Genital oedema - an overview

This chapter provides an overview on genital oedema, signposting to relevant chapters.

Numerous conditions can cause genital oedema, for more information refer to the related chapters at the top right of the page. 

• Inflammatory dermatoses, for example:
  • Lichen simplex - the scrotum/vulva are very itchy and become lichenified (thickened)
  • Latex allergy - for example to condoms 
  • Contact allergic dermatitis - to lubricants, spermicides, and medicaments. Reactions are variable and can cause an eczematous, oedematous and/or bullous eruption 

• Angioedema (with or without urticaria) - causes transient swellings of deeper tissues, often affecting the face (lips, tongue, and eyelids) or other areas such as the genitalia (especially in men). If not associated with urticaria or ACEI, further investigations are required

• Cellulitis - causes tender erythema, if untreated patients become febrile and systemically unwell

• Drug reactions - most commonly a fixed drug eruption; a periodic eruption that is erythematous, sometimes bullous, and tends to fade with hyperpigmentation

• Paraphimosis - a urological emergency when the foreskin becomes trapped behind the corona of the glans penis; most commonly associated with lichen sclerosus

• Primary lymphoedema - occurs due to hypoplasia or aplasia of the lymphatic vessels. Approximately 14% of cases of primary lymphoedema are hereditary. While this can occur at any age, 80% of cases arise in puberty
  

• Secondary lymphoedema - occurs when the lymphatic flow is interrupted or hindered. There are many causes including infection (streptococcus, chlamydia, filaria, lymphogranuloma venereum), damage or resection of the lymph nodes during surgical procedures, radiation, granulomatous disease (including Crohn's disease), hidradenitis suppurativa, Down's syndrome, and extramammary Paget's disease 

• Venous abnormalities - a varicocele, or venous outflow obstruction 

• Henoch-Schönlein purpura - 90% of cases arise in children under 10 years of age. Cutaneous lesions are classically symmetrical affecting extensor surfaces, particularly the elbow, knees, and buttocks. The lesions are erythematous patches within which develop areas of haemorrhage and palpable purpura

• Acute idiopathic scrotal oedema - occurs primarily in boys (as opposed to adults), and is a diagnosis of exclusion

• Other causes of scrotal swelling include secondary to torsion, epididymo-orchitis, testicular carcinoma, hydroceles, and hernias