What Is Fournier Gangrene?
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Fournier Gangrene - Causes, Diagnosis, and Treatment

Published on Nov 01, 2022 and last reviewed on Jul 12, 2023   -  8 min read


Fournier gangrene is a type of acute necrotizing fasciitis of the penis, scrotum, and tissues of the perineal region. Read the article to learn more.


The human body consists of billions of cells and tissues that are designed to carry out their specific functions. These tissues receive blood supply from various blood vessels to carry out their activities. However, the problem arises when these tissues lack blood supply. It can be due to bacterial infection or other conditions that damage the blood vessels. When the tissues do not receive their blood supply, they die, and this condition is known as gangrene.

The risk of gangrene increases when the person suffers from diabetes and conditions that affect blood flow, like atherosclerosis. Gangrene mainly affects the toes, fingers, arms, legs, and internal organs of the body, like the gallbladder. The condition is known as Fournier gangrene when gangrene affects organs like the penis, scrotum, and perineum. It is a medical emergency and needs to be treated at the earliest.

What Is Fournier Gangrene?

Fournier gangrene is a life-threatening disorder that rarely occurs in organs like the penis, scrotum, and perineum (the area between the scrotum and the anus). It is a type of necrotizing fasciitis that spreads rapidly. Necrotizing fasciitis is a condition in which the infection spreads rapidly to the soft tissues, muscles, nerves, and blood vessels, resulting in death. The organs responsible for the reproductive function appear swollen and red. If the condition is left untreated for a long time, the infection spreads rapidly to the body's other tissues, including the thigh, chest, and stomach. Fournier gangrene can result in the death of the person. However, there are treatment options available for the condition, but the patient requires immediate medical care and attention.

What Are the Causes of Fournier Gangrene?

Fournier gangrene is commonly seen in males and has been named after the French physician who discovered it. Fournier gangrene is mainly caused when bacteria enter the genitals through various sources. The bacteria responsible for causing Fournier gangrene are listed below:

  • Escherichia coli (E.coli).

  • Proteus.

  • Staphylococcus.

  • Streptococcus.

  • Bacteroides.

  • Clostridium.

  • Peptostreptococcus.

The bacteria gains entry into the human body through the following ways:

How Do Bacteria Damage the Body in Fournier Gangrene?

The skin is the first line of defense against any bacterial infection. However, the problem occurs when abscesses, ulcers, insect bites, and burn injuries cause a break in the continuity of the skin. As a result, the bacteria enter the body and multiply rapidly to infect the organs. The mechanism by which the bacteria damage the body in Fournier gangrene is described below.

  • First, the bacteria enter the penis, scrotum, and perineal region and damage the muscle fascia and the surrounding tissues.

  • Fascia is a thin layer of connective tissue that covers the body's blood vessels, muscles, nerves, bones, and organs. The skin comprises a layer of connective tissues and fat cells known as subcutaneous tissue.

  • Certain blood vessels are also present in the muscle fascia and the subcutaneous tissue. These blood vessels supply nutrients and oxygen to the body tissues. Also, an artery known as the pudendal artery supplies blood to the scrotum and the sex organs.

  • When the bacteria enter the subcutaneous tissues, they destroy the pudendal artery. As a result, the blood supply to the penis, scrotum, and other sex organs is lost, resulting in the death of the tissues.

  • The bacteria move further and damage the muscles, skin, and arteries of the penis, perineum, and scrotum.

  • Finally, the bacteria spread to the chest, thigh, and stomach and damaged them. At this point, the patient starts experiencing the symptoms. By the time the patient notices the condition, the bacteria have already damaged the major blood vessels of the genital tract.

  • Fournier gangrene is a dangerous condition. Every hour is a battle of life and death, and the patient needs intensive care and protection.

What Are the Risk Factors for Fournier Gangrene?

Fournier gangrene is a severe condition in which the organs of the urogenital tract, like the penis and scrotum, get damaged due to bacterial infection. The factors that increase the risk of Fournier gangrene are listed below:

  1. Diabetes - Diabetes is a condition in which the blood sugar levels are high due to insulin resistance or lack of insulin. High blood glucose levels damage the blood vessels of the body. As a result, the organs like the penis and scrotum fail to receive a good blood supply, increasing the risk of Fournier gangrene.

  2. Smoking - Smokers are more likely to develop Fournier gangrene than non-smokers. Smoking blocks the arteries, resulting in the loss of blood supply to the body's organs.

  3. Atherosclerosis - Atherosclerosis is a condition in which the blood vessels become narrow due to the deposition of fats. As a result, the tissues do not receive a proper blood supply, and they die.

  4. Obesity - Obesity or excessive weight puts pressure on the arteries, increasing gangrene risk. When the arteries get compressed, they cannot supply blood to the body tissues.

  5. Hypertension - Hypertension or high blood pressure increases the risk of gangrene because the blood vessels get damaged when the blood flows under high pressure.

  6. Immunocompromised Disorders - Patients suffering from immunocompromised disorders like Human immunodeficiency virus (HIV) are more likely to suffer from Fournier gangrene. It is because these patients have weak immune systems and cannot fight bacteria.

  7. Cirrhosis - Cirrhosis is a condition in which healthy liver tissues are damaged and replaced by scar tissues. Cirrhosis slows down the blood flow and increases the risk of tissue necrosis and gangrene.

  8. Aging - People above 50 are at a high risk of gangrene because they suffer from other disorders like diabetes and atherosclerosis that damage the blood supply to the tissues.

What Are the Signs and Symptoms of Fournier Gangrene?

The symptoms of Fournier gangrene can be divided into early symptoms and late symptoms. The symptoms that are noticed first are listed below:

  • Swelling of the genitals and the perineum.

  • Pain in the genitals and perineum.

  • Redness of the perineal region.

The symptoms that are seen at a later stage are listed below:

  • The altered mental state of the patient.

  • Fever.

  • Dehydration.

  • Inflammation.

  • Fatigue.

  • Nausea and vomiting.

  • Moderate to severe abdominal pain.

  • Foul smell.

  • Hypotension, or low blood pressure.

  • Tachycardia, or increased heart rate.

  • A crackling sound is heard when the patient rubs the infected area (crepitus).

  • Restricted flow of urine due to urethral obstruction.

  • Urine accumulates in the body cavities rather than the bladder.

What Tests Are Done to Diagnose Fournier Gangrene?

The diagnosis of Fournier gangrene is based on medical history, blood tests, physical examination, and imaging tests. The diagnostic methods are listed below:

1. Medical History - The medical history gives an idea about the patient's general health. The doctor might ask questions related to the symptoms, the time of their onset and progression, drug history, recent injury, and if the patient has undergone any surgery in the past.

2. Physical Examination - The doctor checks the physical signs of Fournier gangrene, like tenderness and swelling in the genitals, skin itching, and inflammation. The heart rate and blood pressure of the patient are also checked because patients who are suffering from Fournier gangrene often present with tachycardia and hypotension.

3. Comprehensive Metabolic Panel - It is a type of blood test that helps the doctor check the levels of white blood cells, electrolytes, glucose, blood gases, creatinine, and proteins in the blood.

4. Imaging Tests - The following imaging tests are usually recommended:

  • Ultrasound - It is a type of imaging test in which the sound waves are sent to the body organs with the help of a device known as a transducer. The advantage of this procedure is that the person is not exposed to X-ray radiation, so it can be carried out in females and children. The doctor moves the transducer at different angles to obtain images of the internal organs. These images help to check whether the disease is Fournier gangrene or a similar disorder like epididymitis or orchitis.

  • Computed Tomography (CT) Scan - In this procedure, the patient is laid on a table, and a liquid (contrast medium) is injected into his body. The table slides into a tunnel-like device where the images are obtained. It provides three-dimensional (3D) images of the internal organs and helps to check the gasses and fluids present in the body. It also helps the doctor to identify the source of the infection.

  • X-rays - X-rays of the body organs help to detect the presence of a tumor, stones, and other diseases that cause infections. It also helps to check the distance up to which the air has spread into the soft tissues.

How to Manage Fournier Gangrene?

Treatment of Fournier gangrene is done with the help of antibiotics and surgery. The treatment options have been described below:

1. Antibiotics - Multiple bacteria are responsible for causing Fournier gangrene. So, the antibiotics must be strong enough to attack and kill all these bacteria. Such antibiotics are known as broad-spectrum antibiotics, as they kill different types of bacteria at the same time. The following drugs are usually recommended:

  • Clindamycin.

  • Vancomycin.

  • A combination of Ampicillin and Sulbactam.

  • Ciprofloxacin.

  • A combination of Piperacillin and Tazobactam.

2. Debridement - Surgical debridement is a procedure in which the dead and infected tissues of the affected area are removed. The affected skin is opened to expose the damaged tissues and the fascia. All the tissues contaminated due to bacterial infection are removed carefully. During the debridement procedure, only the infected tissues are removed and not the organs like the penis or testes.

3. Reconstructive Surgery - After the surgical debridement procedure, the doctor checks the area to ensure the healthy tissues have formed; next, reconstructive surgery is performed wherein the healthy skin is taken from other body areas and placed on the affected side. The surgery aims to restore the normal appearance of the organs affected by gangrene.

4. Hyperbaric Oxygen Therapy - As the name suggests, hyperbaric oxygen therapy aims to provide extra oxygen to the patient to allow wound healing. This therapy is carried out in a pressurized chamber that consists of oxygen. The patient is laid on a table that slides into a plastic tube. The pressure inside the tube slowly rises, exposing the patient to an oxygen-rich environment. When the patient breathes in the chamber, the oxygen enters the body and combines with the blood. This oxygenated blood flows to different organs of the body and slows down bacterial growth.

How to Prevent Fournier Gangrene?

There are no home remedies available to cure Fournier gangrene. However, the following steps help to reduce the risk of gangrene:

  1. The patient must keep his genitals clean to prevent bacterial accumulation.

  2. Use a clean razor while shaving to prevent injury and contamination.

  3. Diabetics must check their genitals and other areas for injury, swelling, or infection. It is because they are at a higher risk of developing Fournier gangrene.

  4. Maintain a healthy body weight and exercise regularly to stay fit.

  5. If the patient has a habit of smoking, chewing tobacco, and drinking alcohol, he must immediately quit these habits.


Fournier gangrene is a condition in which bacteria accumulate in the genitals, mainly the penis, scrotum, and perineal region. The blood supply is lost due to bacterial accumulation, and the tissues present in these areas die. It is a life-threatening condition that cannot be cured at home, and the patient must be rushed to the hospital immediately. The treatment depends on how early the patient notices the symptoms. Antibiotics are enough to cure the disease if the patient consults the doctor on time. However, the patient must undergo surgical debridement and reconstructive surgery in later stages. The disease can also be prevented in several ways, like maintaining a healthy body weight and practicing good hygiene. Consult the doctor to know more about Fournier gangrene and its treatment options.

Frequently Asked Questions


What Is Fournier Gangrene?

Fournier gangrene is a rare genetic disorder that affects the penis, scrotum, and perineum (the area between the scrotum and the anus). It is a life-threatening and rapidly spreading necrotizing fasciitis. The disease is caused by bacteria and is commonly seen in males.


What Type of Bacteria Causes Fournier Gangrene?

The bacteria responsible for causing Fournier gangrene are Escherichia coli (E.coli), Peptostreptococcus, Proteus, Streptococcus, Bacteroides, Clostridium, and Staphylococcus. Fournier gangrene is caused by bacteria entering the genitals through various sources such as genital piercing, abscess or swelling, and urinary tract infection or bladder infection.


What Does Fournier Gangrene Look Like?

Fournier gangrene appears with a swelling of the genitals and perineum. The skin in the affected area becomes red and becomes painful. Later stages are marked by fever, dehydration, changes in the patient's mental state, abdominal pain, and foul-smelling genitals.


How Does Fournier Gangrene Spread?

Fournier gangrene infection spreads along the fascial planes. It is usually limited by the attachment of the Colles' fascia in the perineum (the area between the scrotum and the anus). Infection can involve the scrotum and penis and spread up the anterior abdominal wall to the clavicle. Unless aggressively treated, the infection can rapidly progress to sepsis with multiple organ failure, a common cause of death in these patients.


How Do I Know if I Have Fournier Gangrene?

Fournier gangrene presents with fever, malaise, moderate-to-severe abdominal pain, and swelling in the genital and anal areas (perineal). The foul smell of the affected tissues (fetid suppuration) leads to full-blown (fulminating) gangrene. Rubbing the affected area produces distinct sounds (crepitus) of gas in the wound and tissues moving against one another (palpable crepitus). In severe cases, the death of tissue can extend to the thighs, through the abdominal wall, and up to the chest.


How Does Fournier Gangrene Affect the Body?

Fournier gangrene is a dangerous and potentially fatal condition. It occurs when the blood flow to a large tissue area is cut off due to a bacterial infection. This causes the tissue to break down and die. The disease causes the affected skin to be foul-smelling and brownish-colored.


What Is the Mortality Rate for Fournier Gangrene?

Fournier gangrene is a life-threatening bacterial infection. In severe cases, the bacterial infection can cause sepsis, and gangrene can spread to the genitals, the thighs, and the chest wall. The mortality rate for Fournier gangrene is around 20 % to 30 %.


What Causes Perineal Necrotizing Fasciitis?

Perineal necrotizing fasciitis is a rapidly spreading necrotic inflammation in the soft tissue of the perineal areas, perianal spaces, genital areas, the abdominal wall, and the hips. There are various bacteria causing necrotizing fasciitis, amongst which the most common is group A Streptococcus. This bacteria is also responsible for skin infections and severe illnesses like toxic shock syndrome.


What Does Necrotizing Fasciitis Look Like When It First Starts?

The first symptoms of necrotizing fasciitis include a change in the color of the tissues to red due to inflammation of the affected areas. Severe pain beyond the affected area of the skin. Fever and skin blisters with a crackling sensation under the skin follow this. Grayish foul-smelling discharge from the wound can be present.


Can You Survive Necrotizing Fasciitis?

Though Fournier gangrene is a serious and rapidly spreading bacterial infection, it can be treated. Early diagnosis and an antibiotic regimen can slow down the rate of infection and also helps in healing. Treatment involves immediate administration of intravenous antibiotics and surgical removal of the dead or infected tissue from the wound.


What Are Perineal Tissues?

The perineum is the skin between the genitals, vaginal opening, scrotum, and anus. This skin consists of tissue that comprises the bottom of the pelvic cavity. In males, this area is present between the anus and the bulb of the penis. Whereas in females, it is found between the anus and the posterior limit of the vulvar orifice.


What Is the Perineal Body Composed Of?

The perineum is the area located below the pelvic diaphragm. It is made up of muscle-fascial formations arranged to close the pelvis inferiorly. The perineal body comprises two regions, one dorsal, and one ventral.


What Is Perineal Granulation Tissue?

Any perineal wound leads to raised red patches of tissue called granulation tissue. This can cause bleeding and tissue inflammation. It can be mistaken for a new infection but does not resolve by antibiotics.

Last reviewed at:
12 Jul 2023  -  8 min read




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