Genital Discomfort and Changes: Possible Causes

In many cases, complaints in the genital area are caused by bacteria, fungi or viruses, some of which can be transmitted during sex

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Itching (pruritus), pain or swelling in the genital organs, as well as a burning sensation when urinating (alguria) and discharge from the vagina or discharge from the urethra, can have many different causes. The symptoms are often caused by bacteria, viruses or fungi - often transmitted through sexual contact. But skin diseases, hormonal disorders or cancer or precursors thereof can also make themselves felt with complaints in the genital area. Other possible causes are malformations (for example a cleft urethra), injuries or irritation, for example due to excessive friction.

A doctor should always clarify complaints in the genital area. In addition to the family doctor, the urologist, the gynecologist and the dermatologist are competent contacts for this. Prompt treatment is particularly important for sexually transmitted diseases because they are usually contagious and, without adequate therapy, can have serious long-term effects, such as infertility or cancer. For some diseases - for example testicular torsion or priapism (painful permanent erection) - emergency treatment is necessary.

The following overview only offers a selection of the most important causes of genital complaints. It is not complete and should not be understood as a guide to self-diagnosis. Only the doctor can make the diagnosis.

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Possible causes of genital discomfort in both sexes

Chlamydial infection: Chlamydial infections are among the most common sexually transmitted diseases. The pathogens are mostly Chlamydia trachomatis bacteria. In many cases - especially in women - the infection is symptom-free, so that infected people can unknowingly transmit the pathogen to their partner. If there are any side effects, then above all itching, burning sensation when urinating and discharge. If a chlamydial infection remains undetected, it can spread to other organs (prostate, epididymis; cervix, uterine lining) and render them sterile.

Gonorrhea (gonorrhea): mostly sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae. Typical symptoms in men are inflammation of the urethra (urethritis), pain and burning sensation when urinating, and purulent discharge from the urethra. In women, the infection usually goes unnoticed at first, sometimes the urethra or cervix become inflamed. However, ascending bacteria can infect the internal genital organs and cause inflammation of the fallopian tubes (salpingitis), ovaries (oophoritis) or uterine lining (endometritis).

Syphilis (Lues, Lues venera): A predominantly sexually transmitted disease - caused by the bacterium Treponema pallidum. It can be effectively combated with penicillin (or other antibiotics). In the initial stage, an ulcer typically forms on the penis or vagina, but this does not cause pain; the neighboring lymph nodes swell. If syphilis is not treated, it can lead to severe organ damage after years; in the final stage, the central nervous system is attacked and destroyed.

Genital herpes (herpes genitalis): For the most part caused by herpes simplex viruses of type 2 (HSV 2), but type 1 (pathogen causing cold sores) can also be the cause. Genital herpes is one of the sexually transmitted diseases. Symptoms are itching and burning in the genital area (also on the anus and buttocks), later groups of vesicles that are filled with fluid form in the affected regions, after a while they dry up to form crusts and finally heal. The inguinal lymph nodes may be swollen. However, since the viruses remain in the body after the symptoms disappear, the disease can recur at any time.

Genital warts (Condylomata acuminata): Infection of the genitals (possibly also anus) with the human papilloma virus (HPV). Here, too, the transmission route is sexual contact. Most HPV infections are symptom-free. If genital warts develop, whereby nodules develop into warty structures, then this can only happen weeks after the infection, sometimes even months. They are mostly located on the penis shaft (men) and the labia (women).

Urinary tract infections: Due to their shorter urethra, through which pathogens (mostly Escherichia coli) can more easily enter the urinary tract, women are more likely to be affected by urinary tract infections than men. Symptoms in the genital area (pain / burning sensation when urinating, itching, discharge) are caused by an inflammation of the urethra or bladder.

Trichomoniasis: Inflammation of the vagina and urethra (women) or just urethra (men) caused by parasites (Trichomonas vaginalis). In women, itching occurs on an often red and swollen vagina. In addition, there is a foamy, unpleasant smelling discharge, often also a burning sensation when urinating. Men usually have no complaints.

Eczema: Non-contagious skin diseases can appear in different forms in the genital area, for example as itchy, oozing, blistering or flaky eczema. They also differ in their localization (generalized or limited to individual regions) and extent (small spots, large spots, sharply defined, blurred).

Fungal diseases (mycoses): Fungal infections in the genital area are primarily caused by the yeast Candida albicans. Candida mycoses of the female genital organs mainly affect the vulva and vagina. They are accompanied by itching, burning sensation when urinating, swelling, redness and discharge. In men, the infection manifests itself as balanitis, an inflammation of the glans with itching and reddening. Changes in the skin (papules), whitish deposits and swelling of the foreskin can also occur.

Lichen sclerosus et atropicus: The cause of this skin and mucous membrane disease is not known. In the genital area it initially causes burning and itching, later itchy nodules and whitish skin changes appear that harden over time. In women, the labia, vaginal entrance, perineum and anus are typically affected, in men the glans and foreskin.

Cancer: In women, vulvar carcinoma should be mentioned here (symptoms: itching in the genital area, ulcers and lumps on the labia, secretion, sores, possibly genital warts), in men testicular tumors and penile carcinoma. Testicular cancer mainly affects younger men (20–45 years of age). The main symptom, which is noticeable relatively early on palpation, is usually unilateral swelling or hardening of the testicles. Penile cancer usually develops slowly. Swelling and inflammatory changes in the glans and foreskin can be the first visible and noticeable signs. Later, the lymph nodes in the groin enlarge.

Erythroplasia - triggered by the human papilloma virus (HPV) - is a precancerous stage (precancerosis) of the genitals that occurs in men (penis, glans, foreskin) and women (labia); Oral mucosa and anal region can also be affected. Symptoms are sharply demarcated, large reddish spots that usually do not cause any further symptoms. Skin cancer can develop from untreated erythroplasia.

Possible causes of genital discomfort in women

Bacterial vaginosis (Gardnerella vaginosis / amine colpitis / unspecific colpitis): They can arise when the balance of the protective vaginal flora, which mainly consists of lactic acid bacteria (lactobacilli), is disturbed. Other bacteria - often Gardnerella vaginalis and anaerobic bacteria - then become overweight, which often leads to a white or yellowish discharge and (not always) to an unpleasant, fishy odor in the vaginal region.

Hormonal disorders: The main thing to be mentioned here is the lack of estrogen that occurs during menopause, which causes the vaginal mucous membranes to dry out, which can lead to itching.

Possible causes of genital discomfort in men

Balanitis: Inflammation of the glans penis and / or the foreskin (posthitis) of the male member, which can be caused by bacteria, viruses, fungi or mechanical stimuli. Depending on the cause, different skin changes occur on the glans, usually accompanied by itching and pain.

Prostate inflammation (prostatitis): Bacteria, which mostly enter the prostate via the urethra, are the cause of acute bacterial prostatitis. It is usually accompanied by a high fever, strong and frequent urination, difficult and painful urination (dysuria, alguria), burning sensation in the urethra and discharge. Other signs are an urge to defecate and pain when defecating.

Inflammation of the testicles (orchitis): Can occur as part of other infections when pathogens - mostly viruses - get into the testicular tissue via the blood or lymphatic system or urinary tract. Possible "trigger" diseases are, for example, mumps, chickenpox and Pfeiffer's glandular fever. Symptoms include swollen and sore testicles, reddening of the scrotum, frequent urination, and fever.

Inflammation of the epididymis (epididymitis): infection usually caused by bacteria or viruses, which in the course often also leads to inflammation of the testicles. Typical signs of inflammation of the epididymis are painful swelling of the testicles, reddening of the skin on the scrotum, fever, chills, and pain and burning when urinating.

Changes and abnormalities in the penis: The foreskin constriction (phimosis, paraphimosis), penile fibromatosis and priapism (permanent erection) should be mentioned here. In the case of phimosis, the foreskin cannot be pulled back over the glans. This is still normal in childhood and early adolescence, and pathological phimosis in adults must be treated. An acute emergency here is paraphimosis, in which a forcefully retracted foreskin cuts off the blood supply to the glans.

With penile fibromatosis (penis bones), the penis hardens due to a pathological overgrowth of connective tissue, which can lead to problems during sexual intercourse.

Priapism is also an emergency that must be treated immediately to avoid permanent dysfunction.

Testicular changes and abnormalities: In testicular torsion, a testicle is twisted, causing sudden pain that radiates into the groin. The affected testicle is red and swollen. Testicular torsion is a medical emergency because the damage endangers fertility.

Undescended testicles in babies, in which one testicle has not yet descended into the scrotum, almost always requires treatment in order to prevent testicular cancer and fertility problems.

Swelling in the testicles, which is associated with pain, can also be due to a varicose vein hernia (varicocele) or a water rupture (hydrocele). If nausea, vomiting and abdominal pain are added, it can also be a pinched inguinal hernia that needs to be operated on immediately.

Important note: This article contains general information only and should not be used for self-diagnosis or self-treatment. It cannot replace medical advice. Please understand that we do not answer individual questions.