6 Non-STI Causes of Itching Balls
When Al Bundy put his hand down the front of his pants during an episode of "Married…With Children," guys everywhere understood. While the henpecked patriarch of the Bundy clan didn't go in for a scratch on camera, you know he did after the director yelled "Cut!" Guys everywhere understand the urge to itch and scratch your balls/nuts/scrotum/testicles, whatever word you choose.
It feels good to scratch down there. But when an itch becomes perpetual and nagging, a sexually transmitted infection (STI), such as genital herpes, gonorrhea or chlamydia, could be an obvious culprit. But what if you're certain that can't be the case? Why do your balls itch so bad?
In many cases, an itchy scrotum has nothing to do with sex. Factors such as excess sweat, a lack of airflow, friction and poor hygiene can all lead to irritation and mean, red rashes; so can bacterial and fungal infections in the scrotum area.
The good news is non-STI scrotal skin conditions are highly treatable and manageable, according to Amy Kassouf, M.D., a dermatologist at Cleveland Clinic.
"In extremes, you can get skin breakdown and secondary infections," Kassouf said. "If they're not managed, you can let it get to a point when it's a health concern. But for the most part, it's mostly a comfort concern."
Check out six non-STI reasons your balls may itch:
Reason No. 1 for itchy balls: Jock itch (tinea cruris)
Jock itch, or tinea cruris, is a fungal infection that can affect the scrotum. While the affliction got its name because it's common in athletes, jock itch is also commonly experienced by men who sweat a lot or are overweight.
If a man has recurrent jock itch, Laurence Levine, M.D., a professor of urology at Rush University Medical Center in Chicago, recommends antifungals or drying agents that can help dry up some of the moisture that may accumulate down there.
Levine said jock itch is often hygiene-related.
"This is not to say that somebody is dirty, it just means you happen to be someone who sweats a lot more," he said.
Jock itch can be treated with different antifungal creams, both over-the-counter and prescription formulations. Commonly used antifungal creams include terbinafine (Lamisil) and butenafine (Lotrimin Ultra).
"They're very effective. If it's severe or the fungus starts to go down in the hair follicles, it gets much more difficult to treat," said Kassouf, adding that in more severe cases, an oral antifungal medication may be prescribed. "We have some prescription ones that are a little stronger if you have failed the over-the-counter ones."
Reason No. 2 for itchy balls: Chafing
Chafing occurs when skin rubs together and leads to redness and irritation. Levine said chafing in the scrotal area is more common in men who are overweight.
"It's thigh against thigh all the time, which is also encroaching upon the scrotum all the time," he said. "Nothing is ever hanging free and clear in the breeze."
Moisturizing the skin can help with chafing, because anything that decreases friction—the root cause of chafing—will help; so can powder. Kassouf's preferred powder for chafing is tolnaftate (Zeasorb AF) because it has a carbohydrate that absorbs sweat and it's also an antifungal. It gets rid of the yeast and helps prevent friction.
Kassouf said men should avoid products with cornstarch, such as talcum powder, because it can get in the hair follicles, feed the yeast that's present and cause inflammation.
Reason No. 3 for itchy balls: Eczema
Eczema—a skin condition also known as atopic dermatitis—can appear anywhere on the body and may begin as an itch before you even see the rash. Scratching the itch can cause a rash to develop.
It often presents as patches of irritated, red skin, and small, fluid-filled bumps may develop. Scrotal eczema can spread to the skin on the penis, between the buttocks and around the anus.
Allergens can aggravate the condition, so contact eczema, or contact dermatitis, is another potential issue, Kassouf said.
"Sometimes, it can be simple things like putting on a lotion with a fragrance; you can be allergic to the fragrance and the lotion," she said. "That can be contact dermatitis by itself, or if we're a little bit eczema-prone, it can flare up our eczema, especially in our private areas."
Topical anti-inflammatory creams are the general treatment for eczema, with over-the-counter hydrocortisone being a common one. Stronger prescription creams are also available.
"We have to be a little careful with the very strong ones because they can lead to thinning of the skin and stretch marks if they're overused," Kassouf said. "You want to do that under physician guidance."
Nonsteroidal creams such as Protopic and Elidel effectively treat the inflammation, and Kassouf prefers using these creams in skinfold areas.
Reason No. 4 for itchy balls: Psoriasis
Psoriasis is an incurable chronic autoimmune disease and inflammatory condition associated with skin plaques. When psoriasis is found on the scrotum, it usually also presents in other parts of the body. It can cause severe symptoms, including abrasions, cracks and bleeding, all of which can lead to secondary infections if the condition is not treated.
In comparison to eczema, psoriasis causes more discrete plaques with a thicker scale. However, psoriasis in the skinfolds of the scrotal area can present a bit differently.
"We call that inverse psoriasis, where the plaques are a little bit softer and the scale is a little softer and moister," Kassouf said.
Like eczema, psoriasis is generally treated with topical steroids. While there are fewer nonsteroidal cream options than with eczema, there are many more systemic treatments for psoriasis.
Reason No. 5 for itchy balls: Intertrigo
Caused by skin-to-skin friction and worsened by moisture and heat, intertrigo is an inflammatory skin condition that often presents as a red, bumpy rash in the skinfolds of the groin area. While intertrigo itself is not an infection, it can lead to a yeast infection, especially if the person who acquires it is exercising a lot, is overweight or his skinfolds are especially warm, Kassouf said.
"It's sort of an irritant reaction to the sweat that accumulates, but then you can get yeast growth in there. That I see pretty frequently," she added.
Reason No. 6 for itchy balls: Shaving
Common grooming is another potential cause. Shaving down there can lead to scrotal itch.
"It might feel better right after shaving, but then as those little hairs start to grow back in, they're very rough," Kassouf said. "You can basically give yourself a little beard-burn kind of feeling in that area as those hairs come back in."
Check out this Giddy article for tips on avoiding the post-shave itch.
How to prevent your balls from itching
Prevention might be a strong word, but men can take measures to minimize the chances of scrotum itch.
"Airflow is a big deal," said Kassouf, who recommended wearing looser clothing that allows more airflow in the scrotal area. "As we exercise, we get into a lot of these fancy exercise clothing. There's a lot of elastic, things tend to get cramped in that private area, so you get a lot more friction with the skin."
This causes sweat to get trapped in the skinfolds. The scrotum itself has rugae, a texture of the skin that can trap sweat, which can cause irritant dermatitis. Wearing tight, elastic exercise clothes for working out is fine, but make sure to spend time each day getting a lot of airflow into the genital area.
Avoid allergens and products that have a lot of fragrance. Some people are even allergic to clothing dyes, such as those used in blue jeans.
Showering and bathing with soap and water on a regular basis is also important for prevention.
If one of these many reasons for an itchy scrotum affects you, see a dermatologist. They can provide a diagnosis and treatment plan that will bring your balls much-needed relief.