Hey, i guess a bit of a backstory would be helpful

Patient

Q: Hey,

i guess a bit of a backstory would be helpful. So i was on a holiday in Asia about 2 years ago. I got drunk and messed around with a prostitute. Afterwards, i wasn't diagnosed with anything else than chlamydia - which im thankful for - and while it was quite tough to get rid of (it came back a few times despite me taking anti-biotics and not having unprotected sex) i should be clean now.

Anyway, after that trip i've seen a slow transformation happen with my scrotum. It's upper part of the skin is brown-ish and a lot thicker than it used to be, making my scrotum look very weird when im in retract-mode. When my balls hang loose there's hardly anything wrong with them, except they are probably a bit more red than before and my scrotum skin is a bit more loose. I have no itching around my scrotum but i do have some itching around my anus and i've had a consistent diarrhea for the past 2 years. I have no idea if these 2 things are connected to eachother.

Also i have to mention my epididymis might be swollen. Not completely sure, but sometimes it does look that way when my junk hangs loose.

I've seen my doctor a couple of times but they don't seem to have any good guesses about my situation. And it definitely frustrates me because i know something is very wrong. All i need is a good guess what i might have so i can be more straight forward with my doctor.

Any help ?

Symptoms:  Scrotum skin changes, itching around anus
Doctor

A:   Hello,
Thanks for the query to ATD for an opinion,

After having gone through your complete history, your sexual encounter with a prostitute 2 years back, which caused you chlamydia infection and for which you got treated as well. If your repeat tests have been negative for chlamydia then there is no need to be concerned about recurrence if you have been taking adequate precautions during sex in terms of protection.
Nextly regarding the scrotal skin changes which you are experiencing in terms of thickened scrotal skin over the upper part and loose hanging reddish skin over the lower part which seems stretched and hence the underlying epididymis appears more prominently emulating inflamed and swollen.

If there has been no itching or pain in the stretched scrotal skin which could be likely due to a fungal element, then you need not worry. It is to be understood that scrotal skin reacts to temperature changes, that is if the outside environment is cold then the scrotum shall retract inside the pelvis and the skin shall appear more darker, harder and rugosed, but if the outside temperature is high then the scrotum shall fall loose with hanging balls and stretched skin in order to dissipate excess heat to allow suitable temperature inside the scrotum for sperm production. This is physiological and natural. Considering that you live in Helsinki where temperatures drop to good lower levels, you may have noticed as to whenever you move out of the house, scrotum retracts up and whenever you are inside your warm house, the skin hangs loose.

So, if so is the case then there is no real cause of worry as its normal, unless you have itching , pain and flaky scrotal skin which indicates fungal infection and then you should be seeking treatment for the same from your physician with local anti-fungal application, available on prescription.
I hope I have answered your query in detail,

Wishing you good health,
Regards

Comments / Follow Ups

Patient: Thanks for the quick reply.

What was weird with my chlamydia was that in the follow-up test after treatment (like month after) it was always negative. But my chlamydia symptoms came back later even though i didn't have any sexual contact with anybody. That was very strange and this happened 2 times. Now it seems to have gone away for good.

Anyway, i know how retracting works but my concern is that when my scrotum has retracted it looks so much different and very ugly compared to few years back. Because of the thick skin on the upper part there's no "room" for it and it makes it look very weird, like the skin sticks out on some spots. I'd link a picture if there was an option for it (?).

I don't have itching or flaky skin but the skin has changed, it's very tough to explain though.

1,5 years with this problem seems like a very long time and im starting to think that it's not going away on it's own.

I'd like to post that picture to give more detail if possible.
Doctor: I would like to see the picture. Please post it for perusal.
If any difficulty in posting the same then you may contact the customer support and they shall assist you.
Regards
Patient: http://s29.postimg.org/9jzfy88bb/nimet_n.jpg

That's probably the worst it can look. My scrotum is retracted as much as it can since i was feeling a bit cold and there you can see how the upper part sticks out.
Patient: Any response ? would really like to hear your input on this
Doctor: The scrotal skin looks normal and the rugosity which you term as skin protrusions are normal. The median furrow is hypertrophied and so does the surrounding skin and appears thickened in response to temperature change, i presume. But there is no infection , flakes or inflammation evident.
The hypertrophy can be likely due to continuous friction with tight undergarments possibly but more or less it appears normal.
regards

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