KEYWORDS:Bowen's disease of the penis, Bowen oid papulosis, circumcision, dysesthesia s y ndrom es, dy sf unct ional f oreskin, erosive lichen planus, erythroplasia of Queyrat, lichen sclerosus, male d ys pare unia, nons peci fic b a l a n o p o st h i t i s, s q u a m o u s carcinoma, Zoon's balanitis M al e g en i t al de r m at ol o gy h a s b een a n eg l ec te d f i el d . M e n w i th ge n i ta l s k i n p ro b l em s ca n p re s en t t o d o ct or s (e .g ., i n u ro l og y or g e n i to u r i n a r y m ed i c i n e) w h o ar e n ot t r ai n e d or experienced in their diagnosis and management. The pathogenesis, epidemiology, n a tu r a l h i s t or y an d p r og n os i s o f m a n y m a l e g en i t al de r m at os e s -Z oo n 's b al an i t i s , er os i v e lichen planus, lichen sclerosus, nonspecific balanoposthitis, dysesthesia syndromes and ca r ci n o m a in situ -are ill-understood and treatment is not eviden ce-based. Althou gh penis cancer is rare, it should be preventable or diagnosable at an early stage, thus reducin g morbidity and mortality. Th e guiding ideology behind diagnosi s 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. T h er e i s w i d e n or m al va r i at i on i n th e a n a to my o f t h e pe n i s a n d i ts r e l at i on s h i p t o th e p r ep u ce , pe rh ap s r ef l ect i n g s u s ce pt i b i l i ty to m i n o r em b r y ol o g i ca l a n om a l y. T h e for es k i n i s a de l i c at e, b u sy ti s s u e, i n cl o se c on t ac t w i thu r i n e and exposed to sexual secretions and detergents. These congenital and acquired factors can conspire to produce a dysfu nctional foreskin, often clinically expressed as male sexual dysfunction in the form of male dyspareunia.Expert Rev. Dermatol. 1(2), 24 1-26 0 (2006 )