Genital Dermatology

Penile Cancer: Its types and Risk Factors

June 4, 2013 by Dr.Deepak Leave a Comment

Penile cancer simple means cancer of the penis, which is often encountered in individuals over 50 years. Don’t be scared as there is good chance of a cure if it is diagnosed early and treated. Basically, the more the cancer has advanced the less chance of cure.

Types of Penile Cancer

There are several types of penile cancers depending on their type of cell. The most common one is squamous cell carcinoma, others are listed as below:

Squamous cell penile carcinoma accounts for 95% of the cases
Adenocarcinoma of penis accounts for 5% of the total cases
Carcinoma in situ; a squamous cell cancer that has not yet spread.
Basal cell cancer that accounts for 2% of the total cases are slowly growing and rarely spread to other areas.
Melanoma that account for less than 2% of the cases are more dangerous and can rapidly spread.
Sarcoma that develops from blood vessels, smooth muscle and other connective tissues cells accounts for less than 1% of the cases.

Signs and Symptoms of penis cancer

Long history of bumps or painful ulcers that itches, bleeds and discharge may be the initial symptoms of penile cancer. It may also be associated with balanoposthitis or phimosis, dysuria and painful intercourse. If the sore or growth on the penis doesn’t heal after continue medications penile cancer should be suspected. Sometime there may be foul smelling discharge from the penis. The inguinal lymph node may be swollen. Experts say that neonatal circumcision decreases the risk of penile carcinoma.

How is it diagnosed?

Although your dermatologist may diagnose just by looking, biopsy is required to confirm the case. Complete blood count may also be needed to know about general heath.

Causes and Risk Factors for Penile Cancer

Although the exact cause for penis cancer is not known, there are many factors that can increase the risk of penile cancer; some of them are listed below. Lichen sclerosus, genital warts and uncircumcised penis are by far most common risk factors for penile cancer.

Uncircumcised penis
Phimosis, Paraphimosis and balanitis
Long foreskin
Smegma
Poor or inadequate personal and sexual hygiene
Repetitive inflammation and irritation of the penis
Scarring
Smoking
Lichen planus and lichen sclerosus
Human papillomavirus infection
Multiple sexual partners
Bowenoid papulosis
Squamous hyperplasia
Bowen disease of the penis
Giant condyloma
Erythroplasia of Queyrat
Several other sexually transmitted diseases
HIV infection
Photochemotherapy
Iatrogenic immunosuppression
Psoriasis
PUVA

Treatment of Penile Cancer

Treatment option for cancer of penis depends on location, size and the stage of tumor progression. In case of carcinoma in situ topical creams with laser may be sufficient but for other cancers surgical removal is the best option. In general cancer treatment includes:

Chemotherapy that uses medications to kill cancer cells
Radiation that uses high powered x-rays to kill cancer cells
Surgery that just cuts out and removes the cancer

The outcome of the cancer depends on how far the cancer has spread. For more severe cases and widespread lesion total penectomy (total removal of penis) is often the best option.

Circumcised vs Uncircumcised Penis – Which is Better?

June 1, 2013 by Dr.Deepak 5 Comments

When it comes to circumcised vs uncircumcised penis, several thoughts might come to your mind. Some might do it for cultural, social or religious beliefs while other might do it for being concern about personal hygiene. For some it is just very easy and simple to decide as ongoing cultural or religious beliefs while for some it is hard to decide whether to circumscribe or not. So, if you are planning to have a circumcision, talk to your doctor to help you make the right choice for you. In this article we’ll try to briefs on Circumcised vs Uncircumcised Penis.

What are the benefits of Circumcision?

There are several benefits of circumcision some of which are listed below:

Circumcision reduces the risk of infection. Individual with uncircumcised penis have several penile issues like inflammation, irritation and infection (both fungal and bacterial). It is easier to clean a circumcised penis than uncircumcised one. Bacteria or yeast can breed easily if you don’t take care of your penis every day especially in an uncircumcised penis.

Reduce the risk of inflammatory genital skin diseases. Circumcision reduced the risk of several inflammatory genital diseases, especially those common around glans penis. Individuals with circumcised penis have less chances of having pearly penile papules than uncircumcised ones.

Reduce the risk of having penile cancer. Although penile cancer is itself rare in men, circumcised men have low risk of getting penile cancer than uncircumcised men.

Decrease the risk of cervical cancer in partners. When your penis is free of infections and you are free of any sexually transmitted infection, chances of asymptomatic transmission of diseases like herpes, genital warts (that might increase the risk of cervical cancer) to your partner is less.

Decrease chances of sexually transmitted infections including HIV. Several researches have concluded that people with circumcised penis have less chances of sexually transmitted infection. As circumcision changes the penile ecosystem of bacteria, this perhaps may be the reason for reduced infection and the risk of HIV infection.

Decrease risk of urinary tract infections. It is estimated that urinary tract infection are about ten times more common in men with uncircumcised penis. So, circumcision might reduce the risk of UTI.

Although circumcision has several medical advantages, it also carries some risks just like any other surgical procedures. However, the risks are small; beside minor bleeding and local infection other major complications are very rare. It is for sure that the health benefits of circumcision outweigh its risks. For pain during procedure your doctor will either apply topical or injectable anesthetic so you won’t feel any pain. For post-surgical pain analgesics may be prescribed.

Being said that there has been great debate whether to perform routine circumcision or not. Some recommends routine circumcision while some experts don’t agree. This might be because of the following reason:

Reduce sensitivity. Many people claim that uncircumcised penis was far more sensitive than a circumcised one resulting in less pleasure during sexual activity. However, people with premature ejaculation may benefit from it. You may drop your experiences below if you have something to say about sexual pleasure and other issues if you have.

Associated with some complications. Although major complications are very rare few complications like excessive bleeding and post-surgical infection may sometime be serious if not managed immediately. But still if adequate medications and antibiotics are prescribed chances are very less.

So, if you decide to have your penis circumcised, think twice and make a wise choice, get doctors and experts opinion. If circumcision will help solve your problem with no potential risk, than go for it.

Common Causes of Anal Itching – (Pruritus ani) and its Management

May 9, 2013 by Dr.Deepak 2 Comments

Pruritus ani, commonly referred as anal itching, perianal itching or itchy buttocks hole can cause severe distress and sleep disturbance due to persistent itching. One may even frighten to go to social events due to intense anal itching. It can really ruin one’s professional career as well as personal life. Anal itching actually is not a disease, but rather a symptom or sign and every type of anal itching sign or symptom can be successfully treated regardless of the cause.

Pruritus ani can be due to several factors; it can just be due to common skin dermatoses or could be the skin manifestation of systemic illness. In pruritus ani, itching is often localized in the anal region with little or no itching elsewhere. Pruritus ani is more commonly seen in males then females. Although serious systemic illness is rare in pruritus ani, it is very necessary to do a thorough examination for any malignancies like squamous cell carcinoma and extramammary paget’s disease, so you don’t have to regret later. Below are some of the causes on anal itching

Anal Neurodermatitis
Anal neurodermatitis is one of the causes of pruritus ani and is so intense during night that patients may tear the affected area until it bleeds.

Allergic Contact Dermatitis (ACD)
ACD is another common cause of anal itching. ACD could be due to various agents like fragrances in toilet paper, detergents, bubble baths, preservatives or anything that come in contact with the area.

Irritant Contact Dermatitis (ICD)
ICD may also cause anal itching. Irritant contact dermatitis may result from repetitive exposure to irritants from gastrointestinal contents, like hot spices or inadequate cleaning of the anal area after bowel moments. Anatomical abnormalities of the anal area or fecal incontinence can also leak rectal irritant to the skin causing irritant contact dermatitis.

Eating Habits
Certain foods can cause pruritus ani in some individuals. These may include Tea, coffee, milk products, cheese, chocolates, nuts, popcorn,seeds, carbonated beverages, citrus fruits and drinks, tomatoes and tomato products etc. Smoking and alcohol has also been associated with pruritus ani.

Fungal Infection
Fungal infection is another cause of pruritus ani, it may be associated with red/white swollen rash with fissuring around the anal region. Patients with diabetes are more susceptible for perianal candidiasis. In case of female, candidosis is an important cause and should always prompt screening for diabetes mellitus.

Gonorrhea
When itching is present in female gonorrhea is also suspected, however it is almost ignored in men, especially when itching is the only symptom.

Erythrasma
Although itching is less common, erythrasma involving groin and perianal region may also cause occasional itching.

Seborrheic Dermatitis
Seborrheic dermatitis of the anal area may also cause pruritus ani. However, it may also be evident on other areas like inguinal region, scalp, chest and face.

Lichen Planus and Psoriasis
Sometimes lichen planus and psoriasis can also cause perianal itching but lesion are usually not limited to perianal region, other areas of the body may also be involved.

Pediculosis and Scabies
Pediculosis also causes anal itch, but patient main focus may be on pubic itching. Scabies also can cause anal itching; however itching is not limited to anal area. Itchy lesion in scabies usually involves finger web-space, wrist, axillae and genitals.

Intestinal Parasites Infestation
Pinworm infestation may also cause pruritus ani, especially in children. Night anal itching is very common in pinworm infestation in children. Other intestinal parasites may also cause anal itching.

Other miscellaneous causes:
Hemorrhoids, anal fissure and fistula may also cause or aggravate the itching of anal area.
Although rare, anal warts and condyloma lata (syphilis lesion) may also sometimes cause itching
Persons chronically infected with Strongyloides may also experience pruritus ani

Pruritus ani Treatment

The mainstay of treatment of anal itching is to find out the causative factor responsible for pruritus ani, once the cause has been identified, treatment can tailored accordingly. Avoid scratching or rubbing the anal area. Also, avoid excessive cleaning which can actually make symptoms worse.

Good toilet hygiene should be strictly followed no matter what is the cause of itching. The anal area should always be cleaned with plain water and dried with soft tissue paper when possible. Contact allergy to preservatives in the products are the main concern, so it is wise to avoid all perfumed products or any other products that contains preservatives, just using plain water is better option. A good moisturizer may be applied if there is dryness around the anal region.

If you are obese or you sweat much, you may use cotton ball on the anal area so it will protect from repetitive friction and keep moisture away. Increase your fluid intake. Drink atleast 6-8 glasses of non-caffeine, non-alcohol drinks each day.

Diet can play an important role in the management of anal itching. Avoid foods that aggravate the itching. Avoid foods that causes constipation or diarrhea. Increase fiber intake eat lots of fruits and vegetables.

Topical steroids are effective in case of noninfectious cause of pruritus ani especially non fungal etiology. Use of newer agents like tacrolimus is safer and effective than topical steroids. Use of topical Capsaiein 0.006% is also effective in some cases. When there is inflammation and pain, topical anti-inflammatory and anesthetic lotions (Pramoxine hydrochloride) can be applied alone or in combination with hydrocortisone.

Retrograde Ejaculation – One of the Causes of Semen in Urine

May 8, 2013 by Dr.Deepak Leave a Comment

Retrograde ejaculation occurs when semen enters the bladder instead of going out through penis during ejaculation. This means the semen which normally comes out during orgasm is redirected to the urinary bladder. Sometimes called as dry orgasm, retrograde ejaculation is harmless, but is one of the factors of male infertility. Retrograde ejaculation is also one of the causes of semen in urine.

Normally during ejaculation, the muscle between the prostate and the bladder (the internal sphincter muscle) contracts, that prevents urine outflow and backflow of semen to the bladder. However, due to some pathological or anatomical condition this muscle relaxes or unable to close tightly, this may allow some semen flow backward to the bladder. When this occurs you will still have good orgasm but may ejaculate very little or no semen.

What causes retrograde ejaculation?

Retrograde ejaculation (RE) which is not frequently encountered in hospitals and clinics can be either partial or total. Several factors are associated with it, some of which are listed below:

Prostate or urethral surgery
Medications used to treat hypertension, prostate condition and some mood altering drugs.
Chronic disease like diabetes and multiple sclerosis can cause impairment of the nerve surrounding the prostate and bladder resulting in muscle dysfunction and back-flow of semen.

In short, any anatomical or pathological abnormalities that affect the muscles and nerve that control the prostate and the bladder can result in retrograde ejaculation. RE caused by diabetes or surgery is often not correctable.

Symptoms of Retrograde Ejaculation

Men can still have intense contraction and orgasmic pleasure with no pain or no any other abnormal sensation. The only thing that might look odd is the absence of burst of semen coming out of the penis during orgasm. Individual with RE may experience cloudy urine after orgasm or what people say as “semen in urine”.

Diagnosis and Tests

Usually analysis of urine that is obtained after ejaculation will confirm the diagnosis. The urine is usually cloudy and on lab examination large amount of sperm can be seen in the urine.

Treatment of Retrograde Ejaculation

Treatment and outcome of retrograde ejaculation may vary depending upon the causative factor. Although the condition is harmless, it may often result in infertility. Treatment is tailored towards closing the bladder neck so as to prevent semen backflow. If RE was due to drugs, removal of specific drugs might solve the problem. RE caused by surgical procedure or diabetes might improve with the drugs that help close the neck of the bladder, such drugs may include pseudoephedrine or imipramine. However, these drugs may increase heart rate and blood pressure that might be harmful if you already have high blood pressure or cardiac diseases.

How can I prevent RE

Avoiding drugs that causes retrograde ejaculation and controlling blood sugar level will help prevent retrograde ejaculation.

Retrograde Ejaculation and Pregnancy

Although this condition may cause infertility, men can still produce enough sperm. Sperm can be retrieved from the bladder or immediate urine after ejaculation and used for artificial insemination to achieve pregnancy.

Vaginal Itching: Possible Causes and Effective Remedies

March 28, 2013 by Dr.Deepak 1 Comment

Let’s admit it: you can’t stop itching “down there”. I know it’s an awkward area to scratch, but you can’t help. Your desire to scratch may lead you to squirm in your seat at public bus or at the office. Itching in the vaginal area can be so disturbing that it can affect both your social life and your personal sexual life. Fortunately, most cases of vaginal itching are not that serious, but you may need to visit a dermatologist for proper diagnosis and effective management.

Causes of Vaginal Itching

There are several reasons for vaginal itching, in this article we’ll try to include some of the common causes of feminine itching and some home remedies for vaginal itching.

Menopause Itching

Drop in estrogen level during menopause can lead to vaginal thinning, vaginal dryness and vaginal itching. This can be managed effectively with oral hormonal therapy, skin patches, gel or vaginal form of estrogen. Several vaginal estrogen rings are also available for management of genital and urinary dryness and irritation that can be due to drop in estrogen level in women after menopause.

Vulval eczema

Vulval eczema or vulval dermatitis is another cause of vulvar itching in women. It can develop alone on the vulva or associated with dermatitis in other areas of the body. Women with vulvar eczema may experience vulvar itching and irritation, and may be intense during nights. Some women may also experience burning or stinging like sensation. These symptoms may be aggravated by heat, sweat, menstruation, stress etc.

Vulval Lichen sclerosus (LS) and vulval lichen planus (LP)

Vulval LS and Vulval LP are also common causes of vulval itching in women of all ages. Severe itching, irritation, soreness, thickened skin, patchy pale or white striae are some of the common characteristic features of LS. These white striae may be noticed on the inner aspects of the vulva. These conditions may be more common on postmenopausal women. Vulval LP and LS can be managed effectively with mild, moderate, and potent steroids. As there is small risk of malignant changes (squamous cell carcinoma), one should always seek dermatologist if the lesion persist for long.

Vulvovaginitis

Vulvovaginitis can be due to several causes, bacterial vaginosis is one of the common. Bacterial vaginosis can cause a thin, grey vaginal discharge and fishy odor. Another condition called trichomonas vaginitis is also a common cause of vaginal itching and discharge in sexually active women. It may be associated with itching and foul smelly vaginal discharge that may be yellow-grey or green in color. Discomfort and burning micturition are also common.

Yeast infections in women

Vaginal yeast infection is one of the commonest causes of vaginal itching in women of all ages. It is estimated that about 80% of the women will develop yeast infection at some point in their lives. It is commonly caused by the fungus candida albicans which normally lives in small amount in the vagina and doesn’t cause any disease or symptoms. However, due to some conditions the number of candida increases leading to yeast infection. These conditions may be pregnancy, antibiotics, decrease immune system, obesity, diabetes, etc. Besides extreme vaginal itching and irritation, thick, white, cheesy discharge may be seen. Other symptoms may be painful intercourse, painful urination, redness and swelling of the vulva and severe itching and burning of vagina and labia.

If your symptoms are mild you may treat it yourself in home by buying over the counter anti-fungal medications and feminine itch wash or any home remedies for vaginal itching you can find on net. But it is wise to visit a dermatologist and confirm the case before you proceed with the treatment so you won’t have to regret later for misdiagnosis.

Chemical Irritants

There are several numbers of chemical irritants that can cause vaginal irritation and itching. Some of those include detergents, fabric softeners, contraceptive foams or jellies, condoms, scented toilet paper, feminine sprays, ointments, creams, douches and soaps.

Stress

Stress is another factor that can cause vaginal itching and further make you more susceptible to several bacterial and fungal infections.

Vaginal Itching During Pregnancy

Vaginal itching during pregnancy is quite common issue and may be related with pH level changes in the vagina. However, sometimes it can also be due to vaginal infection. Yeast infection is the commonest one and may present throughout the pregnancy. Details on Vaginal Itching during Pregnancy can be found here.

Vaginal itching in Children

Vaginal itching is quite common in children and young girls. Itching in children aged 2-7 years may be due to bacterial infection and poor toilet hygiene, while children above 8 years until puberty, yeast infection may be the common one. As vaginal area of young girls can be very sensitive, minor irritants like a piece of tissue paper can also cause itching. Most common irritants that can cause itching are soap and shampoo. However, once puberty begins, the vagina tends to be more acidic, that can fight and help prevent infections. More details Here

Vaginal itching and bleeding

Most of the vaginal itching may be regarded as harmless and easily manageable condition if treated early, however when it is associated with bleeding, one should get a prompt consultation with the gynecologist or dermatologist to rule out cancer. Never delay and try to diagnosis your-self just with the articles that you read over internet.

Prevention and Home Remedies for Vaginal Itching

Always keep your genital area clean and dry. Avoid using soap, shampoo and bubble bath to the genital area as they can be irritating. Use warm water to clean the genital area every day.
Don’t over wash the vagina; it can further cause dryness and itching, once daily is usually enough. Avoid douching too.
Stop using fragrances and feminine hygiene sprays in the genital area.
Avoid tight clothing, nylon or silk underwear as these materials can restrict airflow resulting in more sweating and irritation. Always use cotton underwear.
If you are a diabetes patient, always monitor your blood sugar level and keep it under control.
Always use pads and avoid tampons. Avoid using scented pads.
Take protective measures with condoms to avoid getting or spreading sexually transmitted infection.
If you are experiencing vaginal dryness, use good vaginal moisturizers and use water based lubricants during sex.
It is better to avoid sexual intercourse until your symptoms has improved.
If you are on certain antibiotics take yogurt to prevent yeast infection.
Never wipe the area from back to front; this can spread bacteria from anal area to vagina. Always wipe the area with a soft tissue paper from front to back.
Regular use of vinegar soak or baking soda soaks might help for yeast infection.

Remember: If the itching was due to sexually transmitted infection, it is very important to treat your partner as well, even if he might not have the symptoms. If he is not treated chances of reinfection are very high.