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Indian Journal of Sexually Transmitted... 2021Role of male circumcision (MC) as a tool to prevent sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) was assessed. An attempt was made to search... (Review)
Review
Role of male circumcision (MC) as a tool to prevent sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) was assessed. An attempt was made to search articles related to association between MC and STIs/HIV. A thorough search was carried out to find out quality articles published in indexed specialty journals. Centers for Disease Control and Prevention and World Health Organization (WHO) sites were also referred. Warm and moist environment of area under foreskin facilitates some pathogens to persist and replicate. Further, the thinness of foreskin predisposes it to minor trauma and abrasions that facilitate the entry of pathogens. MC reduces HIV infection risk by 50%-60% over time and reduces the risk of men acquiring herpes simplex virus-2 and human papillomavirus (HPV) that can cause penile and other anogenital cancers, by 30%. There is no significant reduction in risk of acquiring syphilis, but reduced risk of acquisition of is reported. MC is reported to be beneficial in conditions such as traumatic injury, Balanitis Xerotica Obliterans, refractory balanoposthitis, and chronic, recurrent urinary tract infections. MC also reduces the chances of penile carcinoma by facilitating improved penile hygiene, lowering HPV/HIV transmission rates, and reducing chronic inflammatory conditions such as phimosis and balanitis. MC has been recommended by the WHO and UNAIDS in 2007 as an additional HIV prevention intervention in settings of high HIV prevalence. MC is an important adjunct to safe sex education, condom use, and vaccination (HPV) in reducing the global burden of HIV/STIs-related morbidity and mortality.
PubMed: 34765930
DOI: 10.4103/ijstd.ijstd_20_21 -
Journal of Gynecology Obstetrics and... Jun 2021The clitoris has a crucial role in the feminine pleasure. Chronic inflammatory dermatosis along with post-menopausal atrophy of the vulva and obstetrical traumas can...
The clitoris has a crucial role in the feminine pleasure. Chronic inflammatory dermatosis along with post-menopausal atrophy of the vulva and obstetrical traumas can cause clitoral phimosis, thereby compromising its function. Medical treatments exist depending on the etiology, but when irreversible scarring occur, a surgical treatment can be necessary to regain its function. We present here our surgical technique that achieves excellent functional results with low morbidity and the outcome of our patients in order to improve this sexual dysfunction.
Topics: Clitoris; Female; Gynecologic Surgical Procedures; Humans; Sexual Dysfunction, Physiological
PubMed: 32971308
DOI: 10.1016/j.jogoh.2020.101919 -
International Journal of Dermatology Dec 2022Balanitis is classically defined as inflammation of the glans penis, often also encompassing the prepuce (balanoposthitis). Several investigations have found that a... (Review)
Review
Balanitis is classically defined as inflammation of the glans penis, often also encompassing the prepuce (balanoposthitis). Several investigations have found that a sizable proportion of urology clinic visits are due to balanitis or related complaints. Balanitis can have numerous complications, including severe pain, urethral stenosis, phimosis, sexual dysfunction, and if untreated, malignancy. Unfortunately, there is no recent or comprehensive review that describes the various etiologies, clinical workup, and treatments for balanitis. Herein this review, we attempt to provide the reader with a complete and updated guide to balanitis in an attempt to improve clinical outcomes.
Topics: Male; Humans; Urology; Dermatology; Balanitis; Phimosis; Penis
PubMed: 34826136
DOI: 10.1111/ijd.15985 -
Journal of Lower Genital Tract Disease Oct 2023Lichen sclerosus (LS) is a chronic inflammatory skin disease. In male patients, it usually involves the glans penis and foreskin and can cause phimosis or meatal...
OBJECTIVE
Lichen sclerosus (LS) is a chronic inflammatory skin disease. In male patients, it usually involves the glans penis and foreskin and can cause phimosis or meatal stenosis. The aim of this cross-sectional case-control study was to identify clinically important comorbidities in male patients with LS.
MATERIALS AND METHODS
By searching Turku University Hospital electronic health records, the authors identified 630 male patients diagnosed with LS between 2004 and 2020. To investigate possible comorbidities, the authors compared this patient group to a 10-fold larger control group.
RESULTS
The incidence of LS increased during the study period, from 5 to 27.5 per 100,000 men. Patients were most often diagnosed at 21 to 25 years of age. Patients with LS exhibited markedly increased risks of penile carcinoma (odds ratio [OR], 81.0; 95% CI = 10.82-3516.7; p < .001) and carcinoma in situ of the penis (OR = 60.5; 95% CI = 7.32-2738.9; p < .001). Patients also more commonly exhibited lichen planus (OR = 16.8; 95% CI = 8.97-32.39; p < .001), psoriasis (OR = 3.3; 95% CI = 1.80-5.70; p = .004), angina pectoris (OR = 1.8; 95% CI = 1.10-2.81; p = .013), obesity (OR = 2.6; 95% CI = 1.72-3.77; p < .001), type 2 diabetes (OR = 2.3; 95% CI = 1.74-3.09; p < .001), and hypertension (OR = 1.9; 95% CI = 1.53-2.37; p < .001). The most commonly performed urological procedures were operation for phimosis, uroflowmetry, and ultrasound measurement of residual urine.
CONCLUSIONS
Genital malignancies, other dermatological conditions, and diseases related to metabolic syndrome should be considered when treating patients with LS.
Topics: Humans; Male; Case-Control Studies; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Lichen Sclerosus et Atrophicus; Phimosis; Young Adult; Adult
PubMed: 37729047
DOI: 10.1097/LGT.0000000000000769 -
The Cochrane Database of Systematic... Jan 2024This is an updated version of a Cochrane Review first published in 2014. Phimosis is a condition in which the prepuce (foreskin) cannot be fully retracted past the head... (Review)
Review
BACKGROUND
This is an updated version of a Cochrane Review first published in 2014. Phimosis is a condition in which the prepuce (foreskin) cannot be fully retracted past the head of the penis (glans). Phimosis is often treated surgically by circumcision or prepuce plasty; however, reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have suggested favorable outcomes.
OBJECTIVES
To assess the effects of topical corticosteroids applied to the stenotic portion of the prepuce for the treatment of phimosis in boys compared with placebo or no treatment.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, LILACS, and ClinicalTrial.gov. We checked reference lists of included studies and relevant reviews for additional studies. There were no restrictions on the language of publication. The date of the last search was 4 October 2023.
SELECTION CRITERIA
We included all randomized controlled trials (RCTs) that compared the use of any topical corticosteroid with placebo or no treatment for boys with any type or degree of phimosis.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, extracted data related to the review's primary and secondary outcomes, and assessed the studies' risk of bias. We used the random-effects model for statistical analyses and expressed dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs). We contacted the authors of the primary articles to request details of the study design and specific outcome data. We used GRADE to assess the certainty of evidence on a per-outcome basis.
MAIN RESULTS
In this update, we identified two new studies with 111 participants, bringing the total number of included studies to 14 (1459 randomized participants). We found that types of corticosteroids investigated, participant age, degree of phimosis, type of phimosis, and treatment duration varied considerably among studies. Compared with placebo or no treatment, topical corticosteroids may increase the complete resolution of phimosis after four to eight weeks of treatment (RR 2.73, 95% CI 1.79 to 4.16; I² = 72%; 10 trials, 834 participants; low-certainty evidence). Based on 252 complete resolutions per 1000 boys in the control group, this corresponds to 436 more complete resolutions per 1000 boys (95% CI 199 more to 796 more). We downgraded the certainty of the evidence by one level for serious study limitations and by one level for serious inconsistency. Topical corticosteroids may also increase the partial resolution of phimosis at four to eight weeks of treatment compared with placebo or no treatment (RR 1.68, 95% CI 1.17 to 2.40; I² = 44%; 7 trials, 745 participants; low-certainty evidence). Based on 297 partial resolutions per 1000 boys in the control group, this corresponds to 202 more partial resolutions per 1000 boys (95% CI 50 more to 416 more). We downgraded the certainty of the evidence by one level for serious study limitations and by one level for serious inconsistency. We are uncertain of the effect of topical corticosteroids compared to placebo on change in retractability score (standardized mean difference [SMD] -1.48, 95% CI -2.93 to -0.03; I²91%; 2 trials, 177 participants; very low-certainty evidence). We downgraded the certainty of the evidence by one level for serious study limitations, one level for serious heterogeneity, and one level for serious imprecision. Compared with placebo, topical corticosteroids may increase the long-term complete resolution of phimosis six or more months after treatment (RR 4.09, 95% CI 2.80 to 5.97; I² = 0%; 2 trials, 280 participants; low-certainty evidence). Based on 171 long-term complete resolutions per 1000 boys in the control group, this corresponds to 528 more complete resolutions per 1000 boys (95% CI 308 more to 850 more). We downgraded the certainty of the evidence by one level for serious study limitations and by one level for serious imprecision. There may be little or no difference in the risk of adverse effects between topical corticosteroids and placebo or no treatment (RR 0.28, 95% CI 0.03 to 2.62; I² = 22%; 11 trials, 1091 participants; low-certainty evidence). Only two of 11 studies that recorded adverse effects reported any adverse effects; one event occurred in the corticosteroid group and six in the control group. We downgraded the certainty of the evidence by one level for serious study limitations and by one level for serious imprecision.
AUTHORS' CONCLUSIONS
Topical corticosteroids, compared to placebo or no treatment, may increase complete and partial resolution of phimosis when assessed after four to eight weeks of treatment, and may increase long-term complete resolution of phimosis assessed six or more months after treatment. Topical corticosteroids may have few or no adverse effects, and we are uncertain about their effect on retractability scores. The body of evidence is limited by poor reporting of methods in the studies, important clinical heterogeneity, and serious imprecision in the results. Future, higher-quality trials with long-term follow-up would likely improve our understanding of the effects of topical corticoids on phimosis in boys.
Topics: Male; Humans; Phimosis; Circumcision, Male; Drug-Related Side Effects and Adverse Reactions; Dermatologic Agents; Adrenal Cortex Hormones
PubMed: 38269441
DOI: 10.1002/14651858.CD008973.pub3 -
Reproduction in Domestic Animals =... Oct 2021The purpose of this paper was to analyse the aetiology and methods of diagnosing reproductive disorders in male dromedary camels. Male camel infertility manifests as one... (Review)
Review
The purpose of this paper was to analyse the aetiology and methods of diagnosing reproductive disorders in male dromedary camels. Male camel infertility manifests as one of three conditions: post-coital infertility (IG), inability to copulate (IC) and lack of sexual desire (LSD). IG is mainly a testicular disorder that is linked to a deteriorated seminogram, arrested spermatogenesis, Sertoli cell-only syndrome and testicular degeneration. For IG diagnosis, semen analysis, testicular biopsy and fine-needle aspiration are gold standards. Testicular ultrasonography was generally inefficient. High serum FSH was found in IG camels with oligo- and azoospermia, implying primary spermatogenesis defects. The testis-expressed protein (TEX101) and the epididymis-expressed protein (ECM1) are reliable biomarkers for distinguishing between obstructive and non-obstructive azoospermia. IC manifests in two forms: phimosis (PHI) and erectile dysfunction (ED). PHI is frequently linked to preputial and penile pathologies, as well as leucocytosis, neutrophilia and elevated nitric oxide metabolites. The majority of camels with ED have normal genital organs, and the condition is associated with an increase in cardiac troponin I. LSD is a rare disorder brought on by hormonal imbalances, high temperatures, stress and debilitating diseases. In conclusion, IG diagnosis necessitates semen analysis, testicular biopsy or fine-needle aspiration, and FSH testing, whereas IC diagnosis requires preputial and penile examinations. Diagnostic aids include serum and seminal biomarkers.
Topics: Animals; Azoospermia; Biomarkers; Camelus; Erectile Dysfunction; Infertility, Male; Male; Phimosis; Sexual Behavior, Animal; Testis
PubMed: 34219309
DOI: 10.1111/rda.13988 -
Journal of Family Medicine and Primary... Jun 2021Balanoposthitis is defined as an inflammatory condition of glans penis and prepuce. There are wide variety of etiologies including both infectious and noninfectious...
BACKGROUND
Balanoposthitis is defined as an inflammatory condition of glans penis and prepuce. There are wide variety of etiologies including both infectious and noninfectious conditions. This study attempts to throw light on information regarding clinical and microbiological aspects of balanoposthitis.
OBJECTIVES
To study various clinical patterns, etiologies, and predisposing factors of balanoposthitis.
METHODOLOGY
A descriptive study was undertaken on 106 cases who presented to sexually transmitted disease (STD) clinic with balanoposthitis between November 2017 and April 2019. A detailed history, physical examination, and investigations like KOH mount, leishman staining, gram staining, dark field microscopy, cultures, and other investigations were done wherever indicated. The data collected was tabulated and analyzed.
RESULTS
In our study, infectious etiology was the most common and was found in 77.36% cases. About 13.41% of cases with infectious balanoposthitis had multiple etiological agents. Noninfectious etiology was found in 22.64% cases. The most common infectious cause of balanoposthitis was candida, noted in 59.76% cases, followed by herpes simplex virus (19.51%), human papilloma virus (13.41%), and scabies (8.54%). Among noninfectious etiologies, adverse drug reaction (4.72% of total cases) was the most common, followed by lichen planus (3.77%) and psoriasis (3.77%). There was significantly higher incidence of phimosis in diabetic patients with candidal balanoposthitis.
CONCLUSION
Identifying the etiology facilitates early treatment and hence reduces the infectivity and transmission of disease and also the disease complications like phimosis. In addition, multiple infectious etiologies should always be kept in mind while evaluating STDs.
PubMed: 34322423
DOI: 10.4103/jfmpc.jfmpc_2467_20 -
Translational Andrology and Urology Jul 2023At present, the only definitive treatment for adult phimosis is circumcision, which is a surgical removal of the prepuce. Novoglan is a novel device that could offer...
BACKGROUND
At present, the only definitive treatment for adult phimosis is circumcision, which is a surgical removal of the prepuce. Novoglan is a novel device that could offer patients with phimosis an alternative to surgery. It is based on application of custom-moulded balloons for gradual skin remodelling and prepuce dilatation. This open-label clinical trial aimed to investigate the safety, efficacy and tolerability of the Novoglan treatment.
METHODS
A prospective trial was conducted on 20 patients with adult phimosis recruited at Macquarie University Hospital and Princess Alexandra Hospital. After eligibility screening and enrolment, patients were provided with the Novoglan product and training. The treatment involved twice daily 10-minute applications for a duration of 4-8 weeks with patient's degree of phimosis assessed before and at 6-8 weeks after the initiation of the treatment. Participants were also asked to complete questionnaires aimed to assess the safety and tolerability of the Novoglan treatment.
RESULTS
The treatment was successful with improved foreskin retraction in 90% of patients and all patients achieving full foreskin retraction after the treatment. Ninety-five percent of patients reported reduced level of anxiety, and over 60% of patients reported reduced pain/discomfort during sexual activity or in general. Similarly, 95% of patients were moderately-to-very satisfied with the treatment and would recommend Novoglan to others. No adverse events were observed and only 15% of participants reported minor side effects.
CONCLUSIONS
The Novoglan-01 trial demonstrated high safety, efficacy and tolerability of the Novoglan treatment for adult phimosis and its high potential as a conservative alternative to circumcision or steroid cream treatment.
TRIAL REGISTRATION
The Novoglan-01 study has been registered with the Australia and New Zealand Clinical Trial Registry under the reference ACTRN 1262 10009 24853, dated 15 July 2021.
PubMed: 37554529
DOI: 10.21037/tau-23-91 -
International Braz J Urol : Official... May 2024
PubMed: 38787615
DOI: 10.1590/S1677-5538.IBJU.2024.9913 -
International Journal of Dermatology Jul 2019Balanitis xerotica obliterans (BXO), or penile lichen sclerosus, is a progressive sclerosing inflammatory dermatosis of the glans penis and foreskin. It is associated... (Review)
Review
Balanitis xerotica obliterans (BXO), or penile lichen sclerosus, is a progressive sclerosing inflammatory dermatosis of the glans penis and foreskin. It is associated with significant morbidity and may result in impaired urinary and sexual function. It was initially described by Stuhmer in 1928, named after its pathological features, and is considered the male equivalent of vulvar lichen sclerosis (LS). The etiology of BXO is uncertain; however, autoimmune disease, local trauma, and genetic and infective causes have been proposed. BXO occurs most commonly on the prepuce and glans penis. It is considered to have premalignant potential to transform into squamous neoplasia. This postulation rests on retrospective studies and parallels drawn with vulvar LS and squamous cell carcinoma (SCC) development. Histologically, BXO and vulvar LS are considered the same disease. There is a paucity of evidence-based guidelines to assist with appropriate follow-up for patients with BXO.
Topics: Administration, Topical; Balanitis Xerotica Obliterans; Carcinoma, Squamous Cell; Circumcision, Male; Dermatology; Diagnosis, Differential; Glucocorticoids; Humans; Male; Penile Neoplasms; Penis; Phimosis; Practice Guidelines as Topic; Precancerous Conditions; Sexual Dysfunction, Physiological; Urination Disorders
PubMed: 30315576
DOI: 10.1111/ijd.14236