What is scrotal atrophy?

Scrotal atrophy has a great impact on male sexual ability. It can lead to impotence, premature ejaculation, and azoospermia. This is mainly because the scrotum is the place where sperm is produced. If the scrotum atrophies, the place where sperm is produced will be affected, causing infertility. However, in life, the main cause of scrotal atrophy is excessive sexual activity or excessive masturbation.

Testicular atrophy refers to a disease in which the male testicles shrink and become flaccid, also known as "testicular atrophy". It is characterized by one or both testicles shrinking and the testicles being small and soft. This disease can cause infertility in most cases, often secondary to mumps or trauma, and some are congenital. Treatment should be targeted at the primary disease.

Causes and common diseases

1. Disease

Varicose veins account for about 30% to 40% of male infertility. Varicose veins can sometimes cause testicular atrophy. Infertile men with severe varicocele usually have testicular atrophy. Varicose veins may cause testicular atrophy due to stasis in the spermatic vein, higher than normal scrotal temperature, testicular nutritional disorders, and toxins.

2. Infection

Infection is an important cause of testicular atrophy, the most common of which is viral orchitis caused by mumps. If the disease occurs after puberty, orchitis complicated by mumps can cause severe local inflammatory reactions, and there may be excessive fluid accumulation in the tunica vaginalis, i.e. acute hydrocele. Smallpox, chickenpox, measles, influenza and other similar infections can occasionally cause secondary orchitis.

Viral infection is the most common cause of testicular atrophy in children and adolescents, especially the mumps virus. When the testicles are invaded by this virus, the spermatogenic tissue in the testicles will be destroyed, the testicles will shrink in size, and the texture will become soft.

3. Damage

If the scrotum or testicles have been hit, causing scrotal hematoma or testicular laceration, even if the wound heals, the testicles will be in a state of insufficient blood supply for a long time and atrophy will occur.

4. Inflammation

Severe orchitis causes testicular swelling and pain that can last for several days. Testicular tissue is damaged by bacterial invasion, leading to atrophy of the testicular tissue.

5. Radioactive substances

Anyone who has long-term contact with radioactive substances, such as those who work with X-rays or isotopes for a long time, will develop testicular atrophy if they do not take good protection.

6. Endocrine diseases

The testicle is an endocrine organ that mainly produces androgens. Diseases of many endocrine-controlling organs in the body, such as the pituitary gland, adrenal glands, and hypothalamus, can interfere with the function of the testicles and cause testicular atrophy.

7. Medication

Long-term use of certain toxic drugs, such as arsenic, or repeated use of anti-androgen estrogen drugs, such as ethidol, can cause testicular atrophy.

Differential diagnosis

1. Testicular dysplasia

Congenital testicular dysgenesis is also known as dysgenesis of the sperm ducts or primary microtestis or Klinefelter syndrome, which is characterized by small testicles, no sperm, and elevated levels of gonadotropin in the blood. The sex chromosomes of patients with this disease are 47,XXY, which means they have one more X chromosome than normal men, so this disease is called 47,XXY syndrome.

2. Testicular swelling and pain

Testicular distension and pain can be roughly divided into two types, namely acute persistent pain and chronic recurrent pain, which are mostly caused by orchitis and testicular injury. Those with testicular injury have a clear history of trauma.

3. No testicles

Normally, the testicles descend into the scrotum during the late development of the fetus in the mother's uterus. However, common testicular diseases can lead to incomplete testicular descent, ectopic testicles, and testicular absence, and symptoms of testicular agenesis, such as cryptorchidism, congenital agenesis, and dwarfism.

4. Testicular pain

Testicular pain is common in orchitis and injury. In addition to bloodstream infection, orchitis is more common when bacteria retrograde through the urethra to the epididymis and testicles, causing epididymitis and orchitis. Clinically, epididymis and testicle swelling and pain can be seen. Testicular injury patients have a history of trauma and local swelling and congestion. Vigorous exercise or sexual intercourse and violence can sometimes cause strong contraction of the levator testis, causing the testicles with too long frenulum to twist, causing severe testicular pain. In chronic pain, mild cases are prolonged, the pain is mild, generalized, and has radiating pain.

Check

1. Routine physical examination

During the physical examination, attention should be paid to the presence of testicles or testicular atrophy, as well as changes in the texture of the testicles. For patients with hypogonadism secondary to pituitary disease, the testicles may be normal or slightly smaller in size, which is related to the duration of the pituitary disease. Elevated serum PRL also indicates a problem with the pituitary gland, often accompanied by hypogonadism. Patients with erectile dysfunction (ED) do not necessarily have low serum testosterone levels. Patients with suspected pituitary tumors need to undergo cranial X-rays or CT scans to confirm the diagnosis.

2. Laboratory inspection

In addition to blood and urine analysis, prostatic fluid and semen routine tests, liver and kidney function, blood electrolytes, blood sugar, blood lipids, and thyroid function tests, serum testosterone (TE), thyroid-stimulating hormone (LSH), luteinizing hormone (LH), prolactin (PRL), etc. should also be measured.

3. Serum testosterone measurement

ED patients should have at least one serum testosterone test. If the test results are within the normal range, there is generally no need to further test other hormones. Testosterone levels in patients with testicular atrophy will generally decrease. If the serum testosterone level is low in the first test, it is best to repeat the test and measure LSH, LH, PRL, etc. at the same time. If the second testosterone level is still low, the patient may have hypogonadism. If serum LSH and LH are normal or increased, hypogonadism is a primary testicular abnormality.

4. Testicular biopsy

The most accurate way to diagnose testicular atrophy is still testicular biopsy.

Treatment principles

Find out the cause of testicular atrophy and treat the underlying disease.