The scrotum (from the Latin scrotum, same meaning) is part, with the penis, of the male external genitalia.

The scrotum, colloquially referred to as “bursa”, is an outer skin sac that hangs in humans between the legs from the base of the penis. Divided in two, the scrotum contains the testes, the two male sex glands that produce testosterone and are the seat of spermatogenesis (sperm production).

The external position of the scrotum makes it possible to keep the testes at a temperature lower than that of the body (around 34-35 ° C), a necessary condition for spermatogenesis. When the temperature is cold, the scrotum retracts on itself to retain heat and bring the testes closer to the body.

The skin covering the scrotum is stretchy, wrinkled in appearance, and becomes covered with hair during puberty. It presents a raphe on the median line, a sort of “seam” of skin which unites the two testicles.

The scrotum is a real pocket of skin. It is made up of different envelopes (from the outside to the inside): the skin, the dartos muscle, the spermatic fascia (membrane that surrounds the spermatic cords and the testicle), the cremaster muscle and the vaginal tunica (testicular envelope) .

Its role is to support the testes, protect them and keep them at a stable temperature, thus ensuring the viability of sperm.

Scrotal lymphedema (or scrotal elephantiasis): rare pathology, it corresponds to the increase, sometimes very important, of the volume of the scrotum. It is caused in the majority of cases by lymphatic filariasis, a parasitic infection that causes damage to the lymphatic system and edema (abnormal increase in certain parts of the body due to the accumulation of fluid under the skin) (2). Lymphedema is not without psychological impacts.

Testicular pain : pain felt in the scrotum which may be due to torsion of the testicles.

Fournier’s gangrene : severe infection of the soft tissues of the genitals, perineum and perianal area which is caused by the infection of several microbes. It results in lightning necrosis of the scrotum which affects young, healthy men. Rare pathology, its diagnosis and treatment are late (3).

Angioceratome : uncommon in adolescents, this vascular pathology generally affects men over 30 years old. It is characterized by the appearance of small red papules (“buttons”) along the vessels on the surface of the scrotum (4).

Pediatric idiopathic acute scrotal edema : it is a benign skin condition which mainly affects children from 5 to 10 years old. It is characterized by the rapid appearance of edema in the scrotum which extends to the surrounding areas (perineum, penis, etc.). Little or no painful pathology, the allergic cause has been considered (5).

Scrotal cancer : this cancer was the first case of occupational cancer declared in 1775 affecting chimney sweeps (see “History” section). Today, studies indicate that this cancer is well controlled (8).

In order to protect and prevent injuries and pain in the scrotum, and therefore in the testicles, it is advisable to wear a protection (shell) during the practice of sport and in particular those of contact and combat.

Echo-doppler : examination which aims to observe the circulation of the blood, it can be performed to study the area of ​​the testicles and scrotum.

Ultrasound : imaging technique based on the use of ultrasound to visualize the internal structure, it is the reference method in scrotal pathology.

IRM : magnetic resonance imaging technique. It is little used in the case of pathologies of the scrotum, it is a complementary examination for difficult cases.

Scintigraphy : imaging technique using radioactive substances injected into the body, it allows you to see the shape and function of an organ. It is generally used to differentiate testicular torsion from epididymitis (inflammation of the epididymis which is located at the top of the testis) (6).

Orchidopexie : surgical intervention that fixes the testicle (s) in the scrotum when they are not naturally descended (7).

Scrotal cancer is the first case of occupational cancer to have been reported in 1775 by the English surgeon Percival Plott (8). In his report, he describes for the first time the link between the environment, here the exposure of chimney sweeps to soot, and the appearance of cancer. Soot contains coal tar, a carcinogen. The accumulation of soot in the folds of the scrotal skin, resulting from the flow of sweat on the body of chimney sweeps, caused the appearance of warts. These warts led to scrotal cancer that spread to the testicles and abdomen. Baths were therefore recommended at the end of the miners’ days, which made it possible to reduce the number of cancers.