Fournier’s gangrene is an uncommon and nasty condition (Figure 80.21) characterised by a polymicrobial infection of the soft tissues of the perineum, external genitalia and peri- anal region. It is a form of necrotising fasciitis. There is rapid onset of gangrene leading to exposure of the scrotal contents. Although it can occur in conjunction with sepsis of the tes- tis, epididymis or perianal region, an obvious cause is absent in over half the cases. It can arise following minor injuries or procedures in the perineal area, such as a bruise, scratch, urethral dilatation, injection of haemorrhoids or opening of a periurethral abscess. Many patients have concurrent illnesses that diminish their defences, most notably diabetes mellitus and alcoholism. There is a mixed infection of aerobic and anaerobic bacte- ria in a fulminating inflammation of the subcutaneous tissues, which results in an obliterative arteritis of the arterioles to the scrotal skin that in turn results in gangrene. The condition can spread rapidly to involve the fascia and skin of the penis, perineum and abdominal wall