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Letters to the Editor
Primary Care November 2001
ÉNEXT TO GODLINESS
To the Editor:
Do you and your readers know that poor male hygiene is the main
cause of female genitourinary (GU) problems?
After practicing medicine for a half-century spending thousands
of nights in emergency rooms and patient wards; attending hundreds
of grand rounds and symposia; and conducting research, reading,
teaching, contemplating, rejoicing, and agonizing for decades–I
feel that I can speak with authority on this subject. In addition,
as a physician, I consider myself to be a scientist. Sometimes,
though, in trying to solve difficult problems scientifically, my
colleagues and I overlook simple–but very obvious– causative
factors. This is the case with male hygiene: If it is poor, it is
the main cause of diseases of the female external and internal genitalia
and the female urinary tract.
For decades, I've observed women experience all gradations of discomfort
involving these organs, from simple vulvovaginal itching to excruciating
urinary tract infections (UTIs). They've suffered through premature
childbirth, postoperative complications, dyspareunia, and infertility.
You may be surprised to learn that most of this pain and suffering
is related to diseases caused by common germs–bacteria, viruses,
and fungi–that are introduced into the vagina by the penis
during sexual intercourse. We humans work with an incredible variety
of materials each day: We count money, we pick our nose, we shake
hands. When males urinate, they inevitably grasp their penis with
their hands, and deposit all the germs collected throughout the
day.
Most hygiene-conscious men wash their hands after urination, acknowledging
the dirtiness of their genitalia and the necessity of keeping their
own hands clean. However, germs remaining on the unwashed penis
are then introduced into their partner's vagina during intercourse.
From here, one of two things will happen. Most of the time, the
female immune system will destroy the germs within hours. The normal
vagina's acidity, along with certain "good" bacteria and certain
white blood cells, act to rid the female genital tract of foreign
invaders.
But you can't always count on Mother Nature. Sometimes the penis
carries virulent germs and/or the woman's immune system is not strong
enough to destroy them. When either or both of these conditions
exist, the disease process begins. First, the unclean penis comes
in contact with the woman's external genitalia. In 2 or 3 days,
symptoms of vulvovaginitis arise. If left untreated, germs ascend
to the upper reproductive tract–the cervix, uterus, fallopian
tubes, and even the ovaries–causing inflammation and infection
of one or more of these organs. Development of pelvic inflammatory
disease (PID) usually follows this scenario. These germs may also
follow an alternate route: They may enter the urethra and then travel
up to the urinary bladder, ureters, and kidneys, causing common
UTIs.
An intermediate situation may also occur. If the invading germs
are only partially destroyed by the woman's immune system, they
may remain in the vagina and cervical canal. Although they do not
cause disease immediately, they stagnate here, in a latent phase.
These germs, when combined with their metabolic products, necrotic
vaginal epithelial cells, and various white blood cells–dead
soldiers on a battlefield–will form a fluid of varying consistency,
color, and odor in few days or weeks. Every day for the past half-century,
this is what I see in 7 to 8 of every 10 vaginas I examine. These
restrained germs, accompanied by this annoying discharge, cause
an intermittent, usually mild vulvovaginitis, but they exact a huge
cost: millions of office visits to OB/GYNs and primary care practitioners,
billions of dollars spent, and lots of pain and suffering.
But this is not all! This equilibrium between the vaginal flora
and the body's immune system can last weeks or years, but it can
break down on any given day for many different reasons: extragenital
disease, malnutrition, exhaustion, a common cold, or even depression.
Or, during sexual intercourse, more virulent germs may be introduced
into the system. In these situations those previously quiescent
bacteria, viruses, and/or fungi will start to multiply, become virulent
again, break the imposed barriers, invade the surrounding areas,
and ascend to the internal genitalia and/or urinary system, producing
painful, debilitating, and costly PID or UTIs. This delicate equilibrium
can also be broken during pelvic surgery, leading to postoperative
infections, or during pregnancy, leading to bacterial invasion of
the amniotic sac and, possibly, premature labor.
Even without a dramatic disruption in the aforementioned equilibrium,
the cervix, being soaked for years, even decades, in this vaginal
discharge, may eventually become inflamed and vulnerable to development
of dysplasias, which may be precursors of cervical cancer.
Despite all of the sophisticated diagnostic tools at our disposal,
as well as the endless array of new-and-improved pharmacotherapies
available, the type of vulvovaginitis diagnosed and treated on a
given day may be completely different from the one caused by a single
act of intercourse the following day. It all depends on the bacteria,
viruses, and/or fungi that the male sex partner acquires with his
hands and deposits on his penis. It doesn't matter if he washes
his hands after urinating; in order to avoid colonizing his penis
with germs and passing them along to his female partner, this man
must wash his hands before urinating.
To test my theory, an epidemiologist, a pathologist, and I collaborated
on a study. We examined the bacterial content of the surface of
the penis in 100 men. The results confirmed my theory. Every penis
harbored one or more colonies of bacteria (eg, Enterococci, Staphylococci,
a-he-molytic Streptococci, Escherichia coli, Micrococci), and many
different types of fungi. It isn't a great leap to imagine that
any one of these organisms could be introduced into a partner's
vagina during sex.
As you may have noticed, this letter doesn't refer to sexually
transmitted diseases (STDs) such as Trichomonas infection, gonorrhea,
chancre, syphilis, condylomas, or acquired immune deficiency syndrome:
These constitute yet another chapter in "the book" on female pathology.
The common, everyday bacteria described above are the cause of most
infections of the female GU tract, as well as most cases of postoperative
GU complications, prematurity, and cervical dysplasia.
The solution is simple: If men want to keep their wives or girlfriends
healthy, they must keep their private parts–that is, their
penis–clean! They must wash their hands thoroughly before urinating,
before touching their penis! Otherwise, they should consider themselves
dirty and wash their private parts before engaging in sexual intercourse.
In addition, they should keep their underwear clean. Properly used
condoms, besides protecting males from the great majority of germs,
will also protect their sex partners from unwanted pregnancy, STDs,
and, just as important, those pesky, ubiquitous germs described
in this letter.
It won't necessarily be easy for males to reverse the direction
of their hygiene practices–from using the toilet and then washing
their hands to washing their hands and then using the toilet–but
once they change their habits, they will no longer be infecting
their partners. If you have doubts, ask the tens of thousands of
patients for whom I have been caring during my long career.
Dengelegi Den Tiberius, MD
Manhasset, NY
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