PUVA Treatment and Male Fertility Concerns
While PUVA therapy is known to be mutagenic and requires genital shielding during treatment, the available evidence does not establish a direct causal link between past PUVA exposure and current low sperm count. The primary concern with PUVA and male genitalia is the dramatically increased risk of genital skin cancers, not fertility impairment.
Understanding PUVA's Effects on Male Genitalia
The British Association of Dermatologists guidelines emphasize that shielding of high-risk areas on the genitalia is essential during PUVA treatment to prevent serious complications 1. This recommendation exists primarily because:
- Men exposed to high levels of PUVA have a 286-fold increased risk of invasive squamous-cell carcinoma of the penis and scrotum compared to the general population 2
- The standard morbidity ratio for genital neoplasms in PUVA-treated patients is 95.7 for invasive squamous-cell carcinoma 2
- This risk is strongly dose-dependent and increases with cumulative PUVA exposure 2
What the Evidence Shows About Fertility
The mutagenic properties of PUVA are well-documented 1, but this relates primarily to:
- Skin cancer risk (the dose-dependent increase in squamous cell carcinomas) 1, 3
- Pregnancy concerns (women should avoid conception during active PUVA therapy) 1
- Teratogenic potential in animal studies, though not confirmed in humans 1, 4
Importantly, a large registry study of 504 infants born after parental PUVA treatment found no increase in infant mortality or congenital malformations 4. While there was an increase in low-birth-weight infants, this was likely related to the underlying disease rather than PUVA treatment itself 4.
Your Specific Situation
The lack of genital shielding during your past PUVA treatment is concerning primarily for skin cancer risk, not fertility. Here's what you should do:
Immediate Actions:
- Undergo a complete dermatological examination of your genital area to screen for any premalignant or malignant lesions 1
- Consult a urologist or fertility specialist to evaluate your low sperm count through comprehensive semen analysis and hormonal assessment
- Consider other common causes of male infertility (varicocele, hormonal imbalances, infections, medications, lifestyle factors)
Long-Term Monitoring:
- Annual full-body skin examinations are recommended for all patients who received >150-200 PUVA treatments 1
- Particular attention to genital skin given your lack of protective shielding during treatment 2
- Self-examination for new or changing lesions in the genital area 5
Important Caveats
Do not assume PUVA caused your low sperm count without proper fertility evaluation. The evidence does not support a direct link between past PUVA exposure and reduced sperm production. Multiple other factors are far more commonly responsible for male infertility and should be systematically evaluated by a fertility specialist.
The real concern from unprotected genital exposure during PUVA is the dramatically elevated risk of genital skin cancers, which requires immediate dermatological assessment and ongoing surveillance 2.