Scrotum injuries can be caused by one or more mechanisms of injury such as trauma, pressure, friction, and moisture. Minor injuries frequently result in pain to the afflicted area, swelling, or ecchymosis.¹

Most Common Types of Injuries and Prevention

Trauma

Boys and men are at high risk of trauma to the external genitalia because of the extracorporeal location of these organs. However, the scrotum and testes are relatively well protected, for several reasons²:

• The testes are inherently mobile within the scrotum.
• Scrotal skin provides for elasticity.
• The cremasteric reflex of the testes offers a protective reflex mechanism.
• The tunica albuginea serves as a physical defense with tensile strength.

Emergency departments across the United States treat the most cases of scrotal injury. Many scrotal injuries are sustained during sporting activities (most frequently, on a bicycle), within the pediatric populations. In the majority of these injuries, external genitalia are involved, and inpatient admission is relatively rare. Penoscrotal injuries represent approximately half of the sports-related injuries.³ Severe scrotal injury can involve a rupture or tear to the scrotum and result in testicular damage. Patients may also experience nausea, swelling, bloody urine, difficulty urinating, and fever. Much of the trauma experienced in this region of the body is accidental. However, certain measures can help prevent injury during high-risk situations such as sports participation.

• Wear protective equipment during sports or other activity participation, particularly in pediatric patients with only one kidney or testicle.
• Wear a jockstrap when playing sports. For sports with a risk of hard impacts, such as baseball, it is also recommended to wear a protective cup.
• Avoid loose clothing and belts near machinery that could grab hold of the clothing or skin.

Moisture-Associated Skin Damage

Moisture-associated skin damage (MASD) consists of inflammation and erosion of skin when exposed to moisture for prolonged periods of time. There are four types of MASD, one of which is incontinence-associated dermatitis. This condition occurs in patients who experience urinary or fecal incontinence.

Typically, MASD of the scrotum manifests with inflammation of the skin surface characterized by redness, swelling, and blister formation. This inflammation may extend from the scrotum to the inner thigh and the buttocks.⁴ When left untreated, MASD on the scrotum can lead to the breakdown of the skin, which may become infected, thereby increasing the inflammation and leading to greater skin breakdown. Incontinence on its own does not cause MASD, and best practices can minimize the likelihood that patients with incontinence will develop MASD. These practices include the following⁴:

• Identify and reverse the causes of incontinence, when possible. This may include using medications, treating urinary tract infections, and treating constipation.
• Optimize nutritional and water intake.
• Use penis condom sheaths.

In instances when incontinence cannot be reversed or prevented, treatment should include the following measures⁴:

• Use absorbent products to wick moisture away from the skin.
• Avoid overhydration and occlusion of the skin.
• Cleanse skin with mild soap and water, rinse, and dry skin thoroughly.
• Use a barrier cream to help protect the skin.
• Install urinary catheters and fecal management systems when necessary.

Pressure Injuries

Often, in clinical settings, patients may be at risk for developing pressure injuries, particularly when caregivers attempt to prevent MASD in creative ways (such as by rolling up a towel).⁵ These types of pressure injuries can be prevented by caring for the skin properly and using clinical best practices for immobile patients.

• Inspect the skin daily.
• Moisturize daily using skin barrier creams, such as zinc oxide, when the patient experiences incontinence.
• Clean, rinse, and dry the skin in the presence of moisture, urine, or feces.
• Pad and protect the area with appropriate dressings.
• Use breathable fabric.
• Reposition the patient every two hours and as needed.

Conclusion

Injuries to the scrotum can be especially painful for patients, although in most instances the damage is superficial and does not result in long-term harm. However, the risk of these types of injuries can be minimized by following best practices, particularly in high-risk scenarios, such as during sports play, when incontinence is experienced, and when an individual is immobile.

References

1. Mevorach RA. Scrotal trauma. Medscape. 2019. https://emedicine.medscape.com/article/441272-overview. Accessed December 19, 2019.

2. Randhawa H, Blankstein U, Davies T. Scrotal trauma: a case report and review of the literature. J Can Urol Assoc. 2019;13(6), 67-71.

3. Bagga HS, Fisher PB, Tasian GE, et al. Sports-related genitourinary injuries presenting to United States emergency departments. J Urol. 2015;85(1)239-244.

4. Voegeli D. New insights on incontinence-associated dermatitis. Independent Nurse. 2017. http://www.independentnurse.co.uk/clinical-article/new-insights-on-inco…. Accessed December 19, 2019.

5. Jimenez F. Tissue trauma to the scrotum: an avoidable offense. WoundSource. 2019. from https://www.woundsource.com/blog/tissue-trauma-scrotum-avoidable-offense. Accessed December 19, 2019.