In my experience almost 100% of patients who appear with burning, itching and pain in the scrotal area are men who have inherited the tendency for atopic dermatitis and then develop irritation or a yeast fungus infection after exercising.

They often self prescribe a weak cortisone cream that is obtained without a prescription. Relief occurs initially but invariably a relapse occurs with more redness. A physician is then consulted and stronger cortisone preparations are prescribed leading to a chronic continual burning sensation with red skin.

It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it.
William Osler

The blood vessels in the scrotal skin are fully dilated. A diagnosis of “dermatitis”(inflamed skin) is made. At times the symptoms are unbearable. These patients have burning and itch 24/7. Partial relief occurs with icy compresses. Physicians offer little help and often the patient is told the diagnosis could be psychological.

A similar situation appears in women called Vulvodynia. These patients are also atopics who typically begin with nonspecific irritation in the vulvar area and they also begin applying cortisone ointments and creams with increasing strengths. Usually their treatment is under the guidance of a gynecologist. Skin examination fails to reveal any pathology – sometimes only a minor amount of redness.

At times biopsies are taken that offer no real help or veer the practitioner in the wrong direction. I suggest that the history of increasing amounts and strengths of steroids with no obvious clinical pathology reveals the diagnosis without looking further. It is sad that these women are often looked upon as neurotic because the physician cannot reconcile the extent of the burning complaint with what they see upon examination.

The cure rate for both of the above syndromes is high but not 100%. It often takes many months or years to achieve resolution.