Study enter NA) NA Conclusion The current case highlights the importance of recognizing PT when it occurs at extra-mammary locations. The entity merits greater attention not only for its malignant potential but also due to the mystery surrounding its origin and the histogenetic link to breast tissue.

The development of the external genitals in female human embryos and foetuses. Part 2: Vaginal vestibule, anal canal, perineal raphe and perineal cutaneous muscles.

Concomitant with the rupture of the cloacal membrane, the perineal skin epithelium thickens (see accompanying article). In this study, we establish in female embryos and foetuses that the thick skin area divides into ventral and dorsal areas at ~14 weeks and gradually becomes restricted to the vaginal vestibule and anal canal thereafter. The dense mesenchymal core of the labia minora, which forms at ~8 weeks, extends dorsally to the anal canal as a midline reinforcement. The skin epithelium overlying this reinforcement is much thinner than the flanking 'thick skin', and is supported by an interrupted basement membrane, which implies epithelial-mesenchymal transformation of the thin midline epithelium and the subsequent establishment of the perineal raphe by the merging of the adjacent thick epithelium. Meanwhile, the anogenital distance in the perineum increases rapidly in length. Perhaps as a consequence, the labia minora cover only the ventral third of the vaginal vestibule at 20 weeks. The endodermal ducts of Bartholin's glands are identifiable at 7 weeks, while acini form at ~12 weeks. The vestibular bulbs become identifiable at ~10 weeks and form vascular networks after ~14.5 weeks. After the rupture of the cloacal membrane, the diameter of the junction of the dorsal cloaca with the anal canal is just a pinhole but widens dorsoventrally after the 7th week. The cutaneous muscles of the perineal area form as a ventrally open U-shaped mesenchymal mass, from which the anal sphincter and bulbospongiosus muscle develop. In conclusion, our findings show that thick skin epithelium persists in the vaginal vestibule and anal canal.

Fournier’s gangrene in voluminous inguinoscrotal herniation: Case report and review of literature

Introduction: Fournier’s gangrene (FG) is a polymicrobial life-threatening infection that affects perineal region and may extend to genitalia and abdominal wall. Necrotizing fasciitis is a rare condition and its association with large inguinoscrotal hernia even rarer. With high mortality rate, some predisposing factors are diabetes and immunodeficiency. Case presentation: We report a case of a 48-year-old man with Fournier’s gangrene associated with voluminous inguinoscrotal herniation which evolved to hernia sac exposure after debridement. Discussion: FG pathophysiology initiates with a localized infection by a combination of gram positive, gram negative and anaerobic bacteria, and its advancing leads to local inflammatory response, thrombosis, blood flow reduction and ischemia. Diagnosis depends on clinical presentation and image evaluation. Conclusion: FG management has been standard in the literature, however its association with inguinoscrotal hernias have not been considered in guidelines. Early diagnosis and proper clinical and surgical treatment are fundamental to avoid life-threatening complications and morbidities.

On intimate care in men: A review

Even though intimate hygiene plays an essential role in the prevention of various genital diseases, there are currently few studies on this topic. There is a wide range of diseases that affect the male genital organs. There is a wide range of diseases that affect the male genital organs. Inflammation of the glans penis (balanitis) occurs in 3–11% of males during their lifetime; one of its leading causes is poor hygiene. However, many non-venereal dermatoses occur in this anatomical region. Most often, patients complain of itching, as well as pain, burning, and various rashes. The most common reason for seeking medical attention is irritant contact dermatitis. Various allergens cause more acute reactions in the anogenital region due to the structural features of the skin of the genitals. Components of detergents and hygiene products, accessories for sexual practices, medications, and contraceptives can become provoking factors of genital allergic dermatitis. Among the dermatoses affecting the male genitalia, lichen planus should be noted, which occurs in males twice as often as in females, and the oral mucosa is often involved in the inflammatory process. Lichen sclerosus can also occur on the skin of the penis, leading to phimosis, a decrease in quality of sexual life, and often requiring circumcision. Psoriasis also can affect the anogenital area. Rashes may be isolated, but other anatomical areas are also involved in most cases. Psoriatic lesions of the genitals are visually different from typical elements in other areas of the skin. Minimizing discomfort due to these diseases is possible by using specialized care products. The skin of the genitals in men has specific features that are important to consider when developing the composition of the products.