Scrotal Swellings: What causes testicles to swell and be painful?

Scrotal Swellings

The testicles are outside the abdominal cavity because the growth and formation of normal spermatozoa require a cooler temperature than that inside the body cavity. These organs exhibit normal retraction within the scrotum, so they tend to be retracted upward under conditions of stimulation and excessive cold. A patient may be totally unaware of the normal shape, feel and contents of his scrotal sac; an assumed abnormality may be something completely normal. On the other hand, the scrotal contents are subject to a large variety of both serious and minor disorders which require accurate early diagnosis for proper management and correction. Therefore any presumed abnormality, swelling, discoloration or pain should be promptly investigated.

What causes sudden scrotal swelling in children? 

Acute scrotal swelling in infancy and childhood is a fact. The young testicle can sometimes be so loosely anchored that it turns on itself and can twist off its blood supply, thereby endangering its viability. In this problem the surgeon has to differentiate between infections in the outlet part of the testicle, twists of an appendage of the testicle and true testicular torsion. The former two conditions do not require surgery, the latter does.

My son has no signs of a testicle on one side. What shall we do? 

The examination confirms the fact that there is no testicle on one side of the scrotum. This side of the scrotal sac is not as well developed as the other. It is possible to feel the testicle very high up in the groin. At this time this testicle is normal, but it has not completed its descent into the scrotum. Hence it is referred to as an undescended testicle. The opposite testicle is obviously normal in size and position.

Hormonal therapy is of questionable value in effecting descent of one testicle. If the testicle has not descended by age four, surgical correction should be performed. There is usually an associated groin hernia, which can be repaired at the same time.

What does the operation do? 

The operation lengthens the attachments of the testicle so that it can be placed in a normal position. If this is done by age four or five, one can fully expect that the testicle will function normally in the production of the male sex hormone and of sperm.

I have never been aware of a testicle on the one side. Until now I've been avoiding seeing a physician about this.

You can see that the scrotum on this side is poorly developed, much smaller than the opposite side. This means that a normal testicle has never resided in the sac. The testicle can, however, be felt in the lower part of the abdomen where it joins the scrotum. In childhood such an undescended testicle must be placed in the scrotum before puberty if it is to produce sperm. If the condition is encountered on one side in the adult, then it may be best to remove the undeveloped testicular remnant because of the slightly increased risk of cancer formation. It is unfortunate that the treatment has been delayed.

I've a swelling in the left testicle that feels like a "bag of worms."

An examination in the standing position demonstrates that straining causes these cords to become even more prominent. These are varicose veins of the testicular venous system (varicocele). Ordinarily they are of no significance except for the dragging sensation that they produce; this can often be relieved by a scrotal suspensory. Surgical correction of the varicocele is advised only when it is associated with male infertility.

I have noticed intermittent swelling of one side of the scrotum. It disappears when I lie down. Sometimes there are gurgles.

These are characteristics of a hernia. Part of the intestine gets into the scrotum when you're up and about; the gurgling is due to gas and fluid in the bowel. The intestine slips back at night because you are totally relaxed. An examination can confirm this by completely pushing the mass from the scrotum into the abdomen. This type of hernia should be repaired. I've noticed a progressive enlargement of one side of the scrotum. It is not painful. I'm only discomforted by its weight and size.

If the swelling cannot be pushed into the abdomen and if a flashlight behind the mass shows that it transilluminates well, there is probably an excessive collect of fluid (called a hydrocele) in the lining of the testicle. The majority of hydroceles in infancy go away spontaneously without any form of treatment. In the adult a physician can attempt initial treatment by removing the fluid with a large needle. Several such taps may cure the condition, but this method carries the danger of introducing infection. Hydroceles in adults are best managed by surgery.

Testicular swelling check at home


What is a scrotal exploratory operation? Why do you want to do it? 

Examination of the testicle may reveal an abnormality in its shape and consistency such as a hard bulge. In addition the hydrocele fluid may be tinged with blood. These are the symptoms of major disease in the area. The operation involves an exposure of the testicle and an inspection and biopsy of the diseased area.

What could it be? 

It could be a tumor or chronic infection of the testicle. This is the only way we will find out. It is not advisable to delay the diagnosis and treatment of a testicular disorder.

What will you do?

 It may be necessary to remove the testicle and its internal attachments and blood vessels. Recall, this is now not a normal organ so even if the testicle is removed, you are not being deprived of a functioning part. These diseased organs are best removed.

What is done if it turns out to be a cancer of the testicle? 

The testicle and its cord will be completely removed. It sometimes is also advisable to remove all the drainage (lymph nodes) of the testis as they extend to involve the groin and abdomen. Postoperative radiation treatments will be given. With this combined treatment survival rates can be as high as 90 percent or less than 20 percent depending on the microscopic evaluation of the cancer type.

What happens to me as a man if one testicle is removed? 

If the remaining testicle is normal, this operation has no effect on virility, sexual performance or the ability to impregnate.

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