Scrotum Health Dictionary

Chronically oedematous (see OEDEMA) and thickened tissue, especially involving the lower extremities and genitalia, which arises from repeated attacks of in?ammation of the skin and subcutaneous tissue, with concurrent obstruction of lymphatic vessels. In a tropical country, the usual cause is lymphatic FILARIASIS.

Filarial elephantiasis Wuchereria bancrofti and Brugia malayi are conveyed to humans by a mosquito bite. Resultant lymphatic obstruction gives rise to enlargement and dis?guration, with thickening of the skin (resembling that of an elephant) in one or both lower limbs and occasionally genitalia (involving particularly the SCROTUM). By the time the condition is recognised, lymphatic damage is irreversible. However, if evidence of continuing activity exists, a course of diethylcarbamazine should be administered (see FILARIASIS). Relief can be obtained by using elastic bandaging, massage, rest, and elevation of the affected limb. Surgery is sometimes indicated. For prevention, destruction of mosquitoes is important.... elephantiasis

An undescended testis (see TESTICLE). The testes normally descend into the scrotum during the seventh month of gestation; until then, the testis is an abdominal organ. If the testes do not descend before the ?rst year of life, they usually remain undescended until puberty – and even then, descent is not achieved in some instances. Fertility is impaired when one testis is affected and is usually absent in the bilateral cases. The incidence of undescended testis in full-term children at birth is 3·5 per cent, falling to less than 2 per cent at one month and 0·7 per cent at one year. Because of the high risk of infertility, undescended testes should be brought down as early as possible and at the latest by the age of two. Sometimes medical treatment with HUMAN CHORIONIC GONADOTROPHIN is helpful but frequently surgical interference is necessary. This is the operation of orchidopexy.... cryptorchidism

This comprises the VAS DEFERENS, nerves and blood vessels, and it runs from the cavity of the ABDOMEN to the TESTICLE in the SCROTUM.... spermatic cord

When testes do not descend into the scrotum, normally in young children (CRYPTORCHIDISM), an operation is performed to correct this. This is called surgical orchidopexy. The main reason is probably cosmetic; however, a testis which has descended is less likely to become cancerous than one which has not. It is less likely that treatment improves future fertility.... orchidopexy

The external organs of reproduction. The term is usually applied to the external parts of the reproductive system: the VULVA in females and PENIS and SCROTUM in males. Rarely the sex of an individual may not be apparent from the genitalia. Genitals develop from a common embryonic structure, and disturbances in the hormone controls of the developing genitalia may produce an individual whose external genitalia are ambiguous. The condition is known as intersex. The individual may be HERMAPHRODITE or PSEUDOHERMAPHRODITE.... genitalia

The absence of one testis, usually the result of the failure of one TESTICLE to drop down into the SCROTUM before birth. Monorchism is sometimes used to describe the condition when one testicle has been destroyed by disease or injury, or has been surgically removed – when, for example, the man has developed cancer of the testicle.... monorchism

A cystic swelling that develops in the SCROTUM when URINE escapes from the URETHRA, usually after injury. Prompt treatment is necessary and this is done by diverting the urine by inserting a suprapubic catheter (see CATHETERS) into the URINARY BLADDER, draining the cystocele and giving the patients antibiotics. The injured urethra can be surgically repaired later.... urocele

Every man has two testicles or testes which are the sexual glands. In the fetus, they develop in the abdomen, but before birth they descend into a fold or pouch of skin known as the SCROTUM. Each testicle consists of up to 1,000 minute tubes lined by cells from which the spermatozoa (see SPERMATOZOON) are formed. Around 4·5 million spermatozoa are produced per gram of testicle per day. These tubes communicate with one another near the centre of the testicle, and are connected by a much coiled tube, the EPIDIDYMIS, with the ductus, or VAS DEFERENS, which enters the abdomen and passes on to the base of the bladder. This duct, after joining a reservoir known as the seminal vesicle, opens, close to the duct from the other side of the body, into the URETHRA where it passes through the PROSTATE GLAND. Owing to the convolutions of these ducts leading from the testicles to the urethra, and their indirect route, the passage from testicle to urethra is over 6 metres (20 feet) in length. In addition to producing spermotozoa, the testicle also forms the hormone TESTOSTERONE which is responsible for the development of male characteristics.... testicle

A soft, painless swelling in the scrotum caused by the space around a testis filling with fluid. A hydrocele may be caused by inflammation, infection, or injury to the testis; occasionally, the cause is a tumour. More often, there is no apparent cause. Hydroceles commonly occur in middle-aged men, and treatment is rarely necessary. If the swelling is uncomfortable or painful, however, the fluid may be withdrawn through a needle. Recurrent swelling may be treated by surgery.... hydrocele

One of 2 male sexual organs, also called testicles, that produce sperm and the hormone testosterone. The testes develop in the fetus within the abdomen and usually descend into the scrotum by birth or within the next few months.

Each testis contains seminiferous tubules that produce sperm. Cells between the seminiferous tubules produce testosterone.

Each testis is suspended by the spermatic cord, composed of the vas deferens, blood vessels, and nerves. (See also testis, undescended.)... testis

The epididymus is the tube which receives the ducts of the testicle; in acute bacterial infection it becomes swollen and painful. The cause may be invasion from an infected bladder or urethra. Symptoms: difficulty in passing urine, painful scrotum.

Indicated: antibacterials. Pulsatilla (American Dispensary)

Alternatives. Teas. Cornsilk, Marshmallow leaves.

Decoction. Marshmallow root.

Tablets/capsules. Pulsatilla, Saw Palmetto. Echinacea. Goldenseal.

Powders. Formula. Equal parts, Saw Palmetto, Pulsatilla, Black Willow, pinch of Cayenne. Dose: 500mg (two 00 capsules or one-third teaspoon) 3-4 times daily.

Liquid extracts. Alternatives. (1) Formula: equal parts: Black Willow, Echinacea, Pulsatilla. Dose: 30- 60 drops. (2) Echinacea 2; Saw Palmetto 2; Thuja 1. Dose: 30-60 drops. 3-4 times daily.

Topical. Scrotal ice packs. Cold Dogwood poultice. ... epididymitis

The thin muscle just under the skin of the SCROTUM which enables the scrotum to alter its shape.... dartos

The male organ through which the tubular URETHRA runs from the neck of the URINARY BLADDER to the exterior at the meatus or opening. URINE and SEMEN are discharged along the urethra, which is surrounded by three cylindrical bodies of erectile tissue, two of which (corpora cavernosa) lie adjacent to each other along the upper length of the penis and one (corpus spongiosum) lies beneath them. Normally the penis hangs down in a ?accid state in front of the SCROTUM. When a man is sexually aroused the erectile tissue, which is of spongy constituency and well supplied with small blood vessels, becomes engorged with blood.

This makes the penis erect and ready for insertion into the woman’s vagina in sexual intercourse. The end of the penis, the glans, is covered by a loose fold of skin – the foreskin or PREPUCE – which retracts when the organ is erect. The foreskin is sometimes removed for cultural or medical reasons.

A common congenital disorder of the penis is HYPOSPADIAS, in which the urethra opens somewhere along the under side; it can be repaired surgically. BALANITIS is in?ammation of the glans and foreskin. (See also REPRODUCTIVE SYSTEM; EJACULATION; IMPOTENCE; PRIAPISM.)... penis

A common contagious itching disease caused by Sarcoptes scabei hominis (see SARCOPTES) which can live only on human skin. The fertilised female burrows into the skin surface, creating a tunnel within the stratum corneum in which she deposits 2–3 eggs per day, as well as faecal pellets which contain the ALLERGEN which initiates the immune reaction responsible for symptoms. The adult female is just visible. Eggs hatch within 3–4 days, producing larvae. After successive moults these become adult mites and the 15-day lifecycle re-starts. A rapid build-up of mite numbers is not noticed by the host until an immune response induces itching after about six weeks. Subsequently, scratching reduces the adult mites to a dozen or fewer. Scabies is spread by skin-to-skin contact, usually via the hands: it thus spreads in a family or sexual setting. Though most common in young adults, scabies can affect any age-group.

Typically the patient complains of widespread severe itching, worse when the body is warm after a bath or in bed. Burrows are visible as wavy black lines 3–5 mm long in the skin of the hands, wrists or sides of the feet. The intensity of the rash depends on the immune response. Papules, pustules, crusts and excoriations are seen on the hands and there may be a widespread eczematous (see DERMATITIS) or urticarial (see URTICARIA) rash elsewhere. Papules or even nodules on the PENIS and SCROTUM are characteristic. In infants, burrows occur on the palms and soles. Diminished immune response in old age, DOWN’S (DOWN) SYNDROME, etc. lead to a type of scabies which is less itching and more scaly. Rarely, absence of immune response causes a mite-saturated, generalised scaly dermatitis (Norwegian scabies). Admission of such a patient to hospital may result in an outbreak of scabies in other patients, sta? and visitors caused by mite-infested airborne scale.

Treatment MALATHION 0·5 per cent aqueous lotion, or PERMETHRIN 5 per cent cream, applied to the whole body, except the head, for 24 hours and then washed o? cures the infection. In infants the head and neck should be included. The secondary eruption may take 2– 3 weeks to settle completely and 10 per cent crotamiton cream is used during this period. It is essential that all intimate contacts be treated simultaneously. FOMITES need not be treated.... scabies

Muscular tissue is divided, according to its function, into three main groups: voluntary muscle, involuntary muscle, and skeletal muscle – of which the ?rst is under control of the will, whilst the latter two discharge their functions independently. The term ‘striped muscle’ is often given to voluntary muscle, because under the microscope all the voluntary muscles show a striped appearance, whilst involuntary muscle is, in the main, unstriped or plain. Heart muscle is partially striped, while certain muscles of the throat, and two small muscles inside the ear, not controllable by willpower, are also striped.

Structure of muscle Skeletal or voluntary muscle forms the bulk of the body’s musculature and contains more than 600 such muscles. They are classi?ed according to their methods of action. A ?exor muscle closes a joint, an extensor opens it; an abductor moves a body part outwards, an adductor moves it in; a depressor lowers a body part and an elevator raises it; while a constrictor (sphincter) muscle surrounds an ori?ce, closing and opening it. Each muscle is enclosed in a sheath of ?brous tissue, known as fascia or epimysium, and, from this, partitions of ?brous tissue, known as perimysium, run into the substance of the muscle, dividing it up into small bundles. Each of these bundles consists in turn of a collection of ?bres, which form the units of the muscle. Each ?bre is about 50 micrometres in thickness and ranges in length from a few millimetres to 300 millimetres. If the ?bre is cut across and examined under a high-powered microscope, it is seen to be further divided into ?brils. Each ?bre is enclosed in an elastic sheath of its own, which allows it to lengthen and shorten, and is known as the sarcolemma. Within the sarcolemma lie numerous nuclei belonging to the muscle ?bre, which was originally developed from a simple cell. To the sarcolemma, at either end, is attached a minute bundle of connective-tissue ?bres which unites the muscle ?bre to its neighbours, or to one of the connective-tissue partitions in the muscle, and by means of these connections the ?bre affects muscle contraction. Between the muscle ?bres, and enveloped in a sheath of connective tissue, lie here and there special structures known as muscle-spindles. Each of these contains thin muscle ?bres, numerous nuclei, and the endings of sensory nerves. (See TOUCH.) The heart muscle comprises short ?bres which communicate with their neighbours via short branches and have no sarcolemma.

Plain or unstriped muscle is found in the following positions: the inner and middle coats of the STOMACH and INTESTINE; the ureters (see URETER) and URINARY BLADDER; the TRACHEA and bronchial tubes; the ducts of glands; the GALL-BLADDER; the UTERUS and FALLOPIAN TUBES; the middle coat of the blood and lymph vessels; the iris and ciliary muscle of the EYE; the dartos muscle of the SCROTUM; and in association with the various glands and hairs in the SKIN. The ?bres are very much smaller than those of striped muscle, although they vary greatly in size. Each has one or more oval nuclei and a delicate sheath of sarcolemma enveloping it. The ?bres are grouped in bundles, much as are the striped ?bres, but they adhere to one another by cement material, not by the tendon bundles found in voluntary muscle.

Development of muscle All the muscles of the developing individual arise from the central layer (mesoderm) of the EMBRYO, each ?bre taking origin from a single cell. Later on in life, muscles have the power both of increasing in size – as the result of use, for example, in athletes – and also of healing, after parts of them have been destroyed by injury. An example of the great extent to which unstriped muscle can develop to meet the demands made on it is the uterus, whose muscular wall develops so much during pregnancy that the organ increases from the weight of 30–40 g (1–1••• oz.) to a weight of around 1 kg (2 lb.), decreasing again to its former small size in the course of a month after childbirth.

Physiology of contraction A muscle is an elaborate chemico-physical system for producing heat and mechanical work. The total energy liberated by a contracting muscle can be exactly measured. From 25–30 per cent of the total energy expended is used in mechanical work. The heat of contracting muscle makes an important contribution to the maintenance of the heat of the body. (See also MYOGLOBIN.)

The energy of muscular contraction is derived from a complicated series of chemical reactions. Complex substances are broken down and built up again, supplying each other with energy for this purpose. The ?rst reaction is the breakdown of adenyl-pyrophosphate into phosphoric acid and adenylic acid (derived from nucleic acid); this supplies the immediate energy for contraction. Next phosphocreatine breaks down into creatine and phosphoric acid, giving energy for the resynthesis of adenyl-pyrophosphate. Creatine is a normal nitrogenous constituent of muscle. Then glycogen through the intermediary stage of sugar bound to phosphate breaks down into lactic acid to supply energy for the resynthesis of phosphocreatine. Finally part of the lactic acid is oxidised to supply energy for building up the rest of the lactic acid into glycogen again. If there is not enough oxygen, lactic acid accumulates and fatigue results.

All of the chemical changes are mediated by the action of several enzymes (see ENZYME).

Involuntary muscle has several peculiarities of contraction. In the heart, rhythmicality is an important feature – one beat appearing to be, in a sense, the cause of the next beat. Tonus is a character of all muscle, but particularly of unstriped muscle in some localities, as in the walls of arteries.

Fatigue occurs when a muscle is made to act for some time and is due to the accumulation of waste products, especially sarcolactic acid (see LACTIC ACID). These substances affect the end-plates of the nerve controlling the muscle, and so prevent destructive overaction of the muscle. As they are rapidly swept away by the blood, the muscle, after a rest (and particularly if the rest is accompanied by massage or by gentle contractions to quicken the circulation) recovers rapidly from the fatigue. Muscular activity over the whole body causes prolonged fatigue which is remedied by rest to allow for metabolic balance to be re-established.... muscle

The SCROTUM may be affected by various skin diseases, particularly eczema (see DERMATITIS) or fungal infection. A HERNIA may pass into the scrotum. Defective development of the testicles may lead to their retention within the abdomen, a condition called undescended testicle.

Hydrocoele is a collection of ?uid distending one or both sides of the scrotum with ?uid. Treatment is by withdrawal of the ?uid using a sterile syringe and aspiration needle.

Hypogonadism Reduced activity of the testes or ovaries (male and female gonads). The result is impaired development of the secondary sexual characteristics (growth of the genitals, breast and adult hair distribution). The cause may be hereditary or the result of a disorder of the PITUITARY GLAND which produces GONADOTROPHINS that stimulate development of the testes and ovaries.

Varicocoele is distension of the veins of the spermatic cord, especially on the left side, the causes being similar to varicose veins elsewhere (see VEINS, DISEASES OF). The chief symptom is a painful dragging sensation in the testicle, especially after exertion. Wearing a support provides relief; rarely, an operation may be advisable. Low sperm-count may accompany a varicocele, in which case surgical removal may be advisable.

Orchitis or acute in?ammation may arise from CYSTITIS, stone in the bladder, and in?ammation in the urinary organs, especially GONORRHOEA. It may also follow MUMPS. Intense pain, swelling and redness occur; treatment consists of rest, support of the scrotum, analgesics as appropriate, and the administration of antibiotics if a de?nitive microorganism can be identi?ed. In some patients the condition may develop and form an ABSCESS.

Torsion or twisting of the spermatic cord is relatively common in adolescents. About half the cases occur in the early hours of the morning during sleep. Typically felt as pain of varying severity in the lower abdomen or scrotum, the testis becomes hard and swollen. Treatment consists of immediate undoing of the torsion by manipulation. If done within a few hours, no harm should ensue; however, this should be followed within six hours by surgical operation to ensure that the torsion has been relieved and to ?x the testes. Late surgical attention may result in ATROPHY of the testis.

Tuberculosis may occur in the testicle, especially when the bladder is already affected. Causing little pain, the infection is often far advanced before attracting attention. The condition generally responds well to treatment with a combination of antituberculous drugs (see also main entry for TUBERCULOSIS).

Tumours of the testes occur in around 600 males annually in the United Kingdom, and are the second most common form of malignant growth in young males. There are two types: SEMINOMA and TERATOMA. When adequately treated the survival rate for the former is 95 per cent, while that for the latter is 50 per cent.

Injuries A severe blow may lead to SHOCK and symptoms of collapse, usually relieved by rest in bed; however, a HAEMATOMA may develop.... testicle, diseases of

The surgical operation performed to render men sterile, or infertile. It consists of ligating, or tying, and then cutting the ductus, or vas, deferens (see TESTICLE). It is quite a simple operation carried out under local anaesthesia, through a small incision or cut (or sometimes two) in the upper part of the SCROTUM. It has no e?ect on sexual drive or ejaculation, and does not cause impotency. It is not immediately e?ective, and several tests, spread over several months, must be carried out before it is safe to assume that sterility has been achieved. Fertility can sometimes be restored by a further operation, to restore the continuity of the vas; this cannot be guaranteed, and only seems to occur in about 20 per cent of those who have had the operation.... vasectomy

Acute inflammation of a testis along with its associated epididymis. Epididymo-orchitis causes severe pain and swelling at the back of the testis, and, in severe cases, swelling and redness of the scrotum.

The inflammation is caused by infection. Often, there is no obvious source of infection, but sometimes the cause is a bacterial urinary tract infection that has spread via the vas deferens to the epididymis. Treatment is with antibiotic drugs. If there is an underlying urinary tract infection, its cause will be investigated. (See also orchitis.)... epididymo-orchitis

A type of hernia in which part of the intestine protrudes through the abdominal wall in the

groin.

It can be direct, in which there is a localized weakness in the abdominal wall, or, in men, indirect, in which the intestine protrudes through the inguinal canal, the passage through which the testes descend into the scrotum.... inguinal hernia

A prosthesis inserted into the penis to help a man suffering from permanent impotence to achieve intercourse.

The various types include a silicone splint inserted in the tissues of the upper surface of the penis, and an inflatable prosthesis that is inflated by squeezing a small bulb in the scrotum.... penile implant

Ultrasound, or ultrasonic, waves comprise very-high-frequency sound waves above 20,000 Hz that the human ear cannot hear. Ultrasound is widely used for diagnosis and also for some treatments. In OBSTETRICS, ultrasound can assess the stage of pregnancy and detect abnormalities in the FETUS (see below). It is a valuable adjunct in the investigation of diseases in the bladder, kidneys, liver, ovaries, pancreas and brain (for more information on these organs and their diseases, see under separate entries); it also detects thromboses (clots) in blood vessels and enables their extent to be assessed. A non-invasive technique that does not need ionising radiation, ultrasound is quick, versatile and relatively inexpensive, with scans being done in any plane of the body. There is little danger to the patient or operator: unlike, for example, XRAYS, ultrasound investigations can be repeated as needed. A contrast medium is not required. Its reliability is dependent upon the skill of the operator.

Ultrasound is replacing ISOTOPE scanning in many situations, and also RADIOGRAPHY. Ultrasound of the liver can separate medical from surgical JAUNDICE in approximately 97 per cent of patients; it is very accurate in detecting and de?ning cystic lesions of the liver, but is less accurate with solid lesions – and yet will detect 85 per cent of secondary deposits (this is less than COMPUTED TOMOGRAPHY [CT] scanning). It is very accurate in detecting gall-stones (see GALL-BLADDER, DISEASES OF) and more accurate than the oral cholecystogram. It is useful as a screening test for pancreatic disease and can di?erentiate carcinoma of the pancreas from chronic pancreatitis with 85 per cent accuracy.

Ultrasound is the ?rst investigation indicated in patients presenting with renal failure, as it can quickly determine the size and shape of the kidney and whether there is any obstruction to the URETER. It is very sensitive to the presence of dilatation of the renal tract and will detect space-occupying lesions, di?erentiating cysts and tumours. It can detect also obstruction of the ureter due to renal stones by showing dilatations of the collecting system and the presence of the calculus. Adrenal (see ADRENAL GLANDS) tumours can be demonstrated by ultrasound, although it is less accurate than CT scanning.

The procedure is now the ?rst test for suspected aortic ANEURYSM and it can also show the presence of clot and delineate the true and false lumen. It is good at demonstrating subphrenic and subhepatic abscesses (see ABSCESS) and will show most intra-abdominal abscesses; CT scanning is however better for the retroperitoneal region. It has a major application in thyroid nodules as it can di?erentiate cystic from solid lesions and show the multiple lesions characteristic of the nodular GOITRE (see also THYROID GLAND, DISEASES OF). It cannot differentiate between a follicular adenoma and a carcinoma, as both these tumours are solid; nor can it demonstrate normal parathyroid glands. However, it can identify adenomas provided that they are more than 6 mm in diameter. Finally, ultrasound can di?erentiate masses in the SCROTUM into testicular and appendicular, and it can demonstrate impalpable testicular tumours. This is important as 15 per cent of testicular tumours metastasise whilst they are still impalpable.

Ultrasonic waves are one of the constituents in the shock treatment of certain types of gallstones and CALCULI in the urinary tract (see LITHOTRIPSY). They are also being used in the treatment of MENIÈRE’S DISEASE and of bruises and strains. In this ?eld of physiotherapy, ultrasonic therapy is proving of particular value in the treatment of acute injuries of soft tissue. If in such cases it is used immediately after the injury, or as soon as possible thereafter, prompt recovery is facilitated. For this reason it is being widely used in the treatment of sports injuries (see also SPORTS MEDICINE). The sound waves stimulate the healing process in damaged tissue.

Doppler ultrasound is a technique which shows the presence of vascular disease in the carotid and peripheral vessels, as it can detect the reduced blood ?ow through narrowed vessels.

Ultrasound in obstetrics Ultrasound has particular applications in obstetrics. A fetus can be seen with ultrasound from the seventh week of pregnancy, and the fetal heart can be demonstrated at this stage. Multiple pregnancy can also be diagnosed at this time by the demonstration of more than one gestation sac containing a viable fetus. A routine obstetric scan is usually performed between the 16th and 18th week of pregnancy when the fetus is easily demonstrated and most photogenic. The fetus can be measured to assess the gestational age, and the anatomy can also be checked. Intra-uterine growth retardation is much more reliably diagnosed by ultrasound than by clinical assessment. The site of the placenta can also be recorded and multiple pregnancies will be diagnosed at this stage. Fetal movements and even the heartbeat can be seen. A second scan is often done between the 32nd and 34th weeks to assess the position, size and growth rate of the baby. The resolution of equipment now available enables pre-natal diagnosis of a wide range of structural abnormalities to be diagnosed. SPINA BIFIDA, HYDROCEPHALUS and ANENCEPHALY are probably the most important, but other anomalies such as multicystic kidney, achondroplasia and certain congenital cardiac anomalies can also be identi?ed. Fetal gender can be determined from 20 weeks of gestation. Ultrasound is also useful as guidance for AMNIOCENTESIS.

In gynaecology, POLYCYSTIC OVARY SYNDROME can readily be detected as well as FIBROID and ovarian cysts. Ultrasound can monitor follicular growth when patients are being treated with infertility drugs. It is also useful in detecting ECTOPIC PREGNANCY. (See also PREGNANCY AND LABOUR.)... ultrasound

A congenital abnormality in which the external genitalia resemble those of the opposite sex, but ovarian or testicular tissue is present as normal. A female pseudohermaphrodite may have an enlarged clitoris resembling a penis and enlarged labia resembling a scrotum. A male may have a very small penis and a divided

scrotum resembling labia. (See also hermaphroditism, sex determination.)... pseudohermaphroditism

A testis that is absent from the scrotum because it has descended into an abnormal position, usually in the groin or at the base of the penis. The condition is most often discovered soon after birth during a routine physical examination. It is treated by orchidopexy. (See also testis, undescended.) ... testis, ectopic

Rare, but increasing in most countries. Three main types: teratomas, seminomas and lymphomas. The latter affect older men.

Symptoms. A hard usually painless mass in the scrotum can give rise to gynaecomastia – abnormal enlargement of the male breasts.

Of possible value. Alternatives: – Abundant herb teas – Cornsilk, Red Clover, Violet leaves.

Decoction. Echinacea 2; Kava Kava 1; Sarsaparilla 1. Mix. Half an ounce (15g) to 1 pint (500ml) water simmered gently 20 minutes. Cup thrice daily.

Formula. Sarsaparilla 2; Kava Kava l; Pulsatilla half; Thuja quarter. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily. Vinchristine.

Diet. See: DIET – CANCER. Researchers from Cambridge University found that an extra pint of milk a day during adolescence was associated with 2 and a half times increased risk of testicular cancer. (Journal of Epidemiology and Community Health, Oct. 1993)

Treatment by or in liaison with a general medical practitioner. ... cancer – testicles

Excessive collection of fluid in the scrotum, the protective covering of the testicles. In infants the condition usually disappears on its own and requires no treatment. In adults, onset is mostly in middle life when it may be withdrawn by needle and syringe. One cause is inflammation of the testicle or of the epididymus.

Treatment. Aspiration or surgery. Pulsatilla is a key remedy. Ellingwood recommends Thuja. Poke root. Pulsatilla: tablets, tincture. Liquid Extract: thrice daily.

Thuja. Tea, liquid extract or tincture. See entry.

Poke root. Tablets, Decoction, liquid extract or tincture. See entry.

Supportives: cold hip bath. Attention to bowels; a laxative may relieve pressure. ... gsl hydrocele

The absence of sperm from semen, causing infertility in males. Azoospermia may be caused by a disorder present at birth or that develops later in life or after vasectomy.

Congenital azoospermia may be due to a chromosomal abnormality such as Klinefelter’s syndrome; failure of the testes to descend into the scrotum; absence of the vasa deferentia (ducts that carry sperm from the testes to the seminal vesicles); or cystic fibrosis.

In some males, azoospermia may be the result of hormonal disorders affecting the onset of puberty. Another cause is blockage of the vasa deferentia, which may follow a sexually transmitted infection, tuberculosis, or surgery on the groin. Azoospermia can also be the result of damage to the testes. This can follow radiotherapy, treatment with certain drugs, and prolonged exposure to heat, or the effects of occupational exposure to toxic chemicals.

If the cause is treatable, sperm production may restart. However, in some cases, the testes will have been permanently damaged.... azoospermia

A group of tropical diseases, caused by various parasitic worms or their larvae, which are transmitted to humans by insect bites.

Some species of worm live in the lymphatic vessels. Swollen lymph nodes and recurring fever are early symptoms. Inflammation of lymph vessels results in localized oedema. Following repeated infections, the affected area, commonly a limb or the scrotum, becomes very enlarged and the skin becomes thick, coarse, and fissured, leading to a condition known as elephantiasis. The larvae of another type of worm invade the eye, causing blindness (see onchocerciasis). A third type, which may sometimes be seen and felt moving beneath the skin, causes loiasis, characterized by irritating and sometimes painful areas of oedema called calabar swellings.

The diagnosis of filariasis is confirmed by microscopic examination of the blood. The anthelmintic drugs diethylcarbamazine or ivermectin most often cure the infection but may cause side effects such as fever, sickness, muscle pains, and increased itching. Diethylcarbamazine can be given preventively, and the use of insecticides and protective clothing help to protect against insect bites. (See also roundworms; insects and disease.)... filariasis

Swelling of the testis or the surrounding tissues in the scrotum. Harmless and painless swellings include epididymal cysts, hydroceles, varicoceles, and spermatoceles. Cancer of the testis (see testis, cancer of) is rare but may be a cause of painless swelling. Swelling that is painful may be caused by a direct blow, torsion of the testis (see testis, torsion of), orchitis, epididymoorchitis, or, in very rare cases, cancer of the testis. Any swelling of the testes should be assessed promptly by a doctor.... testis, swollen

Varicose veins surrounding a testis.

Varicocele is a common condition.

It almost exclusively affects the left testis and is usually harmless, although there may be aching in the scrotum or an abnormally low sperm count (see infertility).

Aching may be relieved by supportive underwear.

Surgery to divide and tie off the swollen veins may be performed if the sperm count is low.... varicocele

n. a localized collection of thin-walled blood vessels covered by a cap of warty material. It is most often seen as angiokeratoma of Fordyce, purple papules on the scrotum or vulva of the elderly, which should not be treated unless they bleed easily. Angiokeratomas can also occur on the hands and feet of children. The condition is not malignant and its cause is unknown. Angiokeratomas may be removed surgically. See also Fabry disease.... angiokeratoma

The male organs involved in the production of sperm and in sexual intercourse. Sperm and male sex hormones (androgen hormones) are produced in the testes, which are suspended in the scrotum. From each testis, sperm pass into an epididymis, where they mature and are stored. Shortly before ejaculation, sperm are propelled into a duct called the vas deferens, which carries the sperm to the seminal vesicles behind the bladder. These 2 sacs produce seminal fluid, which is added to the sperm to produce semen.

Semen travels along 2 ducts to the urethra.

The ducts pass through the prostate gland, which produces secretions that are added to the semen.

At orgasm, semen is ejaculated from the urethra through the erect penis, which is placed in the woman’s vagina during sexual intercourse.... reproductive system, male

Twisting of the spermatic cord that causes severe pain and swelling of the testis. The pain develops rapidly and is sometimes accompanied by abdominal pain and nausea. The testis becomes swollen and very tender, and the skin of the scrotum becomes discoloured. Unless the torsion is treated within a few hours, permanent damage to the testis results. The condition is most common around puberty. It is more likely to occur if the testis is unusually mobile within the scrotum.

Diagnosis is by physical examination.

Surgery is performed to untwist the testis and anchor it in the scrotum with small stitches to prevent recurrence.

If irreversible damage has occurred, orchidectomy is performed.

In either case, the other testis is anchored to the scrotum to prevent torsion on that side.

With prompt treatment, recovery of the testis is complete.... testis, torsion of

A testis that has failed to descend from the abdomen to the scrotum. The condition usually affects only 1 testis and occurs in about 1 per cent of full-term and 10 per cent of premature male babies. An undescended testis often descends within months of birth but rarely descends after this time. An undescended testis does not develop normally, is incapable of normal sperm production, and is at increased risk of developing testicular cancer (see testis, cancer of). If both testes are undescended, infertility results.

A diagnosis is made during a physical examination after birth or later in infancy.

Treatment is by orchidopexy, which usually reduces the risk of later infertility or testicular cancer (see testis, cancer of).

A poorly developed undescended testis may be removed if the other is normal.... testis, undescended

Enlarged, tortuous veins just beneath the skin. Varicose veins most often occur in the legs but can also occur in the anus (see haemorrhoids), oesophagus (see oesophageal varices), and scrotum (see varicocele).

A defect of the valves in the leg veins causes blood to pool in the veins near the surface of the skin, causing them to become varicose. Contributing factors include obesity, hormonal changes and pressure on the pelvic veins during pregnancy, hormonal changes occurring at the menopause, and standing for long periods of time. Varicose veins are common, tend to run in families, and affect more women than men.Varicose veins may not cause any problems but may ache severely; swollen feet and ankles and persistent itching may occur. These symptoms may worsen during the day and can be relieved only by sitting with the legs raised. In women, symptoms are often worse just before menstruation. In severe cases, leg ulcers may occur. Thrombophlebitis may be associated with varicose veins.

Usually, support stockings, regular walking, and sitting with the feet up as much as possible are the only measures required.

In more severe cases, sclerotherapy may be carried out.

Varicose veins may require surgical removal if they become painful or ulcerated, but they may later develop elsewhere.... varicose veins

a superficial reflex in males elicited by stroking the inner side of the upper thigh with a sharp object. If the reflex is intact the scrotum on that side is pulled upwards as the cremaster muscle contracts. Absence or reduction of both cremasteric reflexes indicates an upper *motor neuron lesion; absence of the reflex on one side suggests a lower motor neuron lesion at the level of the first lumbar spinal nerve.... cremasteric reflex

visible sebaceous glands present in most individuals. They are 1–3-mm painless papules that may be noticed on the scrotum, shaft of the penis, labia, and inner surface and border of the lips. They become more visible from puberty onwards and are easier to see when the skin is stretched. Completely harmless, they are not sexually transmitted or infectious and do not require any treatment. [J. A. Fordyce (1858–1925), US dermatologist]... fordyce spots

a rare but potentially life-threatening infection of the scrotum that can rapidly spread to involve the perineum, penis, and anterior abdominal wall. [J. A. Fournier (19th century), French venereologist]... fournier’s gangrene

n. (pl. gubernacula) either of a pair of fibrous strands of tissue that connect the gonads to the inguinal region in the fetus. In the male they guide and possibly move the testes into the scrotum before birth. In the female the ovaries descend only slightly within the abdominal cavity and the gubernacula persist as the round ligaments connecting the ovaries and uterus to the abdominal wall.... gubernaculum

either of a pair of openings that connect the abdominal cavity with the scrotum in the male fetus. The inguinal canals provide a route for the descent of the testes into the scrotum, after which they normally become obliterated.... inguinal canal

(neurodermatitis) thickened eczematous skin that develops at the site of constant rubbing in susceptible individuals. Common sites are the nape of the neck in women and the lower legs or scrotum in men. Stress may be a relevant factor.... lichen simplex chronicus

n. the protrusion of an organ or tissue out of the body cavity in which it normally lies. An inguinal hernia (or rupture) occurs in the lower abdomen; a sac of peritoneum, containing fat or part of the bowel, bulges through a weak part (inguinal canal) of the abdominal wall. It may result from physical straining or coughing. A scrotal hernia is an inguinal hernia so large that it passes into the scrotum; a femoral hernia is similar to an inguinal hernia but protrudes at the top of the thigh, through the point at which the femoral artery passes from the abdomen to the thigh. Other hernias of the abdominal wall include periumbilical, epigastric, and postsurgical hernias. A diaphragmatic hernia is the protrusion of an abdominal organ through the diaphragm into the chest cavity; the most common type is the hiatus hernia, in which the stomach passes partly or completely into the chest cavity through the opening (hiatus) for the oesophagus. This may be associated with *gastro-oesophageal reflux, although most patients have no symptoms.

Hernias may be complicated by becoming impossible to return to their normal site (irreducible); swollen and fixed within their sac (incarcerated); or cut off from their blood supply, becoming painful and eventually gangrenous (strangulated). The best treatment for hernias, especially if they are painful, is surgical repair (see hernioplasty).... hernia

a ridge of skin extending from the anus through the perineum. In males it extends further up the scrotum and penis. It represents a fusion line from embryological development and may be the site of cysts and other harmless structures.... median raphe

n. inflammation of the testis. This causes pain, redness, and swelling of the scrotum, and may be associated with inflammation of the epididymis (epididymo-orchitis). The condition may affect one or both testes; it is usually caused by infection spreading down the vas deferens but can develop in mumps. Mumps orchitis affecting both testes after puberty may result in reduced testicular size and abnormalities in semen analysis, although sterility is rare. Treatment of epididymo-orchitis is by local support and by administration of analgesics and antibiotics; mumps orchitis often responds to *corticosteroids.... orchitis

(oscheo-) combining form denoting the scrotum. Example: oscheocele (a scrotal hernia).... osche

n. inflammation of the prostate gland. This may be due to bacterial infection and can be either acute or chronic. In acute prostatitis the patient has all the symptoms of a urinary infection, including pain in the perineal area, temperature, and shivering. Treatment is by antibiotic administration. In chronic prostatitis, patients commonly complain of pain in the area between the scrotum and the anus, accompanied by *lower urinary tract symptoms. Some of these cases are due to bacterial infection, in which case antibiotics are required. In others, no bacterial infection is demonstrated, although there may be evidence of inflammation. Treatment in these cases involves alpha blockers, anti-inflammatory agents, and occasionally antibiotics. In some men, vigorous prostate massage performed under a general anaesthetic can significantly alleviate symptoms.... prostatitis

n. apparent absence of the testes. This is quite common in young boys, who retract their testes into the groin due to involuntary or reflex contraction of the cremasteric muscle of the suspensory cord (also known as retractile testes). The condition is only important in that it needs to be distinguished from true failure of descent of the testes into the scrotum, which requires early surgical treatment (see cryptorchidism).... pseudocryptorchidism

n. an operation in which the scrotum is surgically explored, usually undertaken to investigate patients with probable obstructive *azoospermia.... scrototomy

n. a malignant tumour of the testis, appearing as a swelling, often painless, in the scrotum. It tends to occur in an older age group than the *teratomas. The treatment for localized disease is surgery involving removal of the testis (see orchidectomy). Secondary tumours in the lungs can be treated with chemotherapy and radiotherapy to the draining lymph nodes. A similar tumour occurs in the ovary (see dysgerminoma).... seminoma

n. a cystic swelling in the scrotum containing sperm. The cyst arises from the epididymis (the duct conveying sperm from the testis) and can be felt as a lump above the testis. Needle *aspiration of the cyst reveals a milky opalescent fluid that contains sperm. Treatment is by surgical removal.... spermatocele

a bandage arranged to support a hanging part of the body. Examples include a sling used to hold an injured lower jaw in position and a bandage used to support the scrotum in various conditions of the male genital organs.... suspensory bandage

n. twisting. Abnormal twisting of a testis within the scrotum or of a loop of bowel in the abdomen may impair blood and nerve supplies to these parts and cause severe damage.... torsion

n. inflammation of the *seminal vesicles and *vas deferens. This usually occurs in association with *prostatitis and causes pain in the perineum, groin, and scrotum and a high temperature. On examination the vasa and seminal vesicles are thickened and tender. Treatment includes administration of antibiotics.... vasovesiculitis

n. a tumour composed of a number of tissues that are not usually found at that site and are derived from all three embryonic *germ layers. Teratomas most frequently occur in the testis and ovary (see dermoid cyst), possibly derived from remnants of embryonic cells that have the ability to differentiate into many types of tissue; in most malignant teratomas, cells from all three *germ layers are present. Malignant teratoma of the testis is found in young men: it is more common in patients with a history of undescended testis. Like *seminoma, it frequently occurs as a painless swelling of one testis (pain is not a good indication that the swelling is benign). Treatment is by *orchidectomy avoiding an incision into the scrotum. The tumour can spread to lymph nodes, lungs, and bone, treatment of which may involve the use of chemotherapy drugs, such as vinblastine, bleomycin, cisplatin, and etoposide, with a high cure rate even in metastatic disease.

Teratomas often produce *alpha-fetoprotein, beta human chorionic gonadotrophin, or both; the presence of these substances (*tumour markers) in the blood is a useful indication of the amount of tumour and the effect of treatment.... teratoma

n. surgical repair of the urethra, especially a urethral *stricture. Anastomotic urethroplasty is used for a short stricture: the area of narrowing is excised and the two adjacent ends are then joined directly to each other. A substitution urethroplasty entails the insertion of a flap or patch of skin from the scrotum or a buccal mucosal graft into the urethra at the site of the stricture, which is laid widely open. The operation can be performed in one stage, although two stages are usual in the reconstruction of a posterior urethral stricture (see urethrostomy). Transpubic urethroplasty is performed to repair a ruptured posterior urethra following a fractured pelvis. Access to the damaged urethra is achieved by partial removal of the pubic bone.... urethroplasty