Testicular swelling, or scrotal enlargement, is a noticeable change in the size or shape of the pouch of skin that holds the testicles. This common symptom can be caused by a wide range of underlying issues, including fluid buildup, infection, or a growth. The urgency of these causes varies significantly, ranging from conditions that resolve on their own to those requiring immediate medical intervention. Any new or unexplained swelling should be evaluated by a healthcare professional. A thorough medical assessment is the only reliable way to determine the cause and secure appropriate treatment.
Understanding the Types of Swelling and Associated Symptoms
Understanding testicular swelling involves characterizing its presentation, as the details offer important diagnostic clues. Swelling can develop suddenly or gradually, and its location indicates whether the testicle, the epididymis (the coiled tube behind the testicle), or the entire scrotal sac is affected. Accompanying symptoms, particularly the level of pain, are critical differentiators between various causes. Swelling may be intensely painful, mildly uncomfortable, or painless, sometimes radiating to the groin or lower abdomen. Other signs like fever, redness, nausea, or vomiting can point toward an infectious or emergent cause.
Causes Requiring Emergency Medical Attention
Testicular swelling requires immediate medical attention to prevent permanent loss of the testicle.
Testicular Torsion
The most time-sensitive condition is testicular torsion, a urological emergency. Torsion occurs when the spermatic cord twists upon itself, cutting off the blood supply. This causes an abrupt onset of severe pain, often accompanied by nausea and vomiting. If blood flow is not restored through emergency surgery within six to eight hours, the testicle can be irreparably damaged.
Epididymitis and Orchitis
Another acute cause is severe acute epididymitis or orchitis, inflammatory conditions of the epididymis or testicle often caused by bacterial infection. While these usually have a gradual onset of pain and swelling, a sudden presentation can mimic torsion. Symptoms often include localized tenderness, redness, and warmth, sometimes with a fever or burning sensation during urination. Differentiating between infection (which increases blood flow) and torsion (which eliminates it) is paramount. Infection requires antibiotics, while torsion requires immediate surgery.
Common Causes of Gradual Swelling
Conditions causing gradual scrotal enlargement are generally non-emergent but still require evaluation.
Hydrocele
A hydrocele is a common cause, involving the accumulation of fluid in the thin sheath surrounding the testicle. This fluid collection typically presents as a painless, smooth swelling that can make the testicle difficult to feel. Physicians often identify a hydrocele using transillumination, where shining a light through the scrotum makes the fluid-filled sac light up.
Varicocele
A varicocele is another frequent cause, describing an enlargement of the veins within the scrotum, often compared to feeling like a “bag of worms.” Varicoceles usually develop over time, most often on the left side, and can cause a dull ache or dragging sensation that lessens when lying down. These swollen veins can sometimes affect sperm production, making varicocele one of the most common reversible causes of male infertility.
Inguinal Hernia
Inguinal hernias can also cause scrotal swelling when abdominal contents push through a weak spot in the abdominal wall and descend into the scrotum. This swelling often becomes more noticeable with physical strain like coughing or lifting. Sometimes a physician can gently push the contents back into the abdomen.
Testicular Cancer and Other Malignancies
The most serious concern associated with testicular swelling is cancer, which is the most common cancer in men aged 15 to 35. Unlike the painful swelling of infections, testicular cancer typically presents as a painless lump or mass confined to the testicle itself. The affected testicle may feel enlarged, firm, or heavy. While pain is not the typical symptom, some men experience a dull ache or a feeling of heaviness in the groin or scrotum. Regular self-examination is important, as early detection of a painless mass greatly improves the high cure rate for this cancer.
What to Expect During Medical Evaluation
A medical evaluation begins with a detailed history of the symptoms, including the onset, severity of pain, and any associated issues like fever or urinary problems. The physician then conducts a thorough physical examination, palpating the scrotum and abdomen to assess the size, location, and consistency of the swelling. The most common diagnostic tool is a scrotal ultrasound with Doppler flow imaging. This non-invasive test uses sound waves to create images, differentiating between solid masses, fluid collections, and inflamed tissue. The Doppler component visualizes blood flow, which helps distinguish testicular torsion (absent flow) from infectious causes like epididymitis (increased flow).