‘Bleeding’ Balls

Dear Dr G,

I am somewhat amused by the queries you have recently addressed relating to the scrotum, ranging from lopsided scrotum, to the itchy balls.

I guess I am going to put the ball in Dr G’s court again this week with another ball issues (no pun intended).

I read with interest last week’s on a reader’s concern, when the itchy balls resulted in the desire to scratch, causing traumatic induced bleeding.

My condition is slightly different. I am a 60-year-old man and has no sexually transmitted infections.

I recently discovered very unsightly blood vessels appearing on the surface of my scrotum.

The condition is painless and not itchy. It is not associated with any form of urination symptoms.

The vessels occasionally become more prominent and burst. This can cause profuse bleeding, which thankfully stopped after a short while.

I am somewhat concerned why these vessels appear over the last three years.

Are they serious? Is this cancer? Can they be treated?

They are also a bit ugly. Can anything be done? Or shall I just accept this.

Sorry to put Dr G on the spot about the balls, hope you can help.

Alan

I am pleased, and somewhat surprised to receive a few queries about the testicles. I guess the months of June and July just seems like the “manhood” kind of months.

The scrotal skin is a robust surface that is fragile and agile at the same time. This is to ensure the mobility of the gonads for temperature adjustment.

Needless to say, such agility will require copious amount of blood supply in order to ensure the proper functioning of the testicles.

One of the skin conditions that can cause bleeding on the scrotal wall is called angiokeratoma.

This is a benign cutaneous lesion of the capillaries on the scrotal wall, resulting in small red and blue coloured marks on the skin.

The skin can also undergo hardening, generally referred as Fabry’s disease.

Agiokeratoma is not a new medical phenomenon, as this condition was first described in 1896. The exact incidence and etiology of angiokeratoma are unknown.

This is a relatively common condition that increases in incidence with advancing age in men.

Although the condition is more prevalent in men, angiokeratoma can also emerge in women, around the area of vulva and vagina.

Generally, the multiple keratotic, dome-shaped vascular papules have diameters ranging from one to six milimetres.

The papules are known to be rather fragile, as the lesions can bleed spontaneously, or on minor trauma and intercourse.

Men generally do not notice the presence of angiokeratoma until it bleeds spontaneously, or the partners begin to comment on the ugliness of appearance.

In some instances, the papules can cause necrosis (dead skin), resulting secondary fungal, bacterial and viral infections.

This in turn causes the lesion to be painful, smelly and occasionally producing pus.

Understandably, men would resort to treatment as it raises the concerns of malignancy.

Most of angiokeratoma cases are treated conservatively.

Some men with repeated bleeding episodes may require interventional radiological treatment, laser or cryotherapy.

Most of the interventions may be only bring about short-term benefit, and therefore, the definitive interventions such as excision and grafting may be necessary for complete removal.

The famous author George Orwell once said: “Happiness can exist only in acceptance”.

When Dr G is put on the spot to deal with Alan’s “bleeding” balls, his advice is – the advancing age in men will not just alter the appearance waist-up, it also changes the texture of the organs waist-down.

Accepting angiokeratoma of the scrotum as part of the ageing process will bring about happiness, without the pain of surgical intervention.