b"of the area. When possible, one should use the bonyaddress the underlying lymphatic dysfunction 209,238241 . landmarks of the pelvis to designate repeatableThe use of microsurgeries, lymphaticovenular measurements. The tissue in the different areas of theanastomosis (LVA) and the new lymph node-to-vein genitalia also needs to be assessed. Is there pitting oranastomosis (LNVA), as an option for the early stages fibrosis? Does the tissue move, or is it adhered,of GLE has increased and can address the actual especially the foreskin, if present? Stemmer Signlymphatic drainage dysfunction 208,225,240,242246 .testing can be performed on the scrotum andWith either surgical approach, the patient will needlabias 224,234236 . A scrotal Stemmer Sign can distinguishto continue compliance for life with the componentslymphatic dysfunction of the scrotum's differentof CDT, especially compression, to maintain internal (hydrocele, - Stemmers) and external improvements and reduce the risk of cellulitis or (+ Stemmers) lymphatic systems. However, bothworsening of the GLE 225,240,242,246,247 .systems can be involved with significant dysfunctions.Applying the components of CDT to the genital region Additional objective evaluation components that arecan be daunting to HCPs due to the shape of the key during GLE evaluations are listed in Figure 10. involved structures, the daily requirements of the As mentioned in Section 1: Primary and Secondaryinvolved systems (urinating, defecation, menstruation, Lymphedema and Lipedema, complete decongestiveintimacy), and the required mobility of the patient therapy (CDT) is the standard treatment for all types of(sitting, standing, transfers, and gait). With some lymphedema, including GLE. A retrospective study of patience and creativity, all components can be 90 males from an andrology center in London, UK, withsuccessfully applied to patients with GLE. Critical GLE showed that 62% could effectively manage theirpoints for the different components of CDT are listed GLE with early conservative CDT and prophylacticin Figure 11. Education would encompass explaining to antibiotics 237 . The true goals of CDT with GLE are tothe patient the importance of the other components, improve quality of life, reduce the signs and symptomssigns and symptoms of infections, and how one can of GLE, and, most importantly, reduce the risk ofparticipate safely in intimate activities with GLE. cellulitis and the need for debulking surgicalIntimacy and sexuality are the two that are most often intervention. One study of 93 patients with GLE foundoverlooked by HCPs. Sexuality is considered a basic that 85% of the males and females had at least oneneed for individuals, and intimacy is how one connects infection annually, and almost one-fourth had six orto others in a meaningful way. The loss of these two more infections yearly 238 . Several studies havecan negatively impact ones overall quality of life. reported that patients who underwent debulkingOther adjuncts to CDT can also be used with GLE.surgeries of the involved genitalia require additionalThe most controversial is the pneumatic compression debulking procedures in the future, some as often aspump. To use safely, one must thoroughly clear the every 58 years, because these surgeries do nottrunk with self-MLD before and after, ensure the pump Compression Manual Lymph Drainage Exercises Skin Care Day garments must be Clear the trunk rst, Exercises should always MUST reduce the risk supportive to competethen the genitals,be completed in aof infection and skin against gravity and last the lowerproximal to distalbreakdown Night garments shouldextremeties (LE).manner to promote Check area daily for focus on the reductionDont clear the LEsuid movement in theskin breakdown, signs of edema and broticbefore the genitals correct direction, soof infection, and other tissueRemember, the externalstart in the upper trunkchanges Bandage with lowgenitalia and the monswith genital lymphedemaRinse/clean after using to medium-stretchpubis drain with theand progress down intothe restroom and inexpensive material,medial thighs/buttocks,the legs intimacyfoam bandages, or light not the abdomen, and Incorporate frequent Change incontinence cohesive bandages may clear best to thecontractions ofpad or diapers (andMust be breathable,posterior trunk transverse abdominus,tampons) every 3 hours, moisture-wicking, and Includes the contractiongluteals, and lumbareven if dryfor sensitive skin toof pelvic oor musclesmusculatureAvoid scrubbing, drying reduce infections andduring MLD to assist Incorporate pelvic oorsoaps, and hot waterskin breakdown with the deep drainage contractions during Use only electric razors The patient should be To ease the patient,MLD, exercises, and Use only water-based able to independentlymake sure they canseveral other timeslubricants or olive oil for don/doff the garmentsalways see you, youduring the day intimacy and clean postfor hygiene have direct hand Exercises should be Do not try to self-contact, and youcompleted withtreat infections, see are explaining whatcompression on or ina physicianyou are doing to avoida pool if the person misinterpretation is continentFigure 11. Complete Decongestive Therapy for Genital Lymphedema| Standardized Approach for the Diagnosis and Management of Lymphedema (LE) and Lymphatic Diseases (LD)|23"