Every man should strive to learn as much as possible about his genital region. The more you know, the more motivated you will be to take care of it.
For example, scrotum health is incredibly important, yet we tend to underestimate it. In this post, we are going to talk about the scrotum, its anatomy, function, and the most common conditions that affect this area.
What is the scrotum?
A common belief is that scrotum is just another term for testicles. Wrong. In the male reproductive system, the scrotum is a thin external sac of skin that hangs from the body at the front of the pelvis, between the legs.
Scrotal mass resides next to the upper thighs, just below your penis. The sac of skin holds a man’s testicles. Testicles or testes are two oval-shaped organs (or glands) responsible for making sperm and are involved in the production of testosterone.
The fibromuscular cutaneous sac located between the penis and anus is dual-chambered, thus forming an expansion of the perineum. The perineum is the area between the anus and genitals. Embryologically speaking, the scrotum derives from the paired genital swellings. During development, the genital swellings fuse in the midline. In the adult person, this fusion is marked by the scrotal raphe. The scrotal raphe, also known as perineal raphe, is a longitudinal line in the middle of the scrotum.
It’s useful to know the scrotum is biologically homologous to the labia majora. The term labia majora refers to the parts of the female genitalia, i.e., two marked folds of skin known as fleshy outer lips of a vagina.
The scrotum hangs outside the body to create the ideal environment in which testicles can produce sperm. Sperm production requires a slightly lower temperature than the rest of the body. Tissues of the scrotum protect testicles and are crucial for your sexual and reproductive health.
Anatomy and function of the scrotum
The scrotum is a fibromuscular cutaneous sac (a sac of skin) divided into two parts by scrotal raphe, i.e., the line down the middle of the scrotum. The perineal raphe connects the internal septum with the scrotum. The internal septum divides the scrotal sac into two parts with similar anatomy. Therefore, each side of the scrotum contains the following:
- Testicle – the site of sperm production. As mentioned above, testicles also produce androgen hormones, of which testosterone is the most significant. Generally speaking, the left testicle lies lower than the right. Testes get their ovular shape from tissues called lobules. Lobules are made of coiled tubes surrounded by dense connective tissues. Testicles are covered with a serous membrane called tunica vaginalis. Tubules in testicles are lined with a layer of tissue called the epithelium. This layer consists of Sertoli cells that generate sperm and participate in the production of testosterone. Among Sertoli cells are spermatogenic cells that divide and turn into sperm cells, i.e., spermatozoa. Next to tubules are tissues called Leydig cells, which produce male hormones. Once the sperm is produced, it moves from testicles to the next structure in the scrotum – epididymis. Rete testis, a network of small tubules, helps move sperm.
- Epididymis – a long, coiled tube whose main purpose is to store sperm and transport it from testicles. Epididymis appears as a curved structure at the back margin of each testicle. The structure has three sections. These sections are head, body, and tail. The head is near the top of the testicle. It stores sperm until it’s ready to undergo maturation. Sperm matures in the body of the epididymis. The body appears as a long, twisted tube. Maturation takes about a week or two on average. The tail connects to the deferent duct, also known as vas deferens or ductus deferens. From this point, the sperm is transported to the ejaculatory tract. In the epididymis, sperm acquires motility as it maturates so that it’s able to fertilize an egg. The epididymis absorbs extra fluid secreted by the testicles, too. This fluid helps move sperm through the reproductive tract.
- Spermatic cord – a bundle of fibers and tissues that create a cord-like structure running through the abdominal region down to the testicles. The spermatic cord appears as a pair with one cord connecting to either the right or left testicle. Each cord contains nerves, blood vessels, lymph vessels, and vas deferens. A loose network of small veins in the spermatic cord is called pampiniform plexus. The primary function of the spermatic cord is to facilitate the passage of semen. The blood vessel’s role is to maintain the blood supply for the testicle, vas deferens, and cremaster muscles. The nerves serve to transport information from the spinal cord to and from the scrotum, cremaster muscle, and testicles.
- Cremaster muscle – covers the testicles and spermatic cord. The muscles move the testicles promoting healthy and motile sperm. Cremaster muscle moves the testicle toward and away from the body to maintain a suitable temperature for the production of sperm. This muscle is the reason your scrotum is closer to the body in winter and hangs lower in summer.
The scrotal wall surrounds all the structures in the scrotum. Dartos fascia, smooth muscle, lines the scrotal wall. Dartos muscle works together with cremaster muscle to tighten or expand the scrotal skin, move it up and down, and regulate the temperature.
Neurovascular supply to the scrotum comes from nearby nerves and vessels. When it comes to the vessels, the scrotum receives arterial supply from the anterior and posterior scrotal arteries. The arterial scrotal artery arises from the external pudendal artery, whereas the posterior derives from the internal pudendal artery. The pudendal arteries are a group of arteries that supply muscles and organs in the pelvic cavity. Veins in the scrotum follow major arteries and drain into the external pudendal veins.
Several nerves are involved in the anatomy of the scrotum. Anterior or frontal scrotal nerves derive from the genital branch of genitofemoral and ilioinguinal nerves. The genitofemoral nerve is a nerve found in the abdomen; it has a genital branch which supplies sensation to the anterior scrotal area. The ilioinguinal nerve is the branch of the first lumbar (spinal) nerve.
On the other hand, the scrotum’s posterior or back area involves nerves from the perineal branches of pudendal nerves and the posterior femoral cutaneous nerve. Pudendal nerves run from the back of the pelvis to near the base of the penis. On the other hand, the posterior femoral cutaneous nerve is, basically, the posterior cutaneous nerve of the thigh.
What conditions affect the scrotum?
Now that you know more about the scrotum’s function and anatomy, it’s time to discuss an important subject. Like other parts of a male genital or reproductive area, the scrotum is also prone to various scrotal conditions.
These conditions may induce different symptoms and negatively affect your quality of life. Below, we are going to discuss the most common conditions that affect the scrotum.
Epididymitis is an inflammation of the epididymis. It can be an acute scrotum condition or a chronic disease. Numbers show that one in 1000 men develops epididymitis each year.
Acute epididymitis accounts for over 600,000 medical visits per year in the United States. It’s also useful to mention that epididymitis is the most common cause of intrascrotal inflammation. The condition usually occurs due to bacterial infection.
Causes of epididymitis
Causes of this problem include:
- Sexually transmitted infections (STIs) – Chlamydia and gonorrhea are the most common causes of epididymitis in young and sexually active men.
- Tuberculosis – rare are the cases when epididymitis occurs due to tuberculosis, but it’s possible.
- Trauma – injury to the groin can cause epididymitis.
- Urine in the epididymis – i.e., chemical epididymitis, occurs when urine flows backward into the epididymis, usually due to straining and heavy lifting.
- Other infections – bacteria from the urinary tract or prostate infection can spread to epididymis. Some viral infections, such as the mumps virus, can cause epididymitis.
Every man can develop epididymitis, but some are at a higher risk than others. If you are sexually active, you are more likely to develop epididymitis if you have sex with a partner who has STI. Having sex without a condom and a history of STIs are also risk factors for epididymitis in sexually active males.
Other risk factors for epididymitis, which also apply to men who aren’t sexually active, include:
- History of prostate or urinary tract infections
- Prostate enlargement
- Uncircumcised penis or anatomical abnormality of the urinary tract
- History of medical procedures involving the urinary tract
Signs and symptoms of epididymitis may include:
- Swollen, red, warm scrotum
- Blood in the semen
- Pain and tenderness that comes gradually in the testicle (on one side usually)
- Pain and discomfort in the lower abdomen or pelvic region
- Painful urination
- Urinary frequency and urgency
- Discharge from penis
- Fever (less common)
Treatment depends on the exact cause of epididymitis. You may need to take antibiotics or antiviral medications.
An inguinal hernia is a problem that occurs in the abdomen near the groin area. It occurs when the tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles.
Inguinal hernias can occur at either of two passages through the abdominal wall, one on each side of the groin. These passages are called inguinal canals. This condition is relatively common and affects about 27% of men. In some cases, inguinal hernias follow the spermatic cord’s path into the scrotum while others stay outside it.
Causes of inguinal hernia
Inguinal hernia, in some cases, has no obvious cause. However, in other cases, the condition may occur due to several causes such as:
- Increased pressure in the abdomen
- Chronic coughing or sneezing
- Strenuous activity
- Straining during urination or bowel movements
- A pre-existing weak spot in the abdomen
Common risk factors for the development of inguinal hernia include:
- Being male
- Being white
- Family history of inguinal hernia
- Previous inguinal hernia or hernia repair
Signs and symptoms of an inguinal hernia may include:
- The bulge in the area on either side of the pubic bone
- Bulge becomes more obvious when you’re upright
- Burning or aching sensation in the bulge
- Weakness or pressure in the groin
- Pain and swelling around the testicles when the protruding intestine descends into the scrotum
The doctor may recommend watchful waiting if your hernia is small and isn’t bothering you. Larger inguinal hernias may require surgery to prevent tissue death due to impaired blood flow.
Testicular torsion happens when a testicle rotates and twists the spermatic cord. This cuts off blood supply to the scrotum but also “blocks” nerve function and sperm transport to the testicle. The impaired blood flow induces sudden and severe pain and/or swelling. For that reason, testicular torsion is a medical emergency.
When we’re talking about this condition, it’s also useful to mention testicular appendage torsion. Testicular appendage torsion is the twisting of a small piece of tissue above the testicle.
Causes of testicular torsion
The exact cause of testicular torsion is unclear. In most cases, men have an inherited trait that causes this problem. Testicular torsion may affect both testicles. Not every man with an inherited trait will experience testicular torsion. The condition usually affects males ages 12 to 18. You can also experience testicular torsion due to scrotal injury, excessively strenuous exercises.
The most common symptoms of testicular torsion include:
- Sudden and severe scrotal pain
- Scrotal swelling
- Nausea and/or vomiting
- Abdominal pain
- Frequent urination
- The testicle is positioned at an unusual angle, or it’s higher than normal
To permanently fix the problem, the doctor may recommend surgery. The sooner they untwist the testis, the higher the chance of it being saved. If treatment is delayed by over 12 hours from the start of pain, 75% need testicle removal.
Testicular cancer is a type of cancer that affects testicles. The American Cancer Society estimates that 9,470 new testicular cancer cases will be diagnosed in the U.S. in 2021. About 440 deaths may occur this year, the report shows. This type of cancer is not that common. It affects about one in 250 men. The average age at diagnosis is 33.
Causes of testicular cancer
The cause of testicular cancer is still unknown. Like other types of cancer, this disease develops when cells start multiplying abnormally within the tissues. In this case, the tissues of the testicles are affected. Cancer tends to start in the germ cells – cells that produce immature sperm.
Risk factors for the development of testicular cancer include:
- Family history of testicular cancer
- Undescended testicle
- Abnormal development of testicle
- Being white
- Being between 15 and 35 years of age
Signs and symptoms of testicular cancer may include the following:
- Enlargement or lump in a testicle
- Enlargement and/or tenderness of breasts
- A dull ache in the abdomen and groin area
- Pain and discomfort in the testicle and/or scrotum
- Back pain
- A sudden collection of fluid in the scrotum
In most cases, testicular cancer affects one testicle only.
Testicular cancer is a treatable condition. The course of the treatment depends on the stage of testicular cancer. The doctor may recommend surgical removal of the affected testicle, chemotherapy, stem cell transplant, or radiation therapy.
Orchitis is an inflammation of one or both testicles. Orchitis alone is uncommon. The condition is usually accompanied by epididymitis. For that reason, the true incidence of orchitis is still unknown.
Causes of orchitis
Causes of orchitis are similar to those of epididymitis. Orhicits can be viral or bacterial. The condition can develop due to:
- Sexually transmitted infections
- Having been born with abnormalities in the urinary tract
- Having had a catheter or other medical instruments inserted into the penis
- Mumps virus
Common risk factors for orchitis include:
- Not being immunized against mumps
- Recurring urinary tract infections
- Multiple sexual partners
- Sex with a partner who has STI
- Having sex without a condom
- History of STI
The most common signs and symptoms of orchitis include:
- Swelling in one or both testicles
- Mild-to-severe pain
- Feeling unwell
- Nausea and/or vomiting
Treatment of orchitis depends on the cause. You may need to take antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs). Serious cases may require hospitalization. In most cases, men with orchitis recover in three to 10 days. But, it may take several weeks for the tenderness in the scrotum to go away.
As you can see, conditions that affect the scrotum are numerous. But the list doesn’t stop there. Other problems that affect the scrotum include:
- Hydrocele – the buildup of excess fluid in the cavities around a testicle. In some men, the condition is present at birth. Other males may develop hydrocele due to injury or inflammation. Symptoms include swelling, dull ache, heaviness in the scrotum. Most cases are resolved on their own without treatment. Severe hydrocele would require surgery.
- Varicocele – swollen collection of veins in the scrotum. The condition is identified in 15% of healthy men and 35% of men with primary infertility. Some men can have varicocele their whole life without requiring treatment. Varicocele may cause testicular shrinkage or infertility.
- Spermatocele – also known as a spermatic cyst, occurs when a fluid-filled sac develops in the epididymis. The epididymal cyst is not dangerous and will not cause cancer. But, large cysts may cause discomfort.
- Bifid scrotum – rare genetic malformation that includes a midline cleft in the scrotum associated with incomplete fusion of labioscrotal folds
- Retractile testicle – a testicle that may move back and forth between the scrotum and the groin. This problem is usually present in kids.
- Accessory scrotum – unusual development anomaly appearing as an additional scrotal tissue besides normally developed scrotum
What are the common symptoms of a scrotum condition?
A wide range of conditions can develop in the scrotum area ranging from the undescended testis to many other things. Sometimes men ignore some symptoms thinking they will go away. You shouldn’t do that. Consult your doctor if you experience the following scrotum symptoms or in the groin region:
- Mild-to-severe pain that comes suddenly or lasts a long time
- Pain in the groin during activity
- Itchy rash
- Feeling of heaviness in the scrotum
- Frequent urination
- Blood in semen or urine
- Drainage or discharge from the penis
- Avoid skin irritants, i.e., products with harsh chemicals
Based on the symptoms, the doctor will suspect what’s the problem. They will perform a physical examination and order certain tests such as scrotal ultrasound to rule out conditions with similar symptoms. Then, they will diagnose the problem and recommend the most suitable treatment approach.
Tips for a healthy scrotum
Although conditions that affect the scrotum can be serious and frustrating, there’s a lot you can do to improve this area’s health. These tips can help you out:
- Do a self-exam by feeling each testicle for lumps or swelling
- Exercise regularly
- Wear protection when playing sports
- Hygiene is essential, so you need to shower or bathe regularly (poor hygiene can lead to smegma, a cheesy-looking substance that builds up in the foreskin and has a foul smell)
- Eat a well-balanced diet
- Avoid clothes, especially underwear, that are too tight
- Wear loose and comfortable clothes
- Use a condom to avoid STIs and foreskin retraction (which can also cause infections)
- Avoid shaving, trim instead
- Ejaculate often
- Get enough sleep
- Quit smoking
- Limit or avoid alcohol consumption
- Consume antioxidant-rich foods
The scrotum is a sac that houses your testicles. Like other parts of the genital area, the scrotum is prone to various conditions. Symptoms of these conditions are painful, frustrating, and affect your quality of life. See your doctor if you notice the symptoms we listed above. Remember, a healthy lifestyle is important for a healthy scrotum.