Scrotal swelling is abnormal enlargement of the scrotum, the sac surrounding the testicles.

Scrotal swelling can occur in males at any age. The swelling can be on one or both sides, and there may be pain. The testicles and penis may or may not be involved.

Testicular torsion is a serious emergency in which the testicle become twisted in the scrotum and loses its blood supply. If this twisting is not relieved quickly, the testicle may be lost permanently. This condition is extremely painful. Call 911 or see your health care provider immediately, because losing blood supply for just a few hours can cause tissue death and the loss of a testicle.

• Certain medical treatments
• Congestive heart failure
• Epididymitis
• Hernia
• Hydrocele
• Injury
• Orchitis
• Surgery in the genital area
• Testicular torsion
• Varicocele

• Apply ice packs to the scrotum for the first 24 hours, followed by sitz baths to decrease swelling.
• If the pain is severe, place a rolled-up towel between the legs just under the scrotum to help relieve pain and reduce swelling, but get medical attention to make sure it is not a torsion.
• Wear a loose-fitting athletic supporter for daily activities.
• Avoid excessive activity until the swelling disappears.

Call your health care provider if:

• You notice any unexplained scrotal swelling
• The swelling is painful
• You have a testicle lump

Your health care provider will perform a physical examination and take a medical history, which may include the following questions:

• When did the swelling develop?
• Did it develop suddenly?
• Is it getting worse?
• How big is the swelling (try to describe in terms such as "twice normal size" or "the size of a golfball")?
• Does the swelling appear to be fluid?
• Can you feel tissue in the swollen area?
• Is the swelling in one part of the scrotum or in the entire scrotum?
• Is the swelling the same on both sides (sometimes a swollen scrotum is actually an enlarged testicle, a testicular lump, or a swollen duct)?
• Have you had surgery on the genital area?
• Have you had an injury or trauma to your genitals?
• Have you had a recent genital infection?
• Does the swelling go down after you rest in bed?
• Do you have any other symptoms?
• Is there any pain in the area around the scrotum?

The physical examination will probably include a detailed examination of the scrotum, testicles, and penis. The combination of a physical exam and history will determine whether you need any tests.

Your health care provider may prescribe antibiotics and pain medications, or recommend surgery. A scrotal ultrasound may be done to determine where the swelling is occurring.

Schneck FX, Bellinger MF. Abnormalities of the Testes and Scrotum and their Surgical Management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 127.

Elder JS. Disorders and Anomalies of the Scrotal Contents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 545.