Athena Speciality Certificate Examination case for male genital dermatology

A 42‐year‐old uncircumcised male presents in clinic with a 7‐year history of progressive difficulty in retracting his foreskin, accompanied by soreness, itching and variable redness around the head of his penis (Fig. 1). He mentions occasional splits in the skin at this site and on direct questioning, avoidance of sexual activity on account of pain. He had taken it upon himself to obtain a full sexual health screen, which was reported as negative. ... Which of the following would not be expected upon performing a genital examination? ... ... The patient's history is typical of men with male genital lichen sclerosus (MGLSc). Other symptoms commonly cited include dysuria, disturbance to urinary flow, bruising and bleeding.1 Symptoms develop insidiously, and are frequently attributed to, and treated for, recurrent candidiasis in the early stages. Sexual dysfunction, particularly male dyspareunia, affects the majority of men with MGLSc, but may not be readily volunteered by patients.1, 2 The diagnosis of MGLSc may be made clinically with a high degree of accuracy.3 Biopsy should be reserved for those cases where precancerous or cancerous change is suspected.4 There are many clinical signs, which may indicate the presence of MGLSc, although a meticulous genital examination is required as these may be subtle.