Fournier gangrene (necrotising fasciitis) – flesh-eating disease of the vulva

Fournier gangrene is a form of necrotising fasciitis (gangrene) that can affect the vulva and/or perineum in women. It most often occurs in men, however, with anyone suffering diabetes, alcoholism, kidney problems, steroid use or immune system deficiencies most at risk.​1,2​

A 2009 study stated that 39 out of 1,680 cases of Fournier gangrene were found in women, in particular older women between the ages of 50 and 100.

Some researchers believe that Fournier gangrene is a polymicrobial skin condition. This type of gangrene can occur after episiotomy or a Bartholin’s abscess.​3​

Symptoms of Fournier gangrene in women​4​

  • Swelling
  • Pain in the perineal or perianal area
  • Fever
  • Weakness
  • Foul odour
  • Pus
  • Skin turns black
  • Occurs quickly

Causes of Fournier gangrene Bacteria are the cause of Fournier gangrene, with both aerobic and anaerobic bacteria found guilty. In one study, the type of bacteria found included:

  • Escherichia coli
  • Klebsiella pneumoniae
  • Enterococcus
  • Morganella
  • Pseudomonas
  • Streptococcus
  • Staphylococcus
  • Proteus
  • Bacteroides spp.
  • Peptostreptococcus
  • Prevotella
  • Clostridium difficile

Treatment of Fournier gangrene

The typical treatment of Fournier gangrene is antibiotics intravenously, with surgical removal of dead tissue. Hyperbaric oxygen chambers have been used to increase oxygen in damaged tissue while also killing anaerobic bacteria.​5,6​

References

  1. 1.
    Hong KS, Yi HJ, Lee R, Kim KH, Chung SS. Prognostic factors and treatment outcomes for patients with Fournier’s gangrene: a retrospective study. International Wound Journal. Published online September 25, 2017:1352-1358. doi:10.1111/iwj.12812
  2. 2.
    Aşcı R, Sarıkaya Şaban, Büyükalpelli R, Yılmaz AF, Yıldız S. Fournier’s Gangrene: Risk Assessment and Enzymatic Debridement with Lyophilized Collagenase Application. European Urology. Published online 1998:411-418. doi:10.1159/000019775
  3. 3.
    Kuzaka B, Wróblewska MM, Borkowski T, et al. Fournier’s Gangrene: Clinical Presentation of 13 Cases. Med Sci Monit. Published online January 28, 2018:548-555. doi:10.12659/msm.905836
  4. 4.
    Zhang N, Yu X, Zhang K, Liu T. A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region. BMC Surg. Published online October 30, 2020. doi:10.1186/s12893-020-00916-3
  5. 5.
    Lewis GD, Majeed M, Olang CA, et al. Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review. Cureus. Published online October 21, 2021. doi:10.7759/cureus.18948
  6. 6.
    Raizandha MA, Hidayatullah F, Kloping YP, Rahman IA, Djatisoesanto W, Rizaldi F. The role of hyperbaric oxygen therapy in Fournier’s Gangrene: A systematic review and meta-analysis of observational studies. Int braz j urol. Published online October 2022:771-781. doi:10.1590/s1677-5538.ibju.2022.0119


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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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