The medical specialty of dermatology diagnoses and treats conditions affecting the skin, hair, and nails across the body. Since the genital area is covered by skin and mucous membranes, examining and treating this region is within a dermatologist’s scope of practice. Dermatological conditions can manifest anywhere, and the skin of the genitals is susceptible to the same range of inflammatory, infectious, and cancerous processes as skin on other body parts. Patients may feel anxious about this examination, given the sensitive nature of the area. Dermatologists are specifically trained to perform these examinations professionally and with respect for patient comfort and privacy.
When the Genital Examination is Necessary
The decision to examine the genital area typically falls into one of two primary scenarios. The first is during a comprehensive total-body skin examination (TBSE), a screening procedure for skin cancers and other conditions. Skin cancer, including melanoma, can develop anywhere, even in areas rarely exposed to the sun, making a thorough inspection of the genital region relevant for complete screening. Approximately 5% of melanomas occur in the genital area and are often diagnosed late because they are frequently overlooked during self-examinations.
The American Academy of Dermatology recommends inspecting the entire skin surface, including the genital area, as part of a complete TBSE. The second, more common scenario is a focused examination driven by a specific patient complaint. This occurs when a person presents with a symptom like a rash, persistent itching, pain, or a suspicious growth in the genital or perianal region.
In these cases, the genital examination is a direct diagnostic necessity to investigate the reported problem, rather than a general screening measure. If a patient declines this part of the examination, the dermatologist may suggest that another provider, such as a gynecologist or urologist, routinely examine the area to ensure comprehensive care is received.
Conditions Dermatologists Diagnose in the Genital Area
Inflammatory Conditions
Dermatologists treat a wide array of conditions affecting the genital skin. Inflammatory conditions are common, such as eczema (dermatitis due to localized irritation) or psoriasis (often debilitating in intertriginous areas). Lichen sclerosus is a specific and serious inflammatory condition that causes ivory-white patches and can lead to scarring and an increased risk of malignancy if left untreated.
Infectious Conditions
Infectious causes are frequently seen, encompassing viral issues like human papillomavirus (HPV) leading to genital warts, or molluscum contagiosum (small, firm papules). Fungal infections like candidiasis (thrush) cause a bright red, itchy rash, while bacterial infections like hidradenitis suppurativa cause painful, boil-like lumps. Sexually transmitted infections, including herpes and syphilis, also produce skin lesions.
Malignancies
Malignancies, though rare, can occur, including melanoma, which is often associated with aggressive courses and poorer outcomes when found on the genitals. Dermatologists also diagnose and treat Squamous cell carcinoma and its precursor, vulval intraepithelial neoplasia (VIN), often requiring a skin biopsy. The skin on the genitals reacts differently to disease than skin elsewhere; for example, lichen planus can present with severe ulcerations and erosions in this area, unlike the typical purple papules seen elsewhere.
Patient Rights and Procedural Expectations During the Exam
The examination of the genital area is considered a sensitive procedure, and patient autonomy and dignity are prioritized throughout the process. Before any examination begins, the dermatologist must explain the nature and necessity of the examination, and the patient must agree to it. This consent is dynamic, meaning the patient retains the right to withdraw consent and stop the examination at any time, even after it has started.
Standard procedure mandates that the patient be treated with respect and dignity, with appropriate privacy maintained at all times. This includes minimizing body exposure through the use of drapes or gowns, only uncovering the specific area that needs inspection. Patients have the right to request a chaperone to be present during the examination, which is often a required policy for the protection and comfort of both the patient and the clinician.
The patient may also request a clinician of their own gender, although this may not always be logistically possible depending on clinic staffing. The dermatologist will explain what they are doing and observing during the procedure, ensuring the patient feels safe and has control over the process. This professional approach helps alleviate anxiety and ensures the examination is conducted effectively.