Genital dermatology: an all-you-need-to-know guide

Top Doctors recently had the opportunity to speak with revered consultant sexual health physician, Dr Rex Melville, who, here in our latest article, describes what genital dermatology is, whilst also outlining what the most common genital dermatological conditions are.

What is genital dermatology?

Genital dermatology refers to problems and symptoms that occur in the intimate parts of the body such as the vulva, penis, as well as the anal area. This branch of medicine is not widely known, often through lack of knowledge by physicians and family doctors, and because patients find it difficult to discuss with health carers.

In terms of genital dermatology, what are the most common conditions that you treat?

There are some genital and anal problems that are common in both men and women. For example, skin conditions that affect other parts of the body, such as eczema (dermatitis) and psoriasis, may intrude onto the skin of the vulva, penis, groins, or around the anus. 

Dry skin in the genital area is another symptom often presented, often occurring due to the individual washing too frequently with harsh or perfumed soaps, which can cause irritation and itchiness in intimate areas.

For women, the common condition of thrush (candidiasis, an overgrowth of a particular yeast) can cause a troubling red rash and soreness, and this can occasionally occur on the glans (helmet) of the penis and foreskin of men.

Even though they are less frequent, I sometimes see patients with lichen sclerosis or lichen planus on the penis or vulva. These genital conditions can cause a gradual onset of red or purple patches with scaling and scarring or tightening of the foreskin (phimosis).

Can a sexual infection be involved?

Genital warts, herpes, and syphilis can cause lumps or spots (often painful) on the genitals. Fortunately, there are some blood and swab tests which can help doctors come to the right decision as to whether an STI is the cause.

What does genital dermatology treatment entail?

There are several creams and ointments that are typically useful in genital skin conditions. Depending on the diagnosis, they include mild to strong steroid (cortisone) creams, anti-fungals, and moisturisers. Antibiotic tablets or even an injection may be needed if we discover you have an STI.

When a man presents to me with what turns out to be lichen sclerosis, we discuss the treatment option of circumcision if the condition isn’t too advanced. Otherwise, he can be offered steroid creams for a short period.

I have been increasingly seeing the condition whereby the individual experiences long-term burning or discomfort in an area of the penis or scrotum, or on the vulva, sometimes called genital pain syndrome. Patients may find medium to long-term relief from this with medicines that dampen down unwanted and damaging nerve impulses.

Some of these tablets (and some creams) belong to the family of tricyclic anti-depressants, and work at very low dosage, even though the patient may not be depressed. Anti-seizure agents such as Gabapentin are often useful too but need special care if used on a long-term basis.

Dr Rex Melville is a highly established consultant genito-urinary physician who specialises in all things sexual health. Consult with him today via his Top Doctors profile to book an appointment with him.