THE SCROTUM
The scrotum is the loose pouch of skin that dangles behind the penis. It consists of an outer layer of sparsely haired, wrinkled skin with an inner lining of muscular tissue. Inside the scrotum a thin membrane divides it into two separate compartments, each of which contains a testis.
The scrotal skin is wrinkled and darker than other body skin and often sports a reddish hue. Several conditions affect the area, most of which also occur on hair-bearing skin found elsewhere on the male body.
Infected Hair Follicles
Scrotal hair follicles can become infected just like those on any other patch of skin. Usually, a common skin bacterium called Staphylococcus aureus is the cause. A small pustule will develop, which can be frightening in this particular area. If in any doubt of the diagnosis, see your doctor for advice. Anti- biotic creams (or tablets) are only occasionally needed. Usually, scrupulous hygiene will allow the condition to resolve.
Boil
Occasionally, an infected hair follicle progresses to form a boil. The groin is a common site due to the warmth, humidity and plentiful skin bacteria present there. A boil starts as a red, painful lump. As it swells, it becomes filled with pus and develops a yellow tip which will eventually burst and drain on its own. Do not try to force the boil by squeezing it this can spread infection. Consult your doctor to confirm the diagnosis and ask if antibiotics are indicated. These are often given to reduce the risk of epididymo-orchitis. Doctors sometimes drain a large boil using a sterile needle to remove the pus, and it is always a good idea to have your urine tested for sugar (boils are more common in patients with sugar diabetes).
Sebaceous Cysts
Skin that bears hair is kept soft by the oil (sebum) secreted by sebaceous glands. These glands open into the hair follicles and, if blocked, become distended by their own secretions. Eventually, enough sebum accumulates to form a sebaceous cyst a smooth, firm nodule in the skin.
The cyst contains a white-yellow cheesy material and sometimes has a visible opening onto the skin. The tip of the grease plug may then look dark brown or black (blackhead) due to the presence of the skin pigment, melanin not dirt as is commonly believed.
All lumps on the scrotum are best checked by a doctor. If the sebaceous cyst is small and causing no problems, it may safely be left alone. Larger cysts may cause friction and are unsightly, so are usually excised under a local anaesthetic.
Sebaceous cysts frequently become infected particularly in the groin region where bacteria are prevalent. An infected cyst is red, swollen, painful and frequently discharges a foul-smelling pus. This is damped down with antibiotics and then excised to prevent future recurrent infections.
If the cyst wall is removed entirely, the sebaceous cyst should not recur. Often, a small piece of cyst wall is inadvertently left behind. This continues to secrete sebum and the cyst will then reform.
Fungal Infections
Skin fungal infections are common in areas that are warm and moist. This includes the fold of skin between the scrotal sack and the top of the thigh. The first symptom is often itching, followed by a dry, red rash with a sharply defined edge. If the area is subjected to heavy sweating (e.g., in the obese) the skin may break down to form a raw, sore area that oozes straw-coloured fluid. This hardens to form pale brown crusts. Treatment involves scrupulous hygiene, keeping the area as dry and open to the air as possible, plus anti-fungal powders or creams.
Scrotal Skin Cancer
Cancer of the scrotal skin usually occurs over the age of 50 years. It was the first cancer to be linked to occupation when, in 1775, scrotal cancer was linked with soot exposure in young chimney sweeps. It is now known that chemicals in soot, tar and oil (hydrocarbons) are carcinogenic, meaning that they can trigger tumours. Oily substances left on the hands are absorbed by penile and scrotal skin during handling of the genitals. Men (such as engineers) who work with oily substances should be scrupulous about washing their hands before (as well as after!) going to the toilet. There is also a risk of oil penetrating through the clothes of garage mechanics, machine operators, etc. Where possible, oil-proof clothes/aprons should be worn.
Scrotal cancer causes an ulcer or lump on the skin. This is often painless and not tender. It will start off small and round but will enlarge to form an irregular shape. Eventually, a pus-stained discharge appears, and if the ulcer is hidden in the fold between the scrotum and leg, this may be the first thing noticed. Sometimes lumps in the groin (swollen glands) are the first sign of a problem, though the scrotal lesion will have been present for some time before the cancer spreads to these lymph nodes. The diagnosis is made with a biopsy and, depending on size, the tumour is treated by surgical removal, radiotherapy, cryotherapy (extreme cold) or chemotherapy.
Scrotal Sinuses
Disease of the underlying testis (e.g. a cancer) or epididymis (e.g. long-term infection) can track through the scrotum to form a passageway known as a sinus. This looks like a red hole which leaks pus-stained or straw-coloured fluid. Any lump, ulcer or discharge noticed in the genital area should be checked with a doctor as soon as possible.
