A swollen scrotum is an enlargement of the sac holding the testicles. Understanding the various reasons behind this swelling is important for proper management.
Common Causes of Swelling
Epididymitis is inflammation of the epididymis, a coiled tube at the back of the testicle that stores and transports sperm. It often stems from a bacterial infection, including sexually transmitted infections (STIs) like gonorrhea or chlamydia in younger, sexually active individuals. Symptoms develop gradually over one to two days and can include scrotal pain, tenderness, redness, and warmth, sometimes accompanied by fever or painful urination. The pain may start behind one testicle and spread to the entire scrotum or groin.
Orchitis is inflammation of one or both testicles, often resulting from a bacterial or viral infection. Mumps is a common viral cause, particularly in teens, with symptoms appearing about four to ten days after salivary gland swelling. Bacterial orchitis can arise from STIs or the spread of bacteria from urinary tract or prostate infections. It causes testicular pain, tenderness, and swelling, which can affect one or both testicles, along with fever, nausea, or a heavy sensation in the scrotum.
A hydrocele is fluid accumulation in the thin sac surrounding a testicle. While common in newborns and often resolving on its own by age one, adults can develop hydroceles due to injury or other health issues. The swelling is painless, though a large hydrocele can cause discomfort or a feeling of heaviness.
A spermatocele, also known as a spermatic cyst, is a benign, fluid-filled sac that forms near the top of a testicle. The exact cause remains unclear, but it may be linked to a blockage in the sperm-transporting tubes. Spermatoceles are painless and often discovered during self-exams or routine physicals. However, if they grow large enough, they can cause discomfort, a feeling of fullness, or a heavy sensation in the affected testicle.
An inguinal hernia develops when a portion of abdominal tissue, such as fat or a loop of intestine, pushes through a weak spot in the lower abdominal wall. This protrusion can extend into the scrotum, causing a noticeable bulge. The bulge may become more prominent with straining, coughing, or lifting, and can be accompanied by a feeling of pressure, heaviness, or pain in the groin or scrotum.
Serious Causes Requiring Immediate Attention
Testicular torsion is a medical emergency where the spermatic cord, which supplies blood to the testicle, twists. This twisting cuts off blood flow, leading to sudden and severe pain in the scrotum, often accompanied by swelling, redness, nausea, and vomiting. The affected testicle may also appear higher than normal or at an unusual angle. Without immediate surgical intervention within six hours, the testicle can suffer permanent damage or even require removal.
Testicular cancer presents as a painless lump or swelling in one of the testicles, though some individuals may experience a dull ache or sharp pain. Other indicators include a feeling of heaviness in the scrotum, a change in testicular size or shape, or sudden fluid buildup. While rare, it is the most common cancer affecting men between 15 and 35 years old. Early detection significantly improves treatment outcomes, making prompt medical evaluation of any suspicious lump or change necessary.
Fournier’s gangrene is a severe, rapidly progressing bacterial infection affecting the genital, perineal, and perianal regions. It causes intense pain, swelling, and redness in the affected area. As the infection advances, skin discoloration (red, purple, or black), blisters, a foul-smelling discharge, and a crackling sensation under the skin (crepitus) may develop. Systemic symptoms like high fever, rapid heartbeat, and signs of sepsis can also occur, necessitating immediate and aggressive medical intervention.
Trauma or injury to the scrotum can result in immediate and severe pain, swelling, and bruising. This can lead to a hematoma, a collection of blood within the scrotum. In some cases, significant force can cause a testicular rupture, where the protective fibrous layer of the testicle tears, requiring surgical repair to save the testicle. Any scrotal injury causing persistent pain, significant swelling, or discoloration warrants urgent medical attention to assess for internal damage or compromised blood flow.
Systemic conditions can also contribute to scrotal swelling. For example, congestive heart failure or kidney failure can cause generalized fluid retention, known as edema, which can manifest as swelling in the scrotum. This type of swelling feels spongy and can affect both sides of the scrotum, and is often accompanied by swelling in the legs. While not a direct scrotal problem, it signals an underlying health issue requiring comprehensive medical management.
When to Seek Medical Care
Any unexplained scrotal swelling warrants medical evaluation due to the wide range of potential causes, some of which are serious. Prompt medical consultation allows for accurate diagnosis and appropriate treatment.
You should seek immediate emergency care if you experience sudden, severe pain in the scrotum, especially if accompanied by nausea, vomiting, or if one testicle appears higher than the other. Scrotal swelling that rapidly increases, is discolored (red, purple, or black), or has a foul odor also requires urgent attention. Any swelling after an injury, especially if it involves persistent pain, bruising, or difficulty urinating, warrants immediate medical evaluation. Even a painless lump or change in testicular size or shape should be assessed by a healthcare provider to rule out conditions like testicular cancer.