Burning scrotum syndrome, otherwise known as “male genital dysaesthesia” or “red scrotum syndrome”, is an uncommon condition whereby men present with burning hot discomfort of the male genitalia, often accompanied by hypersensitivity to touch. Its aetiology is not well understood till date. We report a case of a 20 year-old male with chronic penoscrotal discomfort over 2 years. Physical examination revealed a normal genitalia and perineum. He had a past medical history of obsessive compulsive disorder, and was recently started on sertraline. He was diagnosed with burning scrotum syndrome. The authors propose that this condition may be a manifestation of psychosexual disorder and can be relieved by managing existing underlying psychological condition.

A PubMed search using the search terms “male genital dysaesthesia”, “male genital pain”, “red scrotum syndrome” and “burning scrotum syndrome” was performed to review relevant articles dating from 2010 to present.

In a 2019 case series by Jesus Alberto Cardenas-de la Garza et al., 5 patients with scrotal dysaesthesia from an outpatient dermatology clinic in a tertiary care hospital showed improvement in symptoms with pregabalin. 4 out of these 5 patients were prescribed pregabalin monotherapy and the last patient was prescribed pregabalin and doxycycline. All 5 patients had complete remission within 3 months. A case study by Angelina S. Hwang et al. in 2021 reported a case of a 41 year-old patient with scrotal dysaesthsia without improvement after trial of azithromycin, ibuprofen, betamethasone and systemic steroids, but reported improvement of pain (60%-70%) by 10 days of indomethacin treatment, and by 1 month had complete remission. Recent studies have also proposed that botulinum toxin may be effective. In a 2021 case study by Haya S. Raef et al., a 63 year-old male with scrotal dysaesthesia who failed therapy with mid-potency corticosteroids, pregabalin, gabapentin, received botulinum toxin across his scrotum and perineum and reported dramatic improvement of pain, remaining asymptomatic for about 3 months before he required another maintenance injection. Our patient reported improvement in genital symptoms with emollients and continued treatment with sertraline.

Burning scrotum syndrome is uncommon and leads to stress and disruption in social and sexual relationships. Limited literature and evidence poses a challenge in formulating first-line management recommendations. Moreover, different etiology theories make management approach diverse. In addressing psychosexual urology disorders, a comprehensive history, inter-professional care and positive physician-patient relationship can result in early recognition and timely treatment with appropriate mood modulators.