Male Genital Anomalies

The incidence of male genital anomalies is lower than for female genital anomalies. However, an exact level is difficult to define because of limited and contradictory literature. Hoekstra et al. recorded all of the genitourinary anomalies associated with ARM in 150 children [30]. The genital anomalies in boys were relatively uncommon and mainly of little significance, especially when considering sexual function in later life (Table 36.3).

In a later series, the incidence of genital anomalies was identical, but the pattern was very different. The commonest was ambiguous genitalia and the gender of rearing may not have corresponded to the genotype. Cho et al. recorded 16 anomalies in 69 boys (23%), assuming all of those with ambiguous genitalia were male (Table 36.4) [31]. It would seem, therefore, that there is a wide range of possible genital anomalies in boys, many of which would have little impact on future sexuality or fertility.

Although spinal cord anomalies have a major impact on sexual function in both genders, it tends to be more severe in males, at least in those born with my-elodysplasia. There is a high incidence of neurovesical dysfunction in children with ARM. The main cause is

Table 36.3 Genital anomalies in 80 boys born with ARM [30]

Genital anomalies (n = 8C)

Number

Hypospadias

10

Scrotal deformity

3

Penile duplication

2

Cryptorchidism

2

Micropenis

1

Total

18 (23%)

Table 36.4 Genital anomalies in

male children born with

ARM. Data from Cho et al. [31]

Genital anomaly (n = 69)

Number

Ambiguous genitalia

7

Cryptorchidism

s

Bifid scrotum

4

Total

16 (23%)

Adult Sexual Breast Vagina

Urethra Site of vagina

Anal pull through

Fig. 36.4 Clinical photograph of an adult female born with anorectal and vaginal agenesis

Newly Born Girl Vagina Abnormality

Speculum

Ileal vagina Introitos

Fig. 36.5 Clinical photograph of a vagina constructed from the ileum in a woman born with anorectal agenesis. The appearance is good, but persistent coital haemorrhage has been a severe impediment to regular intercourse the associated spinal abnormalities, especially hemi-vertebrae. The reconstructive surgery probably has little additional effect. The bladder problem is usually an upper motor neurone hyperreflexia due to lumbosacral anomalies. In a review of the literature, 29% of those with a high ARM and 6% with a low anomaly had urinary incontinence [32]. If an analogy can be drawn with the general myelodysplasia population, the impact on potency may not be great, especially if the neurological lesion is incomplete. All males with myelodysplasia with intact sacral reflexes and urinary continence are potent. With absent sacral reflexes, 64% with levels below D10 and 14% with levels above D10 are potent [33]. As most of those with ARM and neuropathy have a level well below D10, few should be impotent.

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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