Granuloma Inguinale (Donovanosis): Symptoms, Diagnosis & Treatment

Granuloma Inguinale (Donovanosis): Symptoms, Diagnosis & Treatment

pediagenosis    October 01, 2026   

GRANULOMA INGUINALE

Granuloma inguinale (also known as “Donovanosis”) is a sexually transmitted bacterial infection of endemic proportions in many underdeveloped countries. The pathognomic feature of the disease are Donovan bodies on Giemsa or Wright stain, intracellular inclusions representing the causative gram negative Klebsiella granulomatis bacteria that have been engulfed by mononuclear phagocytes. Clinically, granuloma inguinale is characterized by painless genital ulcers that appear 10 to 40 days after contact and that can be mistaken for syphilis. However, unlike syphilis, they can progress to mutilate and destroy tissue and are often superinfected with other pathogenic organisms. The lesions occur in the region of contact, which is typically the penile shaft or perineum, and contain Donovan bodies when the superficial layers of the ulcer are scraped or when stained granulation tissue is examined.

Hormonal Changes During Pregnancy: hCG, Estrogen, Progesterone & Placental Hormones

Hormonal Changes During Pregnancy: hCG, Estrogen, Progesterone & Placental Hormones

pediagenosis    September 04, 2026    Comment   

Plate 12-7

HORMONAL FLUCTUATIONS IN PREGNANCY

In addition to its function as the agent of transfer of gases and nutrients, the placenta also has significant endocrine activity. It produces progesterone, which is important in maintaining the pregnancy; somatomammotropin (also known as placental lactogen), which acts to increase the amount of glucose and lipids in the maternal blood; estrogen; insulin-like growth factors; relaxin; and human chorionic gonadotrophin (β-hCG). This hormonal activity is the main cause of the increased maternal blood glucose levels seen in pregnancy, which results in an increased transfer of glucose and lipids to the fetus.

Testis Descent: How the Testis Descends into the Scrotum and Causes of Cryptorchidism

Testis Descent: How the Testis Descends into the Scrotum and Causes of Cryptorchidism

pediagenosis    August 30, 2026   

DESCENT OF THE TESTIS

The early genital ridge on the posterior wall of the coelomic cavity contains the primordial testis and extends from the sixth thoracic to the second sacral segment. At 8 weeks’ gestation, the testis, lying beneath the mesothelium (primitive peritoneum), becomes an elongated, spindle-shaped organ projecting into the coelomic cavity (future abdominal cavity).

Ejaculatory Disorders: Causes, Types, Symptoms, and Treatment

Ejaculatory Disorders: Causes, Types, Symptoms, and Treatment

pediagenosis    August 28, 2026    Comment   

EJACULATORY DISORDERS

Although commonly viewed as a single event, ejaculation is actually two separate processes, termed emission and ejaculation. During emission, the semen is “loaded” into the prostatic urethral chamber. After this, ejaculation is the forcible expulsion of semen from the penis in a series of spurts caused by rhythmic contractions, about 1 second apart, of the pelvic muscles. Ejaculation is different from orgasm or climax, the latter being an event that is centered in the brain that is closely associated with ejaculation.

Normal Birth: Stages of Labor, Fetal Movements, and Delivery Explained

Normal Birth: Stages of Labor, Fetal Movements, and Delivery Explained

pediagenosis    August 27, 2026    Comment   

CARDINAL MOVEMENTS

NORMAL BIRTH

Labor generally begins between the 38th and 42nd week of gestation. Prior to the onset of labor, physicochemical changes occur in the cervix and are collectively called “ripening.” When this is combined with the increasingly frequent and strong uterine contractions of late pregnancy, the cervix begins the process of effacement. In a proposed self-perpetuating process, effacement of the cervix results in the production and liberation of more prostaglandins, further stimulating uterine contractions (Ferguson reflex). Cervical effacement is common before the onset of true labor.

Uterine Inversion: A Rare but Life-Threatening Obstetric Emergency

Uterine Inversion: A Rare but Life-Threatening Obstetric Emergency

pediagenosis    August 26, 2026    Comment   

UTERINE INVERSION

Rarely, the uterus can be turned inside out immediately following the delivery of the placenta. Uncommon and most often iatrogenic, this may be associated with catastrophic bleeding and cardiovascular collapse. Incomplete uterine inversion may also occur. (Rarely the condition has also been reported in nonpregnant patients with intrauterine pathology such as a pedunculated leiomyomata or large endometrial polyp.) The prevalence of uterine inversion is estimated to be about 1 in 6500 to 25,000 deliveries.

Lymphatic Drainage of Internal Genitalia: Uterus, Ovary, Tube, Cervix & Vagina

Lymphatic Drainage of Internal Genitalia: Uterus, Ovary, Tube, Cervix & Vagina

pediagenosis    August 18, 2026    Comment   

LYMPHATIC DRAINAGE II—INTERNAL GENITALIA

The lymphatics of the uterus are contained within three main networks or plexuses one at the base of the endometrium, another in the myometrium, and a third subperitoneally. No lymphatics, surprisingly, have been detected in the superficial parts of the endometrium. The principal collecting trunks pass outward at the isthmus along the course of the uterine vessels. Drainage from the uterine body and from the cervix is similar, except that, in the region of the fundus, lymphatics are more likely to pass directly along with the ovarian lymphatics to the periaortic nodes. Occasionally, also, lymphatics may extend along the inguinal ligament to the femoral nodes. The number of lymph nodes in the group of parauterine nodes is small; most frequently there is a single node immediately lateral to each side of the cervix and adjacent to the pelvic course of the ureter. Although anatomists frequently do not comment about the parauterine nodes, the group receives special attention in radical surgical operations to treat uterine or cervical malignancy. Primary drainage to this node originates in the vagina, cervix, and uterus. Secondary drainage from this node is to the internal iliac nodes on the same side of the pelvis.

Lymphatic Drainage of the External Genitalia: Inguinal Nodes & Cloquet Node

Lymphatic Drainage of the External Genitalia: Inguinal Nodes & Cloquet Node

pediagenosis    August 17, 2026   

LYMPHATIC DRAINAGE—EXTERNAL GENITALIA

A network of lymphatic anastomoses drains the external genitalia, the lower third of the vagina, and the perineum. Bilateral or crossed extension and drainage is common. The superficial femoral nodes are reached through the superficial external pudendal lymphatic vessels, although the superficial external epigastrics may also play a role. From the region of the clitoris, deeper lymphatic vessels may pass direct to the deep femoral nodes, particularly to Cloquet node in the femoral canal, or through the inguinal canal to the external iliac nodes. Cloquet node is thought to be the sentinel node between the superficial and deep inguinal/obturator lymph nodes. Sometimes, intercalated nodes may be encountered in the prepubic area or at the external inguinal ring. The lowermost portion of the vagina, like the vulva, may drain to the femoral nodes. This complex network of lymph nodes is clinically important, for these are the nodes to which cutaneous and vulvovaginal gland malignancies may drain. Regional lymph node dissections are routinely performed in the surgical treatment of vulvar cancer as the status of regional lymph nodes is essential for therapeutic planning and overall prognosis. Superficial nodes in the groin may also become enlarged when significant inflammation is present in vulvar structures (e.g., Bartholin gland infections).

Innervation of Genitalia and Perineum: Nerves, Scrotal Pain & Bulbospongiosus Reflex

Innervation of Genitalia and Perineum: Nerves, Scrotal Pain & Bulbospongiosus Reflex

pediagenosis    August 17, 2026   

Innervation of Genitalia II and of Perineum

The nerves supplying the anterior scrotal wall are the ilioinguinal and the external spermatic branch of the genitofemoral branch of the lumbar nerves. The superficial perineal branches of the internal pudendal nerve, along with branches from the posterior cutaneous nerves of the thigh, innervate the posterior scrotal wall. The unstriated muscle in the dartos fascia is innervated by fine autonomic fibers that arise from the hypogastric plexus and reach the scrotum along with the blood vessels. Because of this complex innervation from various sources, the entire scrotum is difficult to anesthetize with local anesthesia, unlike the spermatic cord and testicles.

Uterus and Adnexa Anatomy: Uterus, Cervix, Fallopian Tubes and Ovaries

Uterus and Adnexa Anatomy: Uterus, Cervix, Fallopian Tubes and Ovaries

pediagenosis    August 14, 2026    Comment   

UTERUS AND ADNEXA

The uterus is a pear-shaped, thick-walled, hollow, muscular organ situated between the bladder and rectum. The fundus is the dome-shaped portion above the level of entrance of the fallopian tubes. The body, or corpus, lies below this and is separated from the cervix by a slight constriction, termed the isthmus. The cavity of the uterine body is a flattened potential space, triangular in shape. The uterine tubes open into its basal angles. Its apex is continuous with the cervical canal at the internal os. The uterine wall is composed of an outer serosal layer (peritoneum); a firm, thick, intermediate coat of smooth muscle (myometrium); and an inner mucosal lining (endometrium).

Male Pseudohermaphroditism (46,XY DSD): Causes, Symptoms, Diagnosis, Treatment & Gonadal Disorders

Male Pseudohermaphroditism (46,XY DSD): Causes, Symptoms, Diagnosis, Treatment & Gonadal Disorders

pediagenosis    August 07, 2026   

INTERSEX: MALE PSEUDOHERMAPHRODITISM I GONADAL

The pseudohermaphrodite is an individual with the gonads of only one sex but with genitalia (internal and external) and secondary sex characters exhibiting sexual ambiguity. Such a simple classification of intersex is based purely on phenotype or morphology, without regard to genetic etiology. Factors that contribute to such disordered development include (1) gene mutations, (2) abnormal maternal hormonal influences, and (3) abnormal hormonal influences from the embryonic gonad, adrenal, or other endocrine organ. The type and degree of disordered development depend on the intensity and timing of these influences during embryonic life.

Scrotal Wall Anatomy: Layers, Structure, Functions, Embryology & Clinical Significance

Scrotal Wall Anatomy: Layers, Structure, Functions, Embryology & Clinical Significance

pediagenosis    August 07, 2026   

SCROTAL WALL

The testicles are maintained in position within the scrotal cavity by the structures of the spermatic cord. Each testicle and spermatic cord is invested in six distinct tissue layers that are acquired as a result of the descent of the gonads from the retroperitoneum into the scrotum during fetal life.

SYPHILIS

SYPHILIS

pediagenosis    July 19, 2026   

SYPHILIS

The scrotal skin is not an uncommon site for a primary syphilitic lesion. The primary stage of syphilis is marked by the appearance of a single sore (chancre), approximately 21 days after exposure. The chancre is usually firm, round, small, and painless, lasts 3 to 6 weeks, and heals without treatment. Regardless of location, the syphilitic chancre is grossly the same (see Plate 2-23). It may occur at the penoscrotal junction with barrier contraceptives. Lesions of the scrotum, however, are much more common in later forms of syphilis, especially during early and late relapses. They appear during relapse within the first 2 years but have been observed many years later as well. Anogenital cutaneous relapse occurs in 40% of cases and scrotal lesions occur in 25% of relapsing cases.

Pelvic and Prostatic Trauma: Causes, Symptoms, Diagnosis, and Management of Posterior Urethral Injury

Pelvic and Prostatic Trauma: Causes, Symptoms, Diagnosis, and Management of Posterior Urethral Injury

pediagenosis    July 09, 2026    Comment   

PELVIC AND PROSTATIC TRAUMA

Penetrating trauma to the prostate gland is rare as it is protected from penetrating objects by the surrounding bony pelvis. However, penetrating injury to the prostate is possible from broken pelvic bones as a consequence of pelvic fracture. The real concern with prostatic trauma, however, involves injury to the posterior and prostatomembranous urethra that lie superior to the urogenital diaphragm. This is most commonly a consequence of forceful blunt trauma to the pelvis.

Breast Development Stages: Tanner Stages, Puberty Changes, and Normal Growth in Girls

Breast Development Stages: Tanner Stages, Puberty Changes, and Normal Growth in Girls

pediagenosis    July 09, 2026    Comment   

THE BREAST  DEVELOPMENTAL STAGES

In a human new born at birth, in the female as well as in the male, the mammary glands have developed sufficiently so that they appear as distinct hemispheroidal elevations, palpable as movable soft masses. This is especially prominent in postterm infants. Histologically, a number of branching channels with layers of lining cells and plugs of basal cells at their ends, the future milk ducts and glandular lobules, respectively, can easily be recognized. In a great number of infants an everted nipple is observed, and in about 10% a greatly enlarged gland can be palpated, a condition that received the unfortunate name of mastitis neonatorum, though no signs of inflammation exist. These early glandular structures may produce a milk like secretion, the “witch’s milk,” starting 2 or 3 days after birth. All these neonatal phenomena in the breast are the result of the very intensive, maternal estrogen driven developmental processes in the last stages of intrauterine life. The changes subside within the first 2 to 3 weeks of life. It is during this period that the breast undergoes marked involutional changes leading to the quiescent stage, which is characteristic of infancy and childhood. During these periods, the male and the female glands consist of a few branching rudimentary ducts lined by flattened epithelium, surrounded by collagenous connective tissue.

Rare Urethral Abnormalities: Causes of Difficult Urination, Recurrent UTIs, and Urethral Diverticulum

Rare Urethral Abnormalities: Causes of Difficult Urination, Recurrent UTIs, and Urethral Diverticulum

pediagenosis    June 13, 2026   

URETHRAL ANOMALIES, VERUMONTANUM DISORDERS

Diverticula are outpouchings of the urethral lumen that occur in both the anterior and posterior urethra. They may be congenital or acquired. The congenital variety, usually located in the penile urethra, is more frequent. Diverticula are further divided into true and false (pseudodiverticula) forms. The true diverticulum is generally congenital in origin and has a mucous membrane lining continuous with that of the urethra, whereas the wall of the false type is initially an unlined pouch as a result of a neoplastic or inflammatory process. Destruction of the mucosal lining of a true diverticulum by inflammation may render the two types indistinguishable. A false, acquired diverticulum may become epithelialized following surgical drainage of a periurethral abscess and may be interpreted as a true variety. Acquired diverticula are frequently observed in spinal cord injury patients who develop painless, undetected periurethral abscesses from chronic urethral catheters. These are “false” at the onset but appear “true” after epithelialization. Acquired pseudodiverticula are frequently found in the posterior urethra following instrumental trauma, whereas congenital diverticula are almost always located on the ventral wall of the anterior urethra.

TRAUMA TO PENIS AND URETHRA

TRAUMA TO PENIS AND URETHRA

pediagenosis    April 25, 2025   

TRAUMA TO PENIS AND URETHRA

Beneath the deep layer of Colles fascia and Buck fascia (see Plate 2-4), the paired corpora cavernosal bodies of the penis are encased in a thick tunica albuginea layer. Rupture of the corpora cavernosa is rare but is encountered from direct trauma or penile fracture from vigorous intercourse or with the use of devices. Rupture of the tunica albuginea usually includes rupture of Buck fascia see Plate 2-4), in which case the penis quickly swells as a result of extravasation of blood. Early surgical repair of the ruptured tunica albuginea may prevent thrombosis and subsequent fibrosis of the erectile tissue with consequent erectile dysfunction.

CYSTS AND CANCER OF THE SCROTUM

CYSTS AND CANCER OF THE SCROTUM

pediagenosis    April 20, 2025   

CYSTS AND CANCER OF THE SCROTUM

Sebaceous cysts (epidermoid, epidermal cysts) of the scrotal wall are not uncommon. Derived from sebaceous glands in the skin, cysts form either from over-production of secretions or as a result of obstruction of the gland outlet. These cysts, usually scrotal, appear as smooth, round cystic tumors, varying in size from a few millimeters to, in rare instances, 8 to 12 cm. Although usually solitary or few in number, the occurrence of several hundred cysts has been described. The secretions contain cholesterol crystals and degenerated epithelial cells, and the fibrous cyst capsule is lined by stratified squamous epithelium with varying degrees of atrophy. Trichilemmal cysts (pilar cysts) are clinically indistinguishable from sebaceous cysts but contain keratinous rather than sebaceous material. Regarding the cyst type, inflammation is common in the obstructed duct and can lead to infection and pain. Sebaceous cysts are not precancerous but have been known to calcify. Definitive treatment is surgical excision, best performed after infection has been quelled with antibiotics. With excision, the entire epithelial sac that lines the cyst must be removed to avoid recurrence.

Delayed Or Absent Puberty

Delayed Or Absent Puberty

pediagenosis    November 19, 2024    Comment   

Delayed Or Absent Puberty

Delayed puberty is defined as the absence of secondary sexual characteristics at age 13 in girls and 16 in boys (Chapters 11 and 12). It may result from: (i) a nonpathologic constitutional delay accompanying a growth delay; (ii) disorders of the hypothalamus or pituitary gland that result in inadequate gonadotropin secretion (hypogonadotropic hypogonadism); and (iii) disorders of the gonads that prevent adequate sex steroid secretion (hypergonadotropic hypogonadism) (Table 29.1). In girls, secondary sexual characteristics may develop without progression to menarche. This form of pubertal dysfunction and other causes of primary amenorrhoea are discussed in Chapter 30. It is important to diagnose and treat delayed or absent puberty because: (i) serious underlying conditions may be present; (ii) abnormal persistence of a child-like phenotype has profound social implications for the teenager and young adult; (iii) prolonged absence of gonadal steroid exposure leads to osteopenia, a failure of normal bone formation. Osteopenia is associated with an increased risk of fractures in weight-bearing bones such as vertebrae, hips and long bones. Treatment of delayed or absent puberty aims to correct underlying disorders. Hormone replacement with estrogen/progesterone or testosterone is often required if hypogonadism is prolonged or age-appropriate sex steroid secretion patterns cannot be restored.

INTERSEX FEMALE PSEUDOHERMAPHRODITISM

INTERSEX FEMALE PSEUDOHERMAPHRODITISM

pediagenosis    September 30, 2023   

INTERSEX: FEMALE PSEUDOHERMAPHRODITISM

A female pseudohermaphrodite is an individual with ovaries but whose external genitalia have a male appearance. This disorder of sexual development usually results from hormonal disturbances. The maternal use of androgens or high doses of certain weakly androgenic synthetic progestogens (progestins) can masculinize or virilize the fetal female external genitalia during susceptible times in pregnancy. An example of a weakly androgenic substance is the sex steroid danazol, a derivative of ethisterone (17α-ethinyl-testosterone) that is used to treat severe endometriosis. Progestogens currently used for luteal support of pregnancy in in vitro fertilization (IVF) protocols or for prevention of preterm birth are progesterone, 17α-hydroxyprogesterone caproate, and dydrogesterone. Along with clitoral enlargement (clitoromegaly), some degree of fusion of the urogenital folds can occur with exposure from the 8th through the 12th week of gestation. This can present as ambiguous genitalia at birth. If exposure occurs after the 12th gestational week, then only clitoral enlargement occurs. Females with clitoral enlargement mature normally and have normal fertility, as there is almost total regression of the genital anomaly. Surgical correction of labioscrotal fusion is also a relatively simple procedure if needed. A much rarer cause of clitoromegaly is Fraser syndrome, characterized by defects including underdevelopment of the eyes (cryptophthalmos) and linked to the gene FRAS1, which may be involved in skin epithelial morphogenesis.