Swelling in the scrotum can be caused by a number of conditions that result in fluid accumulation either around the testicle or within other parts of the scrotum, and is often not cancerous: However, prolonged swelling of the testicles should be evaluated.

Conditions that lead to scrotal swelling include:

  1. Testicular Torsion
  2. Testicular torsion is an emergency condition and requires surgical treatment almost every time. Torsion occurs most commonly in young men after puberty, but can happen any time during a man’s life. Since the blood supply to the testicle comes from the abdomen, the testicle can twist around its blood supply, causing blood flow to the testicle to stop, causing sudden, intense pain. Testicular Torsion symptoms include the scrotum turning red in the area of the twisted testicle, and the testicle becomes firm and somewhat swollen as well. Patients with sudden onset, intense testicular pain and swelling should come immediately to the emergency room for evaluation. Surgical treatment untwists the testicle in an attempt to save it, or sometimes requires removal of the testicle if it is already dead at the time of surgery.

  3. Hydrocele
  4. A hydrocele is a collection of fluid around the testicle, which can cause significant scrotal swelling and a heavy pulling feeling that can be uncomfortable. Treatment of a hydrocele is surgical, with evacuation of the fluid and removal of the sac that contains the fluid. Hydrocele surgery is an outpatient procedure that is done through an incision in the scrotum.

  5. Spermatocele / Epididymal Cyst
  6. A spermatocele or epididymal cyst is a fluid collection that arises from the epididymis, which wraps around the back of the testicle and stores sperm. The difference between an epididymal cyst and spermatocele is that a spermatocele contains sperm, whereas an epididymal cyst does not, but this can only be determined after treatment. Epididymal cysts can form after vasectomy or spontaneously, and most men as they get older develop these, though they are often not noticeable and painless. If an epididymal cyst grows to a large size or is uncomfortable, it can be surgically removed in a short outpatient procedure through a small incision in the scrotum.

  7. Testicular Infection (Orchitis)
  8. Orchitis is an infection of the testicle, and sometimes the epididymis as well (epididymo-orchitis). Orchitis results in intense testicular pain and sometimes fever, as well as testicular and scrotal swelling. The pain often worsens quickly, and patients should see their physician or go to the emergency room or urgent care. Orchitis treatment includes a course of antibiotics. This condition should be quickly evaluated, as your physician will need to ensure that the testicle has not twisted on itself, shutting off its blood supply – this is called torsion and is a surgical emergency.

  9. Testicular Cancer
  10. Testicular cancer can happen at any time in a man’s life, though it is more common in men 25-35, and 55-65 years old. There are a number of testicular tumor types, and the chance of cure depends on the type of tumor and how advanced it is. However, most types of testicular cancer have very high (>90%) cure rates. Testicular cancer often presents as a very firm, often painless, and sometimes irregular mass in the testicle. When a man suspects that he may have a testicular tumor, he should be seen immediately by a doctor. Testicular cancer treatment involves surgical removal of the testicle and assessment to see whether the cancer has spread. If it has spread, additional surgical treatment or chemotherapy may be needed.