Definition and Overview

The scrotum is the sac of skin that holds the testicles (testes), which produce sperm and testosterone. Symptoms affecting this area can involve the testicles themselves, the scrotum, or the structures within including the epididymis, spermatic cord, and blood vessels. These symptoms can manifest as pain, swelling, lumps, changes in size or position, skin changes, or other abnormalities.

Understanding scrotal and testicular symptoms is crucial because while many conditions are benign and easily treatable, some represent medical emergencies. Testicular torsion, for example, requires immediate surgery to save the testicle, while testicular cancer, though relatively rare, is the most common cancer in young men and is highly curable when detected early.

Men often delay seeking medical attention for scrotal symptoms due to embarrassment or fear, but prompt evaluation is important. Regular self-examination and awareness of what's normal can help detect problems early. Any new or concerning symptoms should be evaluated by a healthcare provider to ensure proper diagnosis and treatment.

Common Symptoms and Their Causes

Pain and Discomfort

  • Testicular torsion: Emergency - twisted testicle
  • Epididymitis: Inflammation of epididymis
  • Orchitis: Testicular inflammation
  • Trauma: Injury from sports, accidents
  • Inguinal hernia: Intestine pushing through
  • Kidney stones: Referred pain
  • Post-vasectomy pain: Chronic pain syndrome
  • Nerve irritation: From back problems

Swelling and Enlargement

  • Hydrocele: Fluid around testicle
  • Varicocele: Enlarged veins ("bag of worms")
  • Spermatocele: Cyst in epididymis
  • Scrotal edema: Fluid retention
  • Hematocele: Blood collection
  • Infection: Cellulitis or abscess
  • Heart failure: Generalized edema
  • Lymphatic obstruction: Drainage problems

Lumps and Abnormalities

  • Testicular cancer: Usually painless lump
  • Epididymal cyst: Benign fluid-filled sac
  • Testicular disorders: Various conditions
  • Undescended testicle: Not in scrotum
  • Testicular atrophy: Shrinking testicle
  • Calcifications: Hard spots
  • Torsion of appendix testis: Small structure twist
  • Tuberculosis: Rare granulomas

Types of Symptoms

Local Symptoms

  • Sharp or dull pain
  • Heaviness or dragging sensation
  • Visible swelling
  • Palpable lumps or masses
  • Skin redness or discoloration
  • Warmth to touch
  • Hardness or firmness
  • Size differences between sides

Associated Symptoms

  • Fever with infection
  • Nausea and vomiting
  • Abdominal pain
  • Urinary symptoms
  • Sexual dysfunction
  • Infertility concerns
  • Back or groin pain
  • General malaise

When to Seek Emergency Care

Seek immediate medical attention for:

  • Sudden, severe testicular pain
  • Testicle higher than normal or horizontal
  • Nausea and vomiting with testicular pain
  • Abdominal pain followed by testicular pain
  • Testicular pain after trauma
  • Fever with scrotal redness and swelling
  • Blue or black discoloration
  • Inability to find or feel testicle
  • Severe swelling after surgery
  • Any testicular pain in children/teens
  • Pain not relieved by support or medication

Critical: Testicular torsion is a surgical emergency. Treatment within 6 hours gives the best chance of saving the testicle.

Diagnostic Approach

Healthcare providers evaluate scrotal symptoms through:

Examination and Tests

  • Physical examination: Palpation, transillumination
  • Ultrasound with Doppler: Blood flow assessment
  • Urine tests: Check for infection
  • Blood tests: Tumor markers, infection
  • STD testing: If sexually active
  • CT scan: For complex cases
  • Nuclear scan: If torsion suspected
  • Surgical exploration: When diagnosis unclear

Treatment and Management

Conservative Management

  • Scrotal support (athletic supporter)
  • Ice packs for acute injury
  • Rest and elevation
  • Over-the-counter pain relievers
  • Antibiotics for infections
  • Warm baths for comfort
  • Avoid heavy lifting
  • Loose-fitting underwear

Medical/Surgical Treatment

  • Emergency surgery for torsion
  • Hernia repair surgery
  • Hydrocele drainage or surgery
  • Varicocele repair
  • Cancer treatment (surgery, chemo)
  • Aspiration of cysts
  • Hormone therapy if indicated
  • Nerve blocks for chronic pain

Prevention and Self-Examination

Maintain testicular health:

  • Monthly self-exams: Check for lumps or changes
  • Protective equipment: For sports and activities
  • Safe sex practices: Prevent STDs
  • Prompt treatment: For infections
  • Good hygiene: Keep area clean and dry
  • Supportive underwear: Prevent trauma
  • Manage chronic conditions: Diabetes, etc.
  • Regular check-ups: Annual physicals
  • Know your normal: Detect changes early
  • Avoid tight clothing: Allow proper circulation