Early warning signs of penile cancer and health prevention guidelines for scrotal eczema, itching, and swelling.

Penile cancer is a malignant tumor that grows on the penis. It initially appears as a hard lump on the glans penis, covered by the foreskin, accompanied by itching and pain. Later, bloody discharge comes from the foreskin opening. Soon after, a cauliflower-like tumor appears at the foreskin opening. The tumor continues to enlarge, eventually penetrating the foreskin and becoming fully exposed, emitting a foul odor. When the tumor metastasizes extensively, systemic symptoms such as anemia and weight loss can occur, leading to adverse consequences. Early detection of penile cancer should primarily focus on the following signs: ① Redness, nodules, or lumps appearing under the glans, in the coronal sulcus, or on the inner foreskin. ② The lump under the foreskin continues to enlarge and then ulcerates outwards, reaching the skin of the foreskin or phimosis. ③ The lump under the foreskin erodes the corpora cavernosa. ④ The lump gradually grows from the glans towards the base of the penis. ⑤ The lump metastasizes to the inguinal lymph nodes.

To prevent penile cancer, it's crucial to maintain cleanliness of the external genitalia, especially the area under the foreskin. Men with phimosis, a tight foreskin opening, or paraphimosis should undergo early circumcision. While a long foreskin can be retracted to expose the glans, it constantly covers the urethral opening. If this is kept clean, it doesn't significantly impact health. However, if not cleaned regularly, smegma can cause inflammation of the foreskin and glans, leading to a narrow foreskin opening and eventually adhesions between the foreskin and glans, resulting in phimosis. Phimosis further narrows the urethral opening, making urination difficult, and the inability to retract the foreskin for cleaning further increases the risk of inflammation and adhesions. Smegma buildup under the foreskin, leading to balanitis, is a significant contributing factor to penile cancer. Early circumcision is crucial for timely treatment of balanitis and for the detection and management of precancerous conditions, making it a powerful measure in preventing penile cancer.

To treat penile cancer, the cause must first be identified. It has been proven that long-term irritation from smegma accumulated in the foreskin sac of phimosis or paraphimosis, leading to secondary chronic balanitis, is a significant contributing factor to cancer. Statistics show that over 90% of penile cancer cases involve phimosis or paraphimosis. Once penile cancer develops, erythema, nodules, or lumps first appear under the glans, coronal sulcus, or inside the foreskin. Later, the tumor enlarges, ulcerates outwards, and erodes inwards into the corpora cavernosa, gradually destroying the penis from the glans towards the base. 20%–30% of patients may experience inguinal lymph node metastasis. Treatment methods mainly include surgical removal, radiotherapy, chemotherapy, and laser therapy, with surgery being the primary treatment. When possible, doctors will attempt partial penile amputation to preserve some sexual function, allowing the patient to continue sexual activity. However, if treatment is delayed and the tumor has invaded above the mid-section of the penis, the doctor may have to remove the entire penis and transplant the urethra to the perineum to prevent future complications.

Scrotal eczema is characterized by rashes on the scrotal skin, resembling millet grains, which, when scratched, ooze fluid or become dry and scaly, accompanied by intense itching. It is often caused by unclean scrotal skin, invasion of damp-heat pathogens, and stagnation in the skin. This disease is more common in summer, with unbearable local itching, especially at night, making it difficult for patients to sleep and causing extreme suffering. In the acute phase, the scrotal surface shows pale red or dark red erosions with a large amount of serous exudate forming soft crusts, often accompanied by secondary infection. In the chronic phase, which often develops from the acute phase, the affected area is covered with small grayish-brown scales or crusts, and the scrotal skin becomes thickened, rough, and lichenified.

Treatment methods: ① For initial scrotal papules and vesicles, antihistamines can be taken. Chlorpheniramine tablets: Adults 4 mg, 2-3 times daily, orally. Or terfenadine tablets: Adults and those over 12 years old 60 mg twice daily, orally; children 6-12 years old 30 mg twice daily, orally. Loratadine tablets: Adults 10 mg once daily, orally; children weighing >30 kg 10 mg daily, orally; children weighing <30 kg 5 mg daily, orally. Topical corticosteroid creams, such as Picon cream, Xinfu cream, and fluocinolone acetonide cream, are also acceptable. ② For mild erosion and exudation of scrotal lesions, in addition to oral antihistamines, cold compresses with a 1% alum solution can be used. Dehydrate alum (by roasting it over low heat until it turns to charred powder), dissolve 10 grams of alum in 1000 ml of cooled boiled water, soak a small square towel in the solution, wring it until it no longer drips, and apply it to the red and swollen area of ​​the scrotum. Continue to drip the alum solution onto the towel to keep it moist. Apply the solution for 30 minutes each time, 4 times a day. After applying the solution, dry the scrotum and apply Four Strong Oil. A decoction can be prepared using 10 grams each of Cnidium monnieri, Saposhnikovia divaricata, Schizonepeta tenuifolia, Sophora flavescens, and Angelica sinensis (tail). These ingredients are packaged in a gauze bag and added to 2000 ml of water along with a 2 cm thick cotton pad. The mixture is boiled for 10 minutes. The cotton pad is then removed, wrung until it no longer drips, and the temperature is tested with the back of the hand. When it is not too hot, it is applied to the genital area (if there are skin lesions on the penis, a slightly larger cotton pad should be sewn). A layer of polyethylene film (a food packaging bag is acceptable) is then placed on top to retain heat. Each application lasts 15-20 minutes, three times a day. After application, Cnidium monnieri oil can be applied (Cnidium monnieri is roasted over a low flame until charred, ground into a fine powder, sieved through an 80-mesh sieve to remove residue, and then mixed with an equal amount of vegetable oil). For better results, the genital area can be steamed with the hot steam from this decoction before application, and the dressing can be applied when the temperature is suitable. This treatment is not suitable for patients with purulent infections. Patients with concurrent purulent infections should seek medical treatment for anti-allergy and anti-infection measures; home treatment is not recommended.

Prevention and Precautions: ① During the illness, avoid eating spicy and irritating foods such as fish, shrimp, crab, beef, and mutton. Also avoid alcohol and stimulating beverages such as coffee and cocoa. ② Do not wash the affected area with hot water, and do not rub the affected area with your hands, towels, or clothing. ③ In hot summer, wear loose-fitting trousers made of 100% cotton. Change underwear frequently, especially if you sweat a lot. ④ Avoid sitting on sun-exposed surfaces. ⑤ Shower and change clothes immediately after strenuous exercise. The water temperature should generally be between 35℃ and 40℃. ⑥ Do not purchase medications for internal or external use without a clear diagnosis. For example, during the acute phase of dermatitis or eczema, do not use any irritating topical medications.

Scrotal itching is a common disease in men, often caused by the following reasons: (1) Scrotal eczema: In the initial stage of this disease, it is often acute, with local skin reddening and the appearance of papules or vesicles. Subsequently, the papules or vesicles rupture and merge to form erosions. Later, the skin gradually thickens, the texture deepens, dries and peels, and may even crack. Unbearable itching will occur throughout the course of the disease. In the acute stage, 3% boric acid wet compresses can be used, or zinc oxide paste can be applied externally; in the chronic stage, triamcinolone acetonide ointment can be applied externally, and oral anti-allergy drugs can be taken. (2) Tinea cruris: It is caused by fungal infection. Initially, dense small red papules will appear on the skin. Then the small papules will spread to the periphery, and finally the papules will erode or crack. Tinea cruris is accompanied by severe itching and pain. When treating, antifungal ointments such as clotrimazole ointment should be used externally. Because the skin of the scrotum is delicate, commercially available black and white tinea solutions and salicylic acid alcohol solutions should not be used. (3) Vitamin B₂ deficiency: This is often caused by severe picky eating or poor gastrointestinal absorption. Due to insufficient vitamin B₂ in the body, symmetrical erythema will appear on the scrotal skin. The erythema is about the size of a coin, with clear edges and a few scales on the surface. This disease can be cured quickly by eating more fresh vegetables, soy products and lean meat, and taking vitamin B₂ orally.

The causes of scrotal swelling are multifaceted, including both disease-related and non-disease-related factors. The main causes are as follows: ① Due to illness. Conditions such as hernia, scrotal elephantiasis, testicular tumors, hydrocele, orchitis, epididymitis, and varicocele can also present with this symptom. ② Related to improper sexual activity. Some men frequently watch works of art with sexual descriptions or videos/DVDs containing sexual scenes, coupled with frequent sexual fantasies and urges, or indulge in excessive sexual activity, pursuing pleasure and satisfaction. Too much or too frequent sexual activity, coupled with prolonged intercourse, keeps the penis in a prolonged erection state, leading to chronic scrotal congestion. Conversely, some men, due to separation from their spouse, a spouse's illness, or other reasons resulting in prolonged abstinence or infrequent intercourse, may experience scrotal swelling and discomfort because the genital congestion cannot be effectively released and dissipate. ③ Frequent masturbation or inappropriate contraceptive methods. Methods like withdrawal and urethral compression can cause the genitals to be in a state of constant congestion and scrotal heaviness, leading to a feeling of heaviness in the scrotum. ④ Prolonged standing or walking. This not only increases local blood circulation in the scrotum but also causes congestion in the testicles, epididymis, and spermatic cord, resulting in a feeling of heaviness in the scrotum. ⑤ External factors. Strenuous exercise or emotional excitement can increase local temperature in the scrotum due to accelerated blood circulation. This causes the scrotum to relax, accelerating heat dissipation and causing the testicles to sag, resulting in a feeling of heaviness. ⑥ Clothing factors. Wearing tight-fitting, narrow-crotch pants, especially non-breathable nylon shorts, not only compresses the scrotum, affecting blood circulation but also raises local temperature, slows heat dissipation, and causes excessive sweating, resulting in a constantly damp scrotum. Furthermore, older men and those with weak constitutions or chronic illnesses are also at risk of experiencing scrotal discomfort.

Scrotal swelling and discomfort caused by physiological reasons and improper sexual activity generally do not require special treatment. Strengthening the body through exercise, avoiding excessive fatigue or prolonged standing or walking, maintaining moderate sexual activity (neither too frequent nor abstinent), and abstaining from masturbation to reduce sexual urges will all help prevent or alleviate scrotal swelling and discomfort. For severe symptoms, a scrotal support may be worn under the guidance of a doctor. As for those caused by underlying medical conditions, it is necessary to identify the root cause and treat it accordingly to fundamentally prevent and treat scrotal swelling and discomfort.