Abstract
Male genital dermatology has been a neglected field. Men with genital skin problems can present to doctors (e.g., in urology or genitourinary medicine) who are not trained or experienced in their diagnosis and management. The pathogenesis, epidemiology, natural history and prognosis of many male genital dermatoses – Zoon’s balanitis, erosive lichen planus, lichen sclerosus, nonspecific balanoposthitis, dysesthesia syndromes and carcinoma in situ – are ill-understood and treatment is not evidence-based. Although penis cancer is rare, it should be preventable or diagnosable at an early stage, thus reducing morbidity and mortality. The guiding ideology behind diagnosis and management is to exclude sexually transmitted disease, minimize or abolish sexual and urinary dysfunction and the risk of penis cancer, and to preserve the foreskin if possible. However, much dermatological disease of the male organ can be attributed to the causes or consequences of preputial dysfunction. There is wide normal variation in the anatomy of the penis and its relationship to the prepuce, perhaps reflecting susceptibility to minor embryological anomaly. The foreskin is a delicate, busy tissue, in close contact with urine and exposed to sexual secretions and detergents. These congenital and acquired factors can conspire to produce a dysfunctional foreskin, often clinically expressed as male sexual dysfunction in the form of male dyspareunia.