Perineal groove is a rare benign congenital anomaly with lesion that resembles perforation of mid-perineum or perineal raphe area. A healthy, 9-month-old Caucasian girl developed a smooth, tongue-shaped, 18- × 10-mm red lesion, localized in the midline of the perineum between the anus and vulva; there were multiple erosions and crusted papules on the perineum (Fig 2). 4 or pain in the testicle (not scrotum). Perineal raphe removal? question Its the seem-like line between your scrotum and anus. burning or itching around. So my perineal raphe has been hurting for a about a week now. 7, 1939. Abstract. Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. The causes of perineal pain are pretty varied, but they fall into a few different categories. Perineal injury is an injury to the perineum, the area of the body between the anus and the scrotum. Idk if this is what you meant but examining an FTM bottom surgery post op picture (I am AMAB MTF), the perineal raphe on my body is the exact shape and path of the scarring from the FTM bottom surgery. GP if it isnt healing in the next few days, would go to urgent care or ED for spreading redness, fever over 100. These rare cysts are congenital (present at birth). 6. Low malformations in girls,. The symptoms may remain present for up to 10 days3. The perineal area needs extra care to heal after childbirth, including cool sitz baths to reduce swelling and speed healing. a rare congenital abnormality of failure of fusion of the perineal raphe and discussion. We present a case and review the literature in respect to a 35-year-old man with a non-visible, painless midline swelling in the anterior perineum initially thought to be a liposarcoma. The raphe, that mysterious “ stitch” running along the bottom of the scrotum, is a remnant of our shared human development in the womb. I accidentally cut my perineal raphe. Depending on growth of the bulbospongiosus muscle and corpus spongiosus penis, the midline intermuscular septum obtained a connection to the subcutaneous wavy. You can find info on it online. 2 may differ. All the patients presented with an unusual lesion at the anus or perineum, but no symptoms related to this anomaly. DPS is frequently associated with pelvic organ prolapse (POP) and it is reasonable to postulate, that treatment of POP will also have an impact on DPS. My perineum raphe is irritated and itchy, not at the rectal end but at the penile end, below the corona. The cysts can occur at parameatus, glans penis, penile shaft, scrotum, or perineum. This is one of the most common areas of pain in men and women who suffer from various forms of pelvic pain. How to say perineal. Most reported cases of congenital perineal groove presented as an isolated defect in term or early-term singleton female infants. A wide array of diseases affect the female perineum in adults. Created for people with ongoing healthcare needs. Even intense itching, if left alone, will subside after 5-10 minutes. Consider the discomfort and pain often associated with the testes. Irritation to these nerves from pathologic and biomechanical forces may predispose to dyspareunia. The raphe joins the internal. It is located in the midline and anterior to the anus in an area called the perineal median raphe. However, your body may not let you do so that easily! Many moms experience perineal soreness, pain around the vagina and rectum, after giving birth. Anatomy Name: The Intertrochanteric Line. It occurs. Open in a separate window. While I treated it by cleaning and neosporin I am fearful that I will never be able to have children. A: The symphysis pubis is the joint where the two pubic bones attach, dead center of the perineum. 1. The adductor muscles of the hip originate. The symptoms include: burning, itching, stinging, painful intercourse, pain from sitting, pain from wearing tight jeans, etc. These diseases are amenable to treatment. inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent. Perineum pain: Causes, treatments, and when to see a doctor. First, the area will be cleansed and local anesthesia will be administered using a small needle. To give a little background information he is 73 years old, had a Gleason scale of 8 and has been using a catheter for about 2 years. Case report: cobblestone A 23 year old married man presented to the STD clinic with a complaint of gradual splitting of median raphe. D. 89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 會陰. Causes of itchy perineum can include: Moisture (due to sweating or frequent washing), The abrasion caused by clothing, The pressure of sitting, Chemical irritants like laundry soaps, colognes and scented toilet paper,However, embryological mechanisms have been proposed as follows: (1) a relic of the open cloacal duct, 13 (2) midline fusion failure of medial genital folds between the perineal raphe and the vestibule, 3 4 and (3) urorectal septum developmental defect during cloacal embryological stages at 5th to 8th week of GA. Hematoxylin and eosin staining. General causes, gynecologic causes, and abdominal causes. The most common terms used to refer to this area are: Grundle. The superficial dorsal urogenital stroma forms a complex which comprises elements forming the ventral perineal raphe, superficial perineal septum, and transverse dorsal stroma of the navicular fossa. e. 5. Microscopic. To reduce the inflammation, you can apply a very small amount of 1% or 2% hydrocortisone ointment or cream, after bowel movements and twice a day, to the affected skin. The perineal raphe is a visible line or ridge of tissue on the body that extends from the anus through the perineum to scrotum (male) or labia majora (female). Pain after Radiation for Prostate Cancer. Male here, I have nicked / cut part of the perineal raphe in the area between my scrotum and my butt. Levator ani muscle is the largest component of the pelvic floor. I have a problem that I misturbate a lot. 1 Only a couple hundred case reports of median raphe cysts have been published in the English literature. This means that the cause of the itch is not found. The levator ani is a complex funnel-shaped structure mainly composed of striated muscle with some smooth muscle components. We present a case and review the literature in respect to a 35-year-old man with a non-visible, painless midline swelling in the anterior perineum. Perineal grooves in two newborn babies were. Only 1 dog required veterinary intervention with relation to swelling/irritation around the surgical site in the form of a sterile saline. What Causes Perineum Pain? In all sexes In males In females Takeaway The perineum lies near several nerves, muscles,. a very prominent midline perineal raphe extending from the site of the anal orifice to the scrotum [10]. In most patients, the cysts, which are asymptomatic or unrecognized during childhood, may progress later and become symptomatic during adolescence or adulthood. 1). Because of the rarity, exact incidence cannot be calculated. This was associated with the occurrence of a webbed penis with deficient ventralThe perineum is then examined. . my bottom left testicle feels swollen & my perineal area all the way down to my anus. I had hiv, herpes, vdrl, tsh tests in 2014 & all tests were normal (negative). My perineum raphe is inflamed and swollen. 4 years ago. Before you try kegel exercises, make sure to empty your bladder. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and surrounding structures. Abstract. This condition can also be caused by improper cleaning of the perineal area after using the toilet and also be caused by using toilet paper. The diagnosis is mostly. Anatomy Name: The Intertrochanteric Line. 1 Normal Scrotal Raphe. Perineal groove is a rare congenital midline malformation of the perineal raphe. On vulvar skin, the most common symptoms are soreness, burning, and rawness. This physical finding is known as infantile perianal pyramidal protrusion (IPPP). Anal cancer: this is rare and is 20-30 times less common than colorectal cancer. It is found in both males and females, and arises from the fusion of the urogenital folds. There are lots of Vulvodynia groups online. In males, it contains male external genitalia and the perineal muscles. Perineal fistulas are diagnosed upon discovery of openings on the perineum, meconium or mucus in a small strip running up into the scrotal median raphe, a perineal groove, or a bucket-handle malformation in the anal dimple skin. Perineal Soreness. which will prevent healing. anal pain or itching. There are two. These cysts are referred to as median raphe cysts, an uncommonly encountered clinical condition. pubic lice These conditions don’t always cause symptoms you can easily see. It supports the viscera in the pelvic cavity, and surrounds the various structures that pass through it. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and surrounding structures. One last note: that ridge or seam on the underside of the penis is called the perineal raphe, and it may also be a more sensitive area of the shaft for some individuals. Penile raphe. . Pain medications and numbing sprays: Taking acetaminophen (Tylenol®) or ibuprofen (Advil®) and using pain-numbing sprays can ease the pain while your body heals. Dr. Painful erection; Bruising in the perineal area; Pain to the touch;. The itching/burning/prickly feeling is unbearable and worse at night, and when I wipe after a bowel movement. The perineal raphe is a visible line or ridge of tissue on the body that extends from the anus through the perineum to scrotum (male) or labia majora (female). Median raphe cysts can develop at any site along the midline of the ventral side of the male genital area, from the meatus to the scrotum and perineum (Figure 1). The perineum is the region below the pelvic diaphragm; it consists of muscle-fascial. The crease between the thigh and groin is known by several different names. The perineal body plays an important role in support of the vagina and in normal anal function. - Urate crystals diaper - Degrees of hypospadias - Bilateral cryptorchidism 2 - Sexual maturity rating of pubic hair/genitalia in males (Tanner) - Prader orchidometer - Perineal hypospadias - Atypical genital appearance 1 - Atypical genital appearance 2 - Partial labial adhesion in a prepubertal female - Sexual maturity rating of breast. I was wondering if this is normal and what causes it. 89 may differ. Intervals between panels are 0. Perineal raphe: everything on this line that divides the scrotum in two. 1 2 3. Its been here since 2-3 years. It does not hurt or itch, but it shouldn't be red. Median raphe cysts present anywhere between the external urethral meatus and the anus. Diagnosis can be made by taking some tissue (biopsy) and examining it under a microscope. there was a lil piece of the raphe hanging, as ive read in forums people say that the skin hanging will just. It is found in both males and females, arises from the fusion of the urogenital folds, and is visible running medial through anteroposterior, to the anus where it resolves in a small knot of skin of varying size. I noticed the skin directly next to my perineal raphe (penis) has turned dark brown. We find broad structural homologies between male and female dogs related to erection,. The cut itself is about 1/4 inch. Discussion The urethral folds appear at the undifferentiated stage in the development of the external genitalia and they include the cloacal membrane. 7. This lesion extends vertically downward from the posterior portion of the vaginal fourchette to the anterior rim of the anus. Penile curvature. Perineal soreness is common, especially if you. Treatment is likely to be with chemoradiotherapy. Untreated lichen sclerosus can also increase your chances of developing a type of skin cancer ( penile cancer and vulvar. Duct obstruction, entrapment of pudendal nerve, abscess, prostatitis, perineural cyst, ischiorectal abscess, benign prostatic hypertrophy, and prostatitis. Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which. Treatment of Pain Problems: What You Need to Know What is Perineal Pain? Live pain-free from perineal pain. Do this as long as you have pain. In males, the perineum is the area between the anus and the scrotum. Read the full text or download the PDF: Median raphe cysts are a rare, congenital entity. , 2022). Given the crotch can be sweaty, irritation can arise from perspiration. Median raphe cysts of the perineum are uncommon congenital lesions of the male genitalia. Symptoms or signs of irritation, redness, bleeding, bruising, vaginal discharge, and lesions were deemed more likely to resolve than those of "abnormal examination findings," which included scarring and "enlarged opening. Aside from when I actually run my finger over it, there is no pain. The incision is extended through the paired retractor penis muscles, the bulbospongiousus muscle, the corpus spongiosum penis, and urethral mucosa overlying the stallion catheter. Vulvar trauma,. Perianal streptococcal dermatitis is a bright red, sharply demarcated rash that is caused by group A beta-hemolytic streptococci. Treatment can. If you have pudendal neuralgia, this nerve is injured or compressed and causes stabbing, burning or shooting pain. Apply cool compresses to the perineal area to soothe burning sensations. Postpartum Perineal Care Facts. described perineal groove as an exposed erythematous nonepithelized mucous membrane extending from the vaginal fourchette to the anus (). The scrotum softens and changes color, with the perineal raphe becoming more distinct. Pressure on the scrotal cysts caused expression of a milky fluid from the upper portion of the tract. Using a throwaway account cause this is personal. The diagnoses of infantile pyramidal protrusion and irritant diaper dermatitis were made, both. They may happen after hemorrhoids heal or cleaning that area too. The most common treatment for perineal pain is rest; rest helps the body repair the damage. Hi i am 28 years old uncircumcised male. Median raphe cysts can develop at any site along the midline of the ventral side of the male genital area, from the meatus to the scrotum and perineum (Figure 1). 2 Other symptoms include localized pain, chronic seepage, and excessive moisture. Care of the wound and suture line is done as a clean rather than a sterile procedure. Histology of median raphe cyst. Perineal groove is a rare congenital anomaly characterized by nonepithelialized mucous membrane that appears as an erythematous sulcus in the perineal midline, extending from the posterior vaginal fourchette to the anterior anal orifice. Perineal fistula and other anorectal. Anal cancer: this is rare and is 20-30 times less common than colorectal cancer. The perineum is the region between the thighs that includes the space between the genitals and anus. Image acquired using minimal zoom on a surgical, digital camera. 1 Instead of keratinized epithelial skin, the perineum has a non-epithelialized midline sulcus and mucosal membrane spanning the region from the posterior. Perineal injury can occur and cause swelling and/or a lump between anus and scrotum. Raphe means the line of union of the two halves of various symmetrical body parts, and the term median raphe refers to the perineal raphe, which is also known as the median. Perineal trauma, also known as vaginal tears, is a very typical and expected side effect of vaginal delivery. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The perineum can be divided into two triangular portions by the line between the ischial tuberosities. Main problem is the slight pain irritation putting a limit on stretching for now. Relieved to see that others have had experiences with the raphe area acting up but getting through it nonetheless. Itching and pain. 3. The complexity of the process results from the nervous system not being a ‘hard. Dark marks and scars from ingrown hair and irritation from shaving vagina how can I get rid of them? Acne scar removal procedures White bumps on the back of the penis scar treatment for carbuncle on face (nose)Median raphe cysts. I had really bad vaginal/vulvar pain for a while because of “vulvar varicosities” (in addition to hemorrhoids but their own separate beast, also in the family of varicose veins). A lump can also result. The perineum is divided into the anterior urogenital triangle and the posterior anal triangle; the vulva represents the external genitalia. This means that the cause of the itch is not found. Median raphe cysts are a rare, congenital entity. It is mostly presented in female infants as an isolated anomaly but can be found in males as well []. We present a case and review the literature in respect to a 35-year-old man with a non-visible, painless midline swelling in the anterior perineum initially thought to be a liposarcoma. The 2024 edition of ICD-10-CM R10. The perineal raphe, septum, body, and fasciae are mainly constituted by contributions of the superficial and deep dorsal urogenital stroma. The term is most often used to denote repair of an episiotomy done during childbirth, but it also can mean repair of any tear or laceration of the perineum. read more. We perform scrotal surgery, penile procedures, varicocele and hydrocele repair, and circumcision. Ultrasound confirmed the diagnosis of ectopic testicle. Teenage patients only occasionally are seen with idiopathic hemorrhoids. It is generally not pruritic, unlike many other scrotal dermatoses. I have them since 1-2 years, everytime after using ointment/cream bumps goes out but came back after some days. hi, I am 28 years old patientold man. 1 mm (A–B, B–C), 0. The area may look red and feel painful and be swollen. A careful history and examination are required. The site of the median septum is apparent on the surface of the scrotum along a median longitudinal ridge called the scrotal raphe. compresses the vestibular bulb and constricts the vaginal orifice. ”. No trial reported on perineal trauma. Taint. 1. Itchy Perineum! Hello. This is the American ICD-10-CM version of L02. The perineal body is continuous with the perineal raphe in the scrotal skin. Then pat the area dry. Median raphe cysts usually occur in low-type anorectal malformations and suggest the location of the fistula . Currently, CPG can be divided into two types based on the morphology of perineum, complete and partial (2,3, 8). This rare condition does not usually require surgical correction except for cosmetic reasons or if the. We report the case of a newborn female with a perineal groove and review the limited literature. The mean age of the study group was 6. Been having some pain in my perineum area when I push to pee and today when I was showering I felt a bump in that area that kind of felt like a harder pimple. there may be a light burning sensation as it appears, which last a few minutes. Firstly, my perineal raphe looks red and raised. 1 doctor answer • 1 doctor weighed in. The urethra is the last part of the urinary tract and traverses the corpus spongiosum. Scrotal raphe is a slightly elevated ridge of tissue running from the base of the penis to the midline of the perineum. Thus far, there is no reported case of this anomaly in monozygotic twins. 会阴的具體範圍有不同的定義 [2] ，有一種定義將女性的会阴定義為在陰道及肛門之間的部位，男性的会阴則定義為在陰囊及肛門之間的部位. An ID Reaction can be caused by treating the primary skin condition improperly. Median raphe cysts of the perineum are uncommon congenital lesions of the male genitalia. Symptoms. The perineum is surrounded by several nerve endings. Median raphe cysts are cysts that develop on the median line in the male genital region in any area from the anus to the external meatus. Now i gone to doctor and he gave terbinafine & mometosone furoate cream base with itraconazole 100 mg. scrotum and penis in men. Frontal sections. I remember mine was always raised, dark, and frankly looked like a large scar. 1 Instead of keratinized epithelial skin, the perineum has a non-epithelialized midline sulcus and mucosal membrane spanning the region from the. It is found in the perineal median raphe, which is located in the center and anterior to the anus. I have been having pain between anus and scrotum for two months. The symptoms of perineum infection in females may include pain or discomfort in the perineum area, swelling or redness in the perineum area, itching or. It is the result of a fetal developmental phenomenon whereby the scrotum. Constipation by itself can cause the pain that you have. L02. 8. Definition: Scrotal midline indentation or cleft with absent scrotal raphe. We present a case and review the literature in respect to a 35-year-old man with a non-visible, painless midline swelling in the anterior perineum initially thought to. At this point, perineal raphe is formed. 5 month (range, 0. Even if its a small thing, it bothers me quite a bit. It is found in both males and females, and arises from the fusion of the urogenital folds. In winters i had them rarely but now summer is starting & again bumps are appearing on my perineal raphe. Median raphe cysts usually appear before 30 years of age. Background. The body’s natural response is to form a scar where the tissues have torn. 2. Median raphe cysts present anywhere between the external urethral meatus and the anus. The anomalies which do occur in the median raphe are two: (1) cysts, which may have either stratified or columnar epithelial linings, and. i really am tensed and expecting a solution on this. The perineal body (PB) is the central fibrous skeleton of the perineum and has a pyramid shape in the male and a wedge-shaped in the female; laterally is formed by the perineal smooth muscle, the anterior continuity of the longitudinal anal muscle. Mycotic infection can present with annular lesions with scaly elevated borders and central clearing, or as a bright red rash in a “butterfly” distribution with. Penile/scrotal raphe is red. But perineum pain can also be caused by injuries, urinary tract issues, infections, and other conditions. Many translated example sentences containing "perineal raphe" – Spanish-English dictionary and search engine for Spanish translations. The term "IPPP" was introduced in the medical literature within the past 10 years. It serves as a passage both for urine and semen. Male: median raphe on ventral surface of bulb of penis; perineal body: Male:. Perineal pain occurs adjacent to the anus. Perineum. Doctor's Assistant: The Urologist can. Here, we investigate homologies between male and female perineal structure, identifying structures based on common function, anatomical relationships and attachments. Early perineal raphe seen in two male fetuses. The raphe joins the internal. The coccygeus muscle completes the pelvic floor, which is also called the pelvic diaphragm . The pathogenesis of perineal groove is not clear, and there are few cases reported in the current medical literature. Pudendal neuralgia (or pudendal nerve entrapment) is when you experience chronic pelvic pain from damage or irritation to your pudendal nerve. who do i go to&is this easy/safe to treat?" Answered by Dr. left testicle also feels/looks lower than usual. The most observant and observant now know what it is. vulva, labia and clitoris in women. The proper term to use may depend on the context, situation, and cultural background of the speaker. Hunter Handsfield answered. anal herpes 2. Call/text today: 1-212-204-6300 or make an appointment online. The tissue is formed during fetal development, and it is believed to be a remnant of the embryonic structure that eventually becomes the vulva in females. I have been itching around my vagina area- mostly the perineum and the skin around the anus for 5 months now. Inflammatory bowel disease (IBD), infections, and chronic diarrhea can cause anusitis. Treatments include creams, ointments, medications and home remedies. A 10-month-old girl was referred to Pediatric Gynecology after her parents noticed an increasing genital bulge. 3 ). Thus, in the present study, we will apply a term "perineal raphe" to a raphe behind the root of penis. Try OTC Clotrimazole cream; if no better, see your doctor. Treats urinary incontinence (leaking urine). Median raphe cyst is usually benign and asymptomatic male genitalia lesions. 143 yrs old Male asked about Left perineal pain since last 5 days, 5 doctors answered this and 201 people found it useful. Perineum raphe itch and inflammation. . 225 - other international versions of ICD-10 L02. Common sites are midline of the ventral aspect of the urethra, glans, penile shaft (Fig. Perianal region is an extremely rare location for these lesions. Repeat the massage for 5-10 minutes total, taking breaks when you need to. Antipyretics-. Congenital perineal groove is characterized by an exposed erythematous nonepithelized mucous membranes that resembles exposed wet erythematous sulcus, inflammation, or rupture of the midperineum area. Nov 22, 2021 at 1:46 AM. The perineal raphe is a visible line or ridge of tissue on the human body that extends from the anus through the perineum. At New York Urology Specialists, we offer same-day treatment for pain . my cut has healed but the piece of raphe that was hanging curled up and looks like a pimple?. Get App. Lower back pain; History of herpes zoster or trauma. (A, E) The most anterior side of each series of photos. Perineal groove is a rare benign congenital anomaly with lesion that resembles perforation of mid-perineum or perineal raphe area. Vaginal discharge that smells bad. In winters i had them rarely but now summer is starting & again bumps are appearing on my perineal raphe. It is a basin-shaped muscular diaphragm that helps to support the visceral contents of the pelvis. 3 ). It is the result of a fetal developmental phenomenon whereby the scrotum (the developmental equivalent of the labia in females) and. Methods: We enrolled men with gonococcal infection of the penile raphe and men with urethral. Press down towards the anus and the sides of your vaginal wall. The congenital form of Perianal Pyramidal Protrusion is caused by the dysfunction of the median raphe and is also considered a residual of the urogenital septum. Congenital perineal groove (CPG) is a rare malformation characterized by the presence of a moist sulcus with mucous membrane on the perineum since birth (1, 2). . After pressing skin I can feel hard jelly like mass . Perineal Body: The median raphe of levator ani between the anus and vagina, is reinforced by the central tendon of the perineum. The complete type has the sulcus extended from the posterior fourchette to the. Introduction. perineal raphe: [TA] the central anteroposterior line of the perineum, more marked in the male, being continuous with the raphe of the scrotum. penis and scrotum. increased bowel urgency. In fact, it is reported that up to 85% of women will have some degree of perineal trauma during vaginal delivery (1-3). In men, however, the pain may be located in the perineum but may also radiate to the testes and the rectum. Take pain medication like ibuprofen (Advil) to reduce swelling and pain. It's around 1cm in diameter, was purple (now more pink), and right next to my anus. Redundant vaginal mucosa is excised, and the levator ani muscles are approximated. Once the correct diagnosis is established, treatment is usually straightforward. M. In winters i had them rarely but now summer is starting & again bumps are appearing on my perineal raphe (outer back penis skin). A urinary tract infection (UTI) is an infection in any part of your urinary system, such as your urethra, bladder, ureters, or kidneys. Bulbocavernosus, superficial transverse perineal and external anal sphincter muscles also converge on the central tendon. The perineum is a major area of muscle attachment, which makes it one of the most common sites of pain. The perineal raphe further extends forward to the undersurface of the penis and backward to the anal opening. Hemorrhoids also cause pain and discomfort, but you should be able to tell if what you have is a hemorrhoid due to the number of other symptoms that are commonly associated with them. [1]Lacerations on the perineum, cervix, vagina, and vulva can occur spontaneously or iatrogenically, as with an episiotomy. Perineum is in color. Two patients were excluded as they expired due to concomitant head injury. It's situated between interior thighs and anal region. The mechanism by which a damaging stimulus in the body is perceived as painful by the brain is a complex one which is not yet fully understood. 1-3 The diagnosis can be made in early infancy through the preschool and early school years. Its been here since 2-3 years. So I decided to take a look down there and I am not sure what I am looking at. The perineal. [1]Lacerations on the perineum, cervix, vagina, and vulva can occur spontaneously or iatrogenically, as with an episiotomy. The crease between the thigh and groin is known by several different names. When the area is numb, your OB/GYN may then use a. You should drink a lot of water and take a high fiber diet. 8. The pathological diagnosis was infantile perianal pyramidal protrusion. 5%) (2,4). The cysts can occur at parameatus, glans penis, penile shaft, scrotum, or perineum. FormalPara Definition . These can include perineal pain or discomfort, bruising, haematuria (14. Case report: cobblestone A 23 year old married man presented to the STD clinic with a complaint of gradual splitting of median raphe.