Non-venereal genital disorders comprise a heterogeneous group of inflammatory, infectious (non-sexually transmitted), autoimmune, congenital and neoplastic conditions that affect the external genitalia in both sexes. Although genital symptoms commonly raise concern for sexually transmitted infections (STIs), a substantial proportion of genital complaints are due to conditions that are not sexually transmitted — examples include lichen simplex chronicus, psoriasis, vitiligo, fixed drug eruption, pearly penile papules, vestibular papillomatosis, and certain fungal or parasitic infections such as scabies localized to the genital area. Recognising these entities correctly is essential because misclassification as venereal disease produces unnecessary psychological distress (including venereophobia), leads to inappropriate treatment, and can delay the correct management pathway¹.

Epidemiological studies from tertiary care centres worldwide and from India indicate that non-venereal genital dermatoses are common among patients presenting with genital complaints, often outnumbering venereal causes in dermatology and vulvar clinics. Several hospital-based cross-sectional studies report that non-venereal conditions account for the majority of genital dermatoses seen in routine practice, with prevalence estimates in clinic populations varying by setting, study design and inclusion criteria. Spectrum and relative frequencies vary: some series identify scabies, pigmentary disorders (e.g., vitiligo), and lichen simplex chronicus as frequent diagnoses, while others report a high relative frequency of inflammatory dermatoses, fungal infections or drug eruptions depending on the population studied. These variations underline the importance of local, context-specific data from tertiary centres, which serve as referral hubs and thus reflect both common presentations and more complex or atypical disease².

Multiple factors contribute to under-reporting and delayed presentation of non-venereal genital conditions. Cultural stigma, embarrassment, limited awareness among patients that genital symptoms may be non-sexual in origin, and variable health-seeking behaviour all suppress early clinic attendance. In women, vulvar complaints are often under-recognised both by patients and by primary care providers, resulting in lower recorded prevalence despite potentially high community burden. In men, conversely, some clinic series show a male preponderance for non-venereal genital dermatoses, which may reflect differences in disease biology, presentation, or health-seeking patterns. These sociocultural and sex-specific dynamics complicate epidemiological interpretation and necessitate careful sociodemographic data collection in hospital studies³.

Diagnostic challenges are common in genital dermatology. Lesions that are benign and non-infectious may mimic sexually-transmitted infections clinically (for example, vestibular papillomatosis vs condyloma acuminata; pearly penile papules vs genital warts), and conversely, atypical presentations of STIs can be mistaken for non-venereal dermatoses. Diagnostic tools such as dermoscopy, careful history (including medication and allergy history), targeted laboratory tests, and, where indicated, biopsy, improve diagnostic accuracy. Recent studies emphasise the utility of dermoscopy in differentiating benign genital papules and inflammatory dermatoses, reducing unnecessary anxiety and treatment. Tertiary centres, with access to diagnostic aids and multidisciplinary input, are well placed to characterise the local pattern of disease and recommend practical diagnostic algorithms⁴.

Beyond diagnostic and therapeutic implications, non-venereal genital disorders carry significant psychosocial and quality-of-life impacts. Cross-sectional evidence shows measurable reductions in quality-of-life metrics among affected patients; complaints such as pruritus, pain, dyspareunia, and visible lesions often lead to sexual dysfunction, relationship stress, and mental health sequelae. These downstream effects provide a public-health rationale for systematic study: understanding clinical patterns, age and sex distribution, seasonal or occupational associations, comorbidities, and common misdiagnoses in a tertiary hospital setting will inform targeted education for clinicians and the public, reduce stigma, and guide allocation of diagnostic and therapeutic resources⁵.

Rationale and objectives. Despite several hospital-based series, gaps remain: many studies are single-centre, vary in inclusion criteria (male vs female, paediatric inclusion, infectious vs non-infectious), and differ in diagnostic rigor. Few recent studies comprehensively correlate clinical patterns with epidemiological variables such as age, occupation, comorbidities, prior treatments, and impact on quality of life in the same cohort⁶. A well-designed tertiary-centre study thus has value in (1) documenting the contemporary pattern of non-venereal genital disorders in the local population, (2) identifying common diagnostic pitfalls and referral pathways, (3) quantifying quality-of-life impact, and (4) suggesting context-appropriate clinical algorithms to reduce misdiagnosis and unnecessary STI workups. The present study aims to fill these gaps by providing a systematic clinical and epidemiological description of non-venereal genital disorders presenting to a tertiary care hospital, and by highlighting actionable recommendations for clinical practice.

 OBJECTIVES:  

To determine clinical and epidemiological pattern of non-venereal genital conditions that present as

1. a) genital lesions alone,
2. b) genital and skin lesions,
3. c) oro-genital lesions and
4. d) oro-genital and skin lesions in both males and females

Study Design: Hospital based descriptive study.    

Study area:  The study was conducted in Department of DVL, MNR medical college and Hospital, Fasalwadi, Sangareddy.

Study Period: 1 year.     

Study population: Patients from OPD and IP admitted into the hospital.

Sample size: The study consisted of a total of 200 cases.

Sampling Technique:  Simple random sampling.    

Inclusion Criteria: Patients with the non-venereal lesions of genital, genital and skin, oral-genital and concurrent oro-genital and skin manifestations are included in the study. Some venereal conditions which were transmitted through non- venereal route were included. 

Exclusion criteria: Cases having any venereal diseases were excluded from the study.

Ethical consideration: Institutional Ethical committee permission was taken before the commencement of the study.

Study tools and Data collection procedure:

For the study detailed history including the age, occupation, duration of the disease and the site of affection and history of exposure was taken. Physical examination was done to see any associated lesions elsewhere in the body. Investigations like KOH mount, Gram’s stain, biopsy, histopathological examination and Direct immunofluresence was done where ever it is required to establish the diagnosis. The patients satisfying the inclusion and exclusion criterion as mentioned were taken for the study after an informed written consent. The study included 200 patients of both sexes presenting with genital lesions, oro-genital lesions, genital and skin lesions and oro-genital and skin lesions of non-venereal conditions presenting over a period of 1 year. Data was collected from the selected subjects by recording relevant patient details and a thorough general, systemic and dermatological examination. A proforma was prepared to record the relevant details of the patient, examination, investigation results and the diagnosis. Disease wise comparison was done for both sexes. The data was finally tabulated and analyzed. Microsoft word and Excel have been used to generate tables and graphs.

Prevalence:  The prevalence of non-venereal genital lesion during the period was found to be 6.1 per 1000 patients attending Dermatology department.

Age and sex distribution: The age ranged from 8 months to 77 years with the mean age of 34.80 years and median age of 34 years. Majority of the patients were in the age group of 21-30 (32%) followed by 31-40 (24%).

The age among the male population ranged from 5 years to 77 years while that of female ranged from 8 months to 65 years with the mean age of 35.13 years and 33.92 years respectively. The median age of male was 32 years where as that of female was 38 years. The majority of patients were in the age group of 21-30 years (53 patients) and 31-40 years (14 patients) for male and female patients respectively in the study group. The male: female ratio in the study population was 2.28:1.

Occupational Status:

The majority of the patients were laborers 69 (34.5%) followed by house wives 48 (24%), retired 36 (18%), students 30 (15%) and farmers 7 (3.5%).

Table 1. Classification of non-venereal genital lesions based on sites of involvement

The non-venereal genital lesions were grouped in to four groups according to the involvement of sites affected as genital, oro-genital, genital and skin and concurrent oro- genital and skin lesions. In this study genital alone comprised of 141 (70.5%) accounting for the majority followed by genital and skin in 33 (16.5%), oro-genital and skin in 14 (7%) and oro-genital in 12 (6%). Involvement of genitalia alone was found to be significantly higher than other groups.

Table 2. Distribution of non-venereal lesions involving only genitalia

Among the non-venereal conditions those involved only genitalia majority was constituted by pearly penile papules in 32 patients (18.93%), followed by genital vitiligo in 23 (13.60%) and lichen simplex chronicus in 15 (8.87%). A similar pattern was seen for involvement of male genitalia, whereas genital vitiligo in 7 (20.58%) and candidiasis in 5 (14.7%) were seen as predominant among female genital involvement.

Table 3. Distribution of non-venereal lesions involving genitalia and skin

Of the 33 pateints with lesions involving genitalia with skin 31 (93.93%) were male. Scabies was the predominant disease involved in male with 14 (45.16%) cases, where as one case each of molluscum contagiosum (auto inoculation) and vitiligo were seen among female study population.

Lesions involving oro-genital involvement was predominantly included vitiligo in 6 patients (50%) followed by lichen planus in 2 (16.66%) and fixed drug eruption in 2 (16.66%). Among the male study population oro-genital involvement vitiligo was seen in 4 (57.10%) patients, fixed drug eruption in 2 (28.57%) and one case (14.28%) of lichen planus. 2 patients with vitiligo and one each with candidiasis, lichen planus and pemphigus vulgaris were seen among female patients.

Only 14 patients were found to have concurrent oro-genital and skin involvement of which 8 (57.14%) cases of vitiligo, lichen planus in 3 (21.42%), drug reaction in 3 (21.42%) and one case of disseminated eczema were observed. Among the male study population vitligo in 6 (54.54%) and lichen planus in 3 (27.17%) were predominant whereas 2 (66.66%) cases of vitiligo and one case of toxic epidermal necrolysis were observed among female group.

Table 4. Distribution of non-venereal genital lesions based on etiology

* Number of diseases is more than number of patients since few patients had more than one non venereal lesion

In this study, a total of 34 different types non-venereal genital diseases were studied which are broadly classified in to benign conditions including normal variants, inflammatory conditions, infections and infestations and miscellaneous diseases. The most common disorder was genital vitiligo which accounted 39 patients (16.8%) followed by pearly penile papule in 32 (13.79%) and scabies in 21 (9.05%). The other major disorders encountered included lichen simplex chronicus in 15 (6.4%), sebaceous cyst in 12 (5.17%), drug reactions in 12 (5.17%), lichen planus in 13 (5.6%), calcinosis scrotalis in 10 (4.31%), lichen sclerosus in 8 (3.44%) etc. Pearly penile papules 32 (17.02%) and genital vitiligo 28 patients (14.89%) were the two most common disorders seen in the male population whereas genital vitiligo in 11 (28.21%) and candidiasis in 6 (13.63%) were common disorders seen among female population.

Table 5. Associated other dermatoses and systemic illness

Various other dermatological conditions were associated with non-venereal genital lesons in this study included Pityriasis versicolor, pemphigus vegetans, hirsutism, Lichen simplex chronicus, lymphedema, lymphangioma circumscriptum, psoriasis, striae rubra, tinea cruris, asteatotic eczema, acrochordon, alopecia areata, chronic urticaria, icthyosis, furuncle, aphthous ulcer, paronychia, onychomycosis, nail pitting, fissure feet, seborrheic dermatitis, melasma, acne vulgaris, nummular eczema, Polymorphic light eruptions, Pityriasis alba, pitted keratolysis, seborrheic keratosis, callosity sole etc., These conditions were seen in 31.5% (63) of patients.

There were few associated systemic illness in the study population which included diabetes mellitus, hypertension, urinary tract infection, varicocele, Poly cystic ovarin disease, hydrocele, varicocele, osteoarthritis, Acute lymphoblastic leukemia, renal cell carcinoma, Tetrology of Fallot, Ig A nephropathy and hypothyroidism. Two patients had undergone total abdominal hysterectomy and urinary bladder repair respectively. They accounted for 15% (30) patients.

Table 6. Venerophobia

19 patients in the study gave history of sexual exposure, all 19 were male. Among them 18 patients had venerophobia and thought that they developed the illness because of their high-risk behavior. It was most commonly encountered in patients with vitiligo and pearly penile papules; in 4 (22.22%) patients each. 14 patients had multiple exposure whereas only 4 gave history of unprotected sexual exposure.

Clinical Features of Common Non-Venereal Genital Disorders:

In this hospital-based study, a wide spectrum of non-venereal genital dermatoses was documented, with vitiligo being the most common entity, affecting 39 patients (16.8%). The mean age was 35.8 years, with a male predominance (M:F ratio 2.5:1). Lesions were predominantly genital in distribution, though oro-genital and generalized involvement were also observed. Several patients reported coexistent dermatological or systemic diseases, including alopecia areata, diabetes, and hypothyroidism.

Candidiasis was diagnosed in 15 patients (6.8%), slightly more in men. Typical presentations included papulopustules, erosions, and fissures in males, while women complained of burning, soreness, and curdy discharge. Diabetes mellitus was a major comorbidity in most cases.

Genital lichen planus was found in 13 cases (5.6%), commonly presenting with itching or pain. Lesions were confined to the genitalia in over half, with some extending to oral or cutaneous sites. Fixed drug eruption (FDE) and severe drug reactions were identified in 10 patients, often localized to the glans penis, with offending drugs ranging from NSAIDs to antibiotics and ayurvedic formulations.

Scabies accounted for 21 patients (9.0%), exclusively in males. Scrotal involvement was universal, often with nodules, excoriations, or secondary infections. Sebaceous cysts were seen in 12 cases, mainly solitary scrotal or labial lesions, and scrotal calcinosis was recorded in 10 cases, typically asymptomatic.

Normal variants such as pearly penile papules (32 patients, 13.8%) and benign conditions like angiokeratoma, Fordyce spots, and Bartholin’s cyst were also observed. Among inflammatory dermatoses, lichen simplex chronicus (15 cases), lichen sclerosus (8 cases), irritant contact dermatitis (11 cases), and isolated seborrheic dermatitis were reported.

Infections beyond candidiasis and scabies included herpes zoster, tinea, pyoderma, molluscum contagiosum, and one case of Fournier’s gangrene, which was fatal. Rare and interesting presentations comprised pemphigus vulgaris, Reiter’s disease, Zoon’s balanitis, Hailey–Hailey disease, psoriasis, and subcorneal pustular dermatosis.

Importantly, no premalignant or malignant genital lesions were encountered. The findings highlight the diversity of non-venereal genital disorders, their frequent association with systemic comorbidities, and the psychosocial burden posed by conditions often mistaken for sexually transmitted infections.

Figure 1: Genital vitiligo – Depigmented macules                               Figure 2: Candidal balanoposthitis in a diabetic

over vulva in a 7-year-old girl                                                                patient

Figure 3A. Fixed drug eruption over glans penis                     Figure 3B. Fixed drug eruption over upper lip of the same patient.

Figure 4A. Toxic epidermal necrolysis

Figure 5 Scabies – Multiple discrete papular

lesions with excoriation on hand and genitalia                        

Figure 4B. Toxic epidermal necrolysis

Figure 6A. Lichen sclerosus‐ Sclerosis and depigmentation of prepuce with phimosis

Figure 5 Scabies – Multiple discrete papular lesions with excoriation on hand and genitalia

 Figure 6B. Lichen sclerosus. Skin biopsy H&E 10x. Mild hyperkeratosis with a focal area of homogenization of dermis is seen. A dense lymphocytic infiltrate below the homogenized dermis.

Figure 7A. Pemphigus vulgaris.

  Figure 7B. Pemphigus vulgaris. Erosions over vulva and vagina of the same patient.

Figure 8A. Disseminated eczema involving trunk, face and lips

  Figure 8B. Disseminated eczema. face and lips Papular lesions with erosions and crusting over hans and

Non-venereal genital dermatoses (NVGD) represent a heterogeneous group of conditions with diverse etiologies, encompassing infections, infestations, inflammatory dermatoses, pigmentary disorders, benign tumors, normal variants, and rare systemic associations. Although they are not sexually transmitted, their genital localization often leads to significant psychosocial distress, misdiagnosis as venereal disease, and unnecessary stigmatization. The present study adds to the limited literature on the subject by describing the prevalence, age and sex distribution, and spectrum of NVGD in a tertiary care hospital, and comparing the findings with previous Indian and international studies.

Prevalence: The prevalence of NVGD in our study was 6.1 per 1000 patients attending the dermatology department. This aligns with the prevalence of 2.6 per 1000 reported by Maalik Babu M et al.⁷, though slightly lower than the 14.1 per 10,000 reported in males by Karthikeyan K et al.⁸. The variation could be attributed to differences in study population, methodology, and referral patterns. Overall, the prevalence data highlight that NVGD constitute a significant proportion of dermatological practice, warranting systematic documentation and management.

Age and Sex Distribution: The age of affected patients in our series ranged from 8 months to 77 years, comparable with the ranges reported by Acharya et al.⁹ (1 month–80 years) and Singh N et al.¹⁰ (1–85 years). The peak incidence was observed in the 21–30 years age group, a finding corroborated by Karthikeyan et al.⁸ and Kanaka Prasada Rao M et al.¹¹. In contrast, Singh N et al.¹⁰ found the 41–60 years group predominated among females. The mean age in our study (33.9 years) was close to other reports^8,10.

A male preponderance was noted, with a male-to-female ratio of 2.28:1, similar to Acharya et al.⁹ (1.8:1) and Geeta Shinde et al.¹² (2.33:1). This gender disparity is likely due to increased healthcare-seeking behavior among men for genital symptoms, as well as higher exposure to occupational and environmental risk factors.

 Occupational Profile:

Laborers formed the largest occupational group (34.5%) in our study, followed by housewives (24%). Similar occupational predominance of manual workers was reported by Acharya et al.⁹, Karthikeyan et al.⁸, and Singh N et al.¹⁰, highlighting socioeconomic and environmental determinants in the occurrence of NVGD. Factors such as poor hygiene, increased sweating, and close physical contact may predispose this group to both infectious and non-infectious genital dermatoses.

 Spectrum of Disorders:

A total of 34 distinct NVGD were identified in our cohort, which is higher than the number reported by Karthikeyan et al.⁸ (25 conditions) and Singh N et al.¹⁰ (19 conditions). This reflects the broad clinical heterogeneity and the importance of careful evaluation to avoid misdiagnosis.

Pigmentary Disorders – Vitiligo

Genital vitiligo was the most common condition, observed in 16.8% of patients. This finding parallels the 16% reported by Karthikeyan et al.⁸, 15.8% by Singh N et al.¹⁰, and 20% by Ashok S. Hogade¹³. Khoo LS et al.¹⁴ also documented a similar proportion (16%). Interestingly, our proportion among females (25%) was higher than Singh N et al.¹⁰, suggesting possible sex-related differences in regional cohorts.

Normal Variants – Pearly Penile Papules

Pearly penile papules (PPP) were observed in 13.79% of cases, consistent with the 14.3% reported by Khoo LS et al.¹⁴. However, variations exist across studies: Ashok S. Hogade¹³ reported 10%, Maalik Babu M et al.⁷ 6.6%, and Kanaka Prasada Rao M et al.¹¹ a much higher 21.66%. These differences may be related to sample size, age distribution, and inclusion of asymptomatic cases incidentally detected during clinical examination.

Calcifying and Cystic Lesions

Scrotal calcinosis was seen in 4.31% of patients, aligning with the 4% reported by Karthikeyan et al.⁸. Sebaceous cysts accounted for 5.17%, similar to 3.7% sebaceous hyperplasia reported by Khoo LS et al.¹⁴, though lower than 14% in the study by Karthikeyan et al.⁸. These findings reinforce the benign and often asymptomatic nature of these lesions, though cosmetic concerns may drive consultation.

Infections and Infestations:

Infections and infestations formed about one-quarter of all NVGD in our series. Scabies accounted for 9.05%, comparable to Karthikeyan et al.⁸ (9%) and Ashok S. Hogade¹³ (14%), but lower than Acharya et al.⁹ (15%). Genital candidiasis (6.8%) was closely associated with type 2 diabetes, corroborating the findings of Karthikeyan et al.⁸ and Burly et al.¹⁵. Other infectious dermatoses included herpes zoster, pyoderma, tinea, molluscum contagiosum, and one fatal case of Fournier’s gangrene, similar to previous reports^9,10.

Inflammatory Dermatoses: Lichen simplex chronicus was seen in 6.4% of patients, comparable to Singh N et al.¹⁰ (13.3%) but higher than Acharya et al.⁹ and Karthikeyan et al.⁸. Lichen sclerosus was relatively uncommon in our cohort (3.4%), markedly lower than Singh N et al.¹⁰ (21.7%), but similar to Karthikeyan et al.⁸ (2%). Genital psoriasis was documented in two cases, comparable to other series^8,9.

Drug Reactions:

Adverse drug reactions were identified in 10 patients; most frequently fixed drug eruptions localized to the glans penis. Offending agents included NSAIDs, antibiotics, and ayurvedic preparations. This is higher than the three cases of septran-induced FDE noted by Karthikeyan et al.⁸. One case of toxic epidermal necrolysis involving the vulva parallels the rare reports of female genital involvement documented by Meneux et al.¹⁶.

Rare and Interesting Cases

Our series documented rare cases of Hailey–Hailey disease, Zoon’s balanitis, Reiter’s disease, pemphigus vulgaris with oro-genital involvement, and prepucial ulceration with gangrene in a child undergoing chemotherapy. These highlight the need for clinicians to remain vigilant for atypical presentations of systemic or autoimmune disorders involving the genitalia. Comparable reports exist for Hailey–Hailey disease^17,18 and pemphigus¹⁹, though other entities such as Zoon’s balanitis were not widely reported in Indian series.

Venerophobia: An important psychosocial finding was the presence of venerophobia in 18 male patients, often triggered by sexual exposure history despite non-venereal etiology of their lesions. This dimension is rarely addressed in earlier studies, but it underscores the need for counseling, reassurance, and patient education to reduce stigma and anxiety associated with genital dermatoses.

Comparison with Other Studies: Our study mirrors the broad trends in NVGD epidemiology while also presenting unique findings. Genital vitiligo consistently emerges as one of the most common conditions across multiple series^8,10,13, while scabies and candidiasis dominate the infectious spectrum^7,9. Differences in the leading conditions (e.g., psoriasis in Geeta Shinde et al.¹², lichen sclerosus in Singh N et al.¹⁰) emphasize regional variation in prevalence and possibly genetic or environmental influences.

Clinical Implications: NVGD, though non-infectious, pose diagnostic challenges due to their localization, overlap with sexually transmitted infections, and frequent psychosocial impact. Misdiagnosis can result in unnecessary treatments, stigmatization, and psychological morbidity. Our findings highlight the importance of multidisciplinary clinics, integrating dermatology, gynecology, venereology, pathology, and psychological support for comprehensive management.

The study was conducted in a tertiary care dermatology outpatient setting, which may underestimate premalignant or malignant lesions that present primarily to oncology or gynecology departments. Additionally, the cross-sectional design limits inference on natural history or treatment outcomes.

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