Scrotal Swelling & Chronic Testicular Pain

There are many different “nonacute” scrotal conditions in men.

Normal anatomy of the scrotum:

  • There are many structures that may be involved in nonacute scrotal conditions:
    • Testis
    • Tunica vaginalis
    • Epididymis
    • Spermatic cord and vas deferens
  • Testis (testicle):
    • Produces sperm and testosterone
  • Tunica vaginalis:
    • A fascial layer that surrounds the testicle
    • Fluid may accumulate here, causing swelling
  • Epididymis:
    • Storage and transportation of sperm
  • Vas deferens:
    • Carries sperm from the epididymis out of the body

Scrotal swelling:

  • Your doctor will perform a physical exam to determine the cause of your scrotal swelling:
    • Swelling around the spermatic cord, feeling like a “bag of worms” may represent a varicocele, or dilated veins to the testicle
    • Unilateral or bilateral swelling around the testicle which feels very uniform is suggestive of a hydrocele
    • Swelling above or behind the testicle, which arises from the epididymis, is likely a spermatocele or epididymal cyst
  • Your doctor may order a scrotal ultrasound to try and determine the cause of the swelling

Testicular pain may be caused by many different conditions. Your family physician will complete the initial work-up for your testicular pain. Patients with chronic pain that does not improve may be referred to urology.

Some of the common causes include:

  • Infection
  • Tumor
  • Groin hernia – either a present hernia or one that has been repaired
  • Torsion of the testicle
  • Trauma
  • Pelvic floor muscle tension
  • Tendonitis
  • Referred pain

Conservative treatments for chronic testicular pain:

  • Heat
  • Ice
  • Scrotal support (tight boxers/briefs)
  • Analgesia (Tylenol or Advil as necessary)
  • Physiotherapy for back or pelvic floor tension

More information:

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