Scrotal Swelling

Scrotal swelling refers to enlargement of the scrotum, the sac of skin that contains the testicles. This swelling can affect one or both sides and may develop suddenly or gradually over time. While some causes are benign and painless, others represent medical emergencies requiring immediate treatment. The swelling may result from fluid accumulation, enlarged blood vessels, hernias, infections, or testicular problems. Understanding the characteristics of the swelling, associated symptoms, and timing helps determine the urgency of medical evaluation.

🚨 Seek Emergency Care IMMEDIATELY If:

You have sudden severe testicular pain, nausea/vomiting with scrotal pain, testicle sitting higher than normal, pain not relieved by elevation, fever with scrotal swelling, or trauma followed by severe swelling. Testicular torsion is a surgical emergency - delaying treatment beyond 6 hours significantly increases risk of testicle loss.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.

Common Causes

Fluid Collections

  • Hydrocele:
    • Most common cause in adults
    • Fluid around testicle
    • Usually painless
    • Transilluminates with light
    • Can be congenital or acquired
    • May fluctuate in size
  • Spermatocele:
    • Cyst in epididymis
    • Contains sperm
    • Usually above testicle
    • Smooth, round mass
    • Generally painless
  • Hematocele:
    • Blood collection
    • Usually from trauma
    • Does not transilluminate
    • May be painful
    • Can be large

Vascular Causes

  • Varicocele:
    • Dilated veins in scrotum
    • "Bag of worms" feeling
    • More common on left side
    • Worse when standing
    • May affect fertility
    • Dull aching pain
  • Testicular torsion:
    • MEDICAL EMERGENCY
    • Sudden severe pain
    • Testicle elevated
    • Absent cremasteric reflex
    • Nausea and vomiting
    • Most common in teens

Infections

  • Epididymitis:
    • Inflammation of epididymis
    • Gradual onset pain
    • Tenderness at back of testicle
    • May have urinary symptoms
    • STI or UTI cause
    • Relieved by elevation
  • Orchitis:
    • Testicular inflammation
    • Often with epididymitis
    • Viral (mumps) or bacterial
    • Swollen, tender testicle
    • Fever common
  • Fournier's gangrene:
    • MEDICAL EMERGENCY
    • Necrotizing infection
    • Rapid progression
    • Severe pain and fever
    • Skin changes
    • High mortality
  • Cellulitis:
    • Skin infection
    • Red, warm, tender
    • May spread rapidly
    • Fever possible

Hernias

  • Inguinal hernia:
    • Intestine into scrotum
    • Increases with straining
    • May reduce when lying down
    • Can become incarcerated
    • Bowel sounds over scrotum
  • Incarcerated hernia:
    • Cannot be reduced
    • Painful swelling
    • Risk of strangulation
    • Requires urgent surgery

Testicular Conditions

  • Testicular cancer:
    • Painless lump or swelling
    • Testicle feels heavy
    • May have dull ache
    • Most common 15-35 years
    • Firm, irregular mass
  • Testicular trauma:
    • Direct injury
    • Immediate swelling
    • Severe pain
    • May cause hematocele
    • Risk of rupture
  • Testicular appendix torsion:
    • Blue dot sign
    • Upper pole tenderness
    • Less severe than testicular torsion
    • Mainly in boys

Systemic Causes

  • Heart failure:
    • Dependent edema
    • Bilateral swelling
    • Pitting edema
    • Also leg swelling
  • Liver disease:
    • Ascites extension
    • Portal hypertension
    • Bilateral swelling
  • Kidney disease:
    • Fluid retention
    • Generalized edema
    • Bilateral involvement
  • Lymphatic obstruction:
    • Filariasis (elephantiasis)
    • Post-surgical
    • Malignancy
    • Non-pitting edema

Other Causes

  • Idiopathic scrotal edema: Children, self-limiting
  • Allergic reactions: Insect bites, contact dermatitis
  • Henoch-Schönlein purpura: Vasculitis in children
  • Post-vasectomy: Normal post-operative swelling
  • Drug reactions: Some medications

Associated Symptoms

Pain Characteristics

  • Sudden severe pain (torsion)
  • Gradual onset pain (infection)
  • Dull aching (varicocele)
  • Sharp pain (trauma)
  • Painless swelling (hydrocele, tumor)
  • Pain with urination
  • Pain during sexual activity

Local Symptoms

  • Redness of scrotal skin
  • Warmth to touch
  • Skin changes or discoloration
  • Visible veins
  • Lumps or masses
  • Heaviness sensation
  • Discharge from penis

Systemic Symptoms

  • Fever and chills
  • Nausea and vomiting
  • Abdominal pain
  • Urinary symptoms
  • Weight loss
  • Night sweats
  • Fatigue

Diagnosis and Evaluation

Medical History

  • Onset and duration of swelling
  • Pain characteristics
  • Previous episodes
  • Sexual history
  • Recent trauma
  • Urinary symptoms
  • Medical conditions
  • Recent surgeries

Physical Examination

  • Inspection:
    • Size and symmetry
    • Skin appearance
    • Position of testicles
    • Visible masses
  • Palpation:
    • Tenderness location
    • Consistency of swelling
    • Testicular lie
    • Cremasteric reflex
    • Transillumination

Diagnostic Tests

  • Ultrasound with Doppler:
    • First-line imaging
    • Evaluates blood flow
    • Identifies masses
    • Diagnoses torsion
  • Urinalysis:
    • Infection screening
    • STI testing
    • Urethral swab if indicated
  • Blood tests:
    • CBC for infection
    • Tumor markers (AFP, hCG, LDH)
    • Kidney/liver function
  • Other imaging:
    • CT for trauma/complications
    • MRI for complex cases

Treatment Options

Emergency Treatment

  • Testicular torsion:
    • Immediate surgical detorsion
    • Bilateral orchiopexy
    • Orchiectomy if non-viable
    • Time is critical
  • Incarcerated hernia:
    • Manual reduction attempt
    • Emergency surgery if fails
    • Hernia repair
  • Fournier's gangrene:
    • Aggressive debridement
    • Broad-spectrum antibiotics
    • ICU care

Medical Management

  • Infections:
    • Antibiotics (oral or IV)
    • Pain management
    • Scrotal support
    • Rest and elevation
  • Inflammatory conditions:
    • NSAIDs
    • Ice packs (first 24-48 hours)
    • Scrotal elevation
    • Activity restriction
  • Systemic causes:
    • Treat underlying condition
    • Diuretics if appropriate
    • Compression garments

Surgical Treatment

  • Hydrocele repair: If large or symptomatic
  • Varicocelectomy: For pain or infertility
  • Hernia repair: Elective or emergency
  • Orchiectomy: For cancer or non-viable testicle
  • Spermatocelectomy: If large or bothersome

Conservative Management

  • Scrotal support/athletic supporter
  • Avoid heavy lifting
  • Warm or cool compresses
  • Over-the-counter pain relief
  • Observation for small hydroceles
  • Regular self-examination

Prevention

  • Wear protective gear during sports
  • Practice safe sex to prevent STIs
  • Prompt treatment of UTIs
  • Regular testicular self-exams
  • Mumps vaccination
  • Proper lifting techniques
  • Maintain healthy weight
  • Manage chronic conditions

When to Seek Medical Care

Emergency - Call 911 or Go to ER

  • Sudden severe testicular pain
  • Nausea/vomiting with scrotal pain
  • Testicle higher than normal
  • Severe trauma to scrotum
  • Rapidly spreading redness/swelling
  • High fever with scrotal symptoms
  • Unable to urinate

See Doctor Within 24 Hours

  • Moderate scrotal pain
  • New swelling without severe pain
  • Fever with scrotal swelling
  • Pain with urination
  • Discharge from penis
  • Swelling after minor trauma

Schedule Appointment

  • Painless scrotal swelling
  • Gradually increasing swelling
  • Feeling of heaviness
  • Visible veins in scrotum
  • Small lumps or masses
  • Chronic mild discomfort