Scrotal issues: what men need to know

Written by: Mr Rowland Rees
Edited by: Cameron Gibson-Watt

Discovering a problem ‘down there’ can be worrying at first. Fortunately, conditions affecting the scrotum and testicles aren’t usually serious and treatment is pretty straightforward. But, learning more about the possible causes of these conditions can be the first step to putting your mind at ease. Mr Rowland Rees, a leading consultant urologist in Hampshire and London, tells us the most common causes of swelling and pain in the scrotum and how they are treated.

Causes of swelling in the scrotum

It’s important to note that you should always check with your doctor if you have any pain or swelling in the scrotum or testicles, just to be certain. If you discover a lump or you have consistent pain then you must visit your doctor, as this could be a sign of testicular cancer.

  • Hydrocele – a hydrocele is a collection of fluid around the testicle. This is usually caused by an infection, inflammation or injury and can accumulate between the layers surrounding the testicle and spermatic cord. Symptoms at first may not be obvious, but as it enlarges it may cause a feeling of heaviness or pressure in the scrotum when walking or sitting. A doctor may drain this fluid but most of the time it comes back. Surgery can be offered if the symptoms cause discomfort and affect daily activities.
  • Epididymal cysts – usually found on the top end of the testis but can develop around the body. They are non-cancerous growths filled with a clear liquid. Most are around 1-2cm in size but they can be bigger. Treatment isn’t necessary but if they interfere with sperm passage or get very large and cause discomfort then surgery may be needed.
  • Varicocoele – this is a collection of dilated veins in the spermatic cord. The veins carry blood away from the testicle but when the valves aren’t working properly, blood may build up in this area which causes them to stretch. This is very similar to varicose veins. Indications for treatment could be troublesome pain or infertility. Symptoms include feeling a dragging sensation around the testicle. Surgery is normally an option to remove them which involves microsurgical subinguinal varicocoele repair.
  • Epididymo-orchitis – this is inflammation of the epididymis or testicle and is usually due to infection. It is quite common in men aged 15-30 years old and men over 60 years. Symptoms included a swollen testicle with a red and enlarged scrotum. High temperature and a general feeling of being unwell may be present because of the infection. Antibiotics are usually the main form of treatment.
  • Testicular lumps – if a lump is found then a urologist must examine the area for testicular cancer. An ultrasound scan can be done to check this as well.  The first symptom of cancer is often a small, firm, painless lump on the testicle the size of a pea or a marble. Sometimes, this lump can be painful and cause swelling and discomfort.


What does pain in the scrotum or testicles mean?

It depends on the type of pain. It can either be acute pain, which means it is short-lasting, or chronic pain, which means it is long-term.


Acute, sudden and severe pain can be caused by torsion of a testicle. In other words, twisting of the spermatic cord that carries blood to the scrotum. This reduced blood flow often causes sudden and severe pain. If this is the case, then emergency surgery is required.


What about chronic scrotal pain that doesn’t go away?

Chronic scrotal pain can be caused by a variety of conditions. These include ongoing infections, longstanding inflammation, nerve problems, psychological issues, varicocoele, urinary conditions or previous surgery.


To diagnose the cause, a doctor must do a full investigation of all potential causes. The treatment will, therefore, be individualised and targeted at the underlying cause or condition.


There are various techniques and medications to reduce the pain which include nerve injections and psychological treatment approaches. Very rarely the testis or epididymis has to be removed.


If you are experiencing any of the symptoms mentioned in this article and would like to talk to a specialist, visit Mr Rowland Rees’s profile and book a consultation with him.

By Mr Rowland Rees

Mr Rowland Rees is a leading consultant urologist in Hampshire and London, who has extensive experience in general urology, including male infertility, erectile dysfunction, male incontinence surgery, penile skin lesions and cancer, genital lymphodema, vasectomy reversal and testosterone deficiency. He is one of the UK’s few full-time dedicated specialists in andrology and genito-urethral surgery such as hydrocele, foreskin surgery and managing foreskin problems in general.

Mr Rees trained in urology on the south coast and subsequently undertook his andrology fellowship where he worked and researched with some of the world’s leading experts in the field.

He is past chairman of the executive committee of the andrology section of the British Association of Urological Surgeons. Mr Rees is involved in clinical research at Southampton University and is the principal investigator for two national trials in urethral surgery.

Mr Rowland Rees offers face-to-face, online, and telephone consultations to his patients, depending on preference. For the UK's Private Healthcare Information Network (PHIN) statistics and feedback about Mr Rees' practice, please see here

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