Dorsal perforation of prepuce: a common end point of severe ulcerative genital diseases?

Severe ulcerative genital diseases can cause destruction of the prepuce, glans, or sometimes of the whole penis (phagedena). We observed a characteristic pattern of partial destruction of the prepuce as a result of a wide variety of ulcerative genital diseases. Five patients, two with severe genital herpes, one with hidradenitis suppurativa, and two with donovanosis presented with perforation on the dorsal surface of the prepuce. In four of them, the glans protruded through the defect and in one, the defect was not large enough to allow protrusion of the glans. In two patients, the preputial sac was obliterated. The relatively decreased blood supply of the prepuce is the probable explanation for perforation at this selective site.