Dear Dr. G,

I am a 35-year-old man who has some really embarrassing problems to consult with.

In recent months, I noticed that I have a constant itch in my pants.

When it itches, I really cannot resist the desire to scratch. Sometimes it even bleeds.

Despite trying my best not to scratch, I often get “caught” reaching into my pants in public. I worry this will get me in trouble.

I went to see the doctor who treated me with antifungal.

Despite two weeks of medicine and ointment, there has been no improvement with the itchiness. In fact, it has gotten worse.

My wife said the itch is all in my mind and insisted I should just learn to resist the temptation.

I went back to see the doctor and he reckoned it might be due to overweight and excessive sweating. Hence the hygiene (or lack of it) is to be blamed.

I would like to put Dr. G on the spot for a solution for my itch in the pants.

What are the common causes of itchy scrotum?

Besides the roughness of my scrotum, the skin is ugly and unsightly. Can anything be done at all?

Can the itch be due to sexually transmitted infections?

I was told to resist scratching! I don’t mean to be rude, but seriously? When the itch comes, how to resist? Easier said than done, right?

Please help

Yours truly,
Itch Ian

The itchiness of the scrotum, or delicately described as itchy balls, is a common condition amongst men of all ages. The skin irritation in the scrotum can be infectious and non- infectious in origin. Scrotal itch is often referred to as Jock itch. In the United States, Jock Itch accounts for nearly 20% of all visits to the dermatologists. Of course, such skin complaints are more prevalent in hot and humid climates, as the crotch area of men is moist and warm, ideal in harboring pathogens such as fungus.

The fungal infection of the scrotal skin is also known as tinea cruris. This results in constant overwhelming itch of the scrotum, and the compelling desire to scratch. Tinea cruris usually affects the scrotum and adjacent skin caused by the fungus such as trichophyton rubrum and epidermophyton floccosum. Adults are affected by tinea cruris more than children, especially the ones who are overweight and suffering from diabetes. This skin infection is highly contagious and can be transmitted by contaminated towels or hotel bedroom sheets. Other risk factors also include poor hygiene and tight fitting undergarments. Moreover, the infections can be self-induced from the hands and feet.

Constant scratching often results in complicated secondary skin infections that are difficult to treat. The treatment of uncomplicated fungal infection is achievable by topical antifungal, and oral antifungal. Hygienic measures such as keeping the scrotum dry after a shower and using separate towels for the groin. Using a hair dryer for the groin after shower (certainly gives a different meaning to blow drying) can also be helpful to prevent tinea cruris.

Sexually transmitted Infections are less likely to cause scrotal itchiness. However, infections such as scabies and herpes are well recognised to cause skin breaches and ulceration. Such complications can lead to scrotal itchiness. In addition, other sexually transmissible infections such as HPV may also result in itchiness around the genitalia, especially during active infections.

Non-infective causes of the itch in the pants are scrotal eczema, psoriasis, and lichen simplex. The complaint often poses a diagnostic and therapeutic challenge to clinicians. Scrotal eczema is also known as dermatitis of the scrotal skin. This is often referred to as “the itch that rashes”. Hence the typical presentation is the itching arises before redness. The exact cause of the scrotal eczema is unknown and it can also affect skin around the anus, between the buttocks and on the penis. Hence, men with scrotal eczema present with itchy balls often complain of itchy bum too. However, unlike tinea cruris, this skin condition is non-contagious, and can be treated with topical or oral steroids. Applications of natural remedies such as tea tree oil and virgin coconut oil are well recognised to relieve the itch, as these remedies possess antibacterial properties.

The humorous American poet, Ogden Nash once said: “Happiness is having a scratch for every itch.” When it comes to scrotal itch, instant gratification is granted when that compelling desire arises to scratch, however the price to pay afterwards can be more complicated skin infections.

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