A swollen testicle, or scrotal enlargement, indicates an abnormal increase in the size of the sac holding the testicles. This enlargement can be caused by inflammation, fluid buildup, abnormal growth, or other conditions. Because the underlying causes range from non-urgent issues to medical emergencies, any noticeable swelling requires professional medical review, regardless of whether pain is present.
Immediate Medical Emergencies
The most time-sensitive cause is testicular torsion, which demands immediate emergency intervention. Torsion occurs when the spermatic cord, containing the blood vessels supplying the testicle, twists upon itself. This twisting cuts off the blood supply, leading to tissue death if not resolved quickly.
The primary symptom is the sudden onset of severe pain in the scrotum, often accompanied by abdominal pain, nausea, and vomiting. The affected testicle may appear higher than normal or positioned at an unusual angle.
Surgical correction must be performed within four to six hours of symptom onset to maximize the chance of saving the testicle. After 12 hours, the chance of salvage drops significantly, and after 24 hours, permanent damage requiring removal is likely. Any acute, severe scrotal pain or swelling should be treated as a surgical emergency requiring immediate transport to the nearest emergency department.
Common Non-Urgent Causes of Swelling
Swelling that develops gradually or is less acutely painful is often attributed to conditions that are not immediate surgical emergencies but still require medical attention. Common causes include epididymitis and orchitis, where inflammation affects the epididymis (the coiled tube behind the testicle) or the testicle itself.
This inflammation is frequently caused by a bacterial infection, sometimes sexually transmitted, or less commonly, a viral infection. Symptoms typically include pain and swelling developing over a few days, often with tenderness and sometimes a fever. Discomfort associated with epididymitis can sometimes be relieved by elevating the scrotum.
A hydrocele is a painless accumulation of clear fluid surrounding the testicle, often described as feeling like a fluid-filled balloon. While common in infants, it can also develop in adult males due to injury or inflammation. Although benign, a large hydrocele may cause a feeling of heaviness or pressure.
Another frequent cause is a varicocele, the abnormal enlargement of veins within the scrotum, often compared to a “bag of worms.” Varicoceles typically cause a dull ache, and swelling is more noticeable when standing upright due to gravity. An inguinal hernia can also present as scrotal swelling when tissue pushes through a weak spot in the abdominal wall and descends into the scrotal sac.
Medical Evaluation and Treatment Paths
A medical evaluation for scrotal swelling begins with a physical examination and detailed history to differentiate between urgent and non-urgent conditions. Initial testing often includes a urine test to check for signs of bacterial infection, which can indicate epididymitis.
Imaging is often performed using a Doppler ultrasound, the primary diagnostic tool. This non-invasive test uses sound waves to visualize internal structures and assess blood flow. In testicular torsion, the ultrasound shows an absence of blood flow, while in epididymitis, inflammation causes a notable increase.
Treatment pathways are determined by the underlying diagnosis. Torsion necessitates emergency surgery to untwist the spermatic cord and restore blood flow. If a bacterial infection like epididymitis is confirmed, treatment involves specific antibiotics and supportive care, such as rest and pain management.
For hydrocele and varicocele, treatment may be watchful waiting if the swelling is asymptomatic. Surgical repair may be recommended if they cause discomfort, affect fertility, or if the diagnosis is uncertain. A painless, firm lump or mass can occasionally signal testicular cancer, a serious cause requiring prompt surgical removal for diagnosis and treatment.