Hydrocele—a collection of fluid around the testicles that can cause a large swelling in the scrotum— is a disabling condition that causes both physical and mental pain to an estimated 25 million men worldwide, according to the WHO.
Men living in India are disproportionately affected—accounting for nearly half of all men suffering from the disabling condition, one of the manifestations of lymphatic filariasis—a vector-borne neglected tropical disease caused by bites from mosquitoes that breed in stagnant water. The majority of people at risk live in rural areas with poor sanitation and hygiene conditions, urban slums and coastal areas. It is preventable if most areas could be cleaned and mosquito-breeding sites were sanitized, and if the population consumed the preventative drugs distributed by the government annually for up to 5 years.
Filarial hydrocele seriously impacts day-to-day life as well as sexual and marital relations. Affected men are embarrassed to go out or socialize in the community, and they often become an object of ridicule and prejudice because of the myths and stigma surrounding the hard-to-hide condition. They feel a sense of shame.
Men and their wives also fear impotency, and many marriages are put at risk because of the impact of hydrocele on their relationships. The problem afflicts sexually active men in their prime. For unmarried men, this physically obvious condition ruins any chances of marriage.
In due course, acute attacks impair mobility, sometimes leading victims to lose work, or work fewer days or hours when paid work is physically possible. A total incapacity to work is not unusual, which further harms affected families.
A large hydrocele may obstruct the testicular blood supply, leading to atrophy and impairment of fertility. There are other complications such as hemorrhage, rupture or calcification of the fluid.
Lepra’s work in Bihar state in India reveals that the average age of men when they seek treatment is 41, but they have waited on average 7 years before taking this step. The average income of their households is just $75 per month, $100 less than the average household income in the state. 42% of the men are affected bilaterally.
Hydrocele can only be cured through relatively simple surgery (hydrocelectomy), which can relieve all of these problems and return a man to a full and active life, restoring family relationships. The surgery permanently blocks the accumulation of fluid in the testicles, without affecting the man’s fertility in any way. Thousands of men are waiting for the surgery—if only they could afford the procedure, at a cost of around 1,500 INR ($23) in Bihar state.
As part of a 5-year programme in Samastipur, one of the most endemic districts in Bihar, Lepra aims to reach 49,000 men affected by hydrocele and to provide the surgery free of charge. New programmes will also be started in Odisha and Andhra Pradesh, equally endemic for lymphatic filariasis. Awareness-raising amongst government and private stakeholders is a key component of the programs, ensuring that the needs of LF-affected people are addressed at several levels. Lepra’s Blue Peter Public Health and Research Centre in India is considering undertaking research into hydrocele, but is looking for funding partners.
Madhavi Sakuru Meekcoms, an international development specialist and a graduate of the Rural Management programme at the Xavier University in India, is a programmes officer for India with Lepra. Radhika Rajamani is a communications consultant at Lepra in India with nearly 20 years experience as a journalist for one of India's leading dailies. Learn more about Lepra
Editor’s Note: This article is the latest in our monthly series of commentaries highlighting honorable mentions from the 2015 Global Health Untold Stories contest, co-sponsored by Global Health NOW and the Consortium of Universities for Global Health.
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