Letters to the Editor

Male Dyspareunia in the Uncircumcised Patient


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Am Fam Physician. 1999 Jul 1;60(1):54-56.

to the editor: Male dyspareunia in the uncircumcised patient often results from balanitis xerotica obliterans (BXO), also known as lichen sclerosus et atrophicus.1

Our patient was a 40-year-old Jewish immigrant from Russia who requested a ritual circumcision on an outpatient basis. He maintained good personal hygiene but had developed dyspareunia. Examination revealed balanitis xerotica obliterans. The glans and mucosa were white, smooth and atrophic, and the meatus showed erosion. Varicose veins were present on the dorsal mucosa of the prepuce. In addition, a very tight frenulum caused a frenular chordee2 (Figure 1).

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FIGURE 1.

Genital balanitis xerotica obliterans that caused male dyspareunia. The glans was white, smooth and atrophic, and erosion was apparent on the meatus. In addition, the very tight frenulum caused a frenular chordee.


FIGURE 1.

Genital balanitis xerotica obliterans that caused male dyspareunia. The glans was white, smooth and atrophic, and erosion was apparent on the meatus. In addition, the very tight frenulum caused a frenular chordee.

BXO is an inflammatory deteriorative condition. The scarring or sclerosis that may result can trigger, among other conditions, phimosis, meatal stenosis, pain on erection1 and male dyspareunia.

BXO is not limited to adults. Children may also have BXO1 and its related condition, posthitis xerotica obliterans3; however, these conditions are often missed.1,2 Circumcision is the treatment of choice.4 Drs. Ledwig and Weigand reported that “we were unable to find a case of lichen sclerosus et atrophicus of the glans or prepuce in a male circumcised in infancy.”1

The Mohel (ritual circumciser) performed the circumcision on the patient in the usual sterile fashion on an outpatient basis (Figure 2). Post-circumcision care consisted of sitz baths, an astringent wet dressing two times per day and applications of A + D ointment six to eight times per day. Treatment was discontinued after one month. The patient's condition improved, and he was able to resume normal marital relations (Figure 3).

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FIGURE 2.

Immediately after the circumcision. Notice that the mucosa too was white, smooth and atrophic. The frenular chordee was resolved with lysis of the frenulum.


FIGURE 2.

Immediately after the circumcision. Notice that the mucosa too was white, smooth and atrophic. The frenular chordee was resolved with lysis of the frenulum.

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FIGURE 3.

One month after circumcision. The condition greatly improved, and the patient resumed normal marital relations.


FIGURE 3.

One month after circumcision. The condition greatly improved, and the patient resumed normal marital relations.

REFERENCES

1. Ledwig PA, Weigand DA. Late circumcision and lichen sclerosus et atrophicus of the penis. J Am Acad Dermatol. 1989;20(2 Pt 1):211–4.

2. Whelan P. Male dyspareunia due to short frenulum: an indication for adult circumcision. Br Med J. 1977;2(6103):1633–4.

3. Weitzner S. Posthitis xerotica obliterans in a 12-year-old boy. Am J Dis Child. 1972;123:68–9.

4. Meffert JJ, Davis BM, Grimwood RE. Lichen sclerosus. J Am Acad Dermatol. 1995;32:393–416.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.



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