Non-cancer causes of testicular or scrotal symptoms
Problems other than cancer can also cause symptoms in the testicles or scrotum. Here are some of the more common causes of testicular symptoms, but they are not the only ones. Because it’s hard to figure out the cause based on symptoms alone, it’s important to have any testicular or scrotal change looked at by a health care professional.
Some of the conditions that can cause a testicular lump, swelling, and/or pain include:
- Torsion of the testicle
- Infection, including epididymitis and orchitis
- Epididymal cyst/spermatocele
- Inguinal hernia
- Kidney stone
These are discussed in more detail below.
Torsion of the testicle
In testiclular torsion, one of the testicles gets twisted inside the scrotum. This cuts off the blood supply to the testicle, epididymis, and other structures, leading to sudden, severe pain in the scrotum along with swelling and redness. It can also cause belly pain or nausea and vomiting.
Testicular torsion occurs most often in teen boys, but may occur later in life.
It is often diagnosed using ultrasound of the testicle/scrotum (see our document Imaging Tests for more information about ultrasound). Torsion is an emergency that needs to be treated right away. Treatment is surgery to untwist the testicle, which restores the blood supply. If the torsion isn’t treated right away (within about 6 hours), the testicle can die and will have to be removed. If it isn’t removed soon enough, it can even cause problems with the other testicle.
Physical injury to the scrotum or testicle can cause pain right way, or it may cause slowly worsening pain and swelling later on as the scrotum swells or fills with blood (known as a hematocele). Sometimes treatment may be needed to stop the bleeding, but the problem may get better on its own.
A testicular injury can be very painful, but it does not cause cancer.
Infections in the scrotal area are usually caused by bacteria or viruses.
Epididymitis is inflammation of the epididymis, the coiled tube next to each testicle that stores sperm. This can be caused by a sexually transmitted infection, but it can also be caused by other types of infection. Epididymitis can cause:
- Pain and swelling on one side of the scrotum. The pain tends to come on slowly, and it may spread to the side or back.
- Pain when passing urine
- Milky discharge from the penis
If the infection is caused by bacteria, treatment with antibiotics often will make the symptoms go away completely. But if these problems continue after you have taken antibiotics, you need to go back to the doctor.
Orchitis happens when the testicle(s) becomes inflamed. It can cause painful swelling in one or both testicles. It also can impair fertility (make it harder to get a woman pregnant).
Orchitis can be caused by bacteria, including those that cause sexually transmitted infections and epididymitis. In fact, epididymitis and orchitis can occur together.
Viral infections (like mumps) are common causes of orchitis. About 1 in 5 men who has mumps as an adult will have orchitis in one or both testicles. This was much more common before children started getting a vaccine against the mumps virus.
Sometimes a testicle can feel enlarged because fluid has collected around it. This is called a hydrocele. It’s usually painless unless it grows too large. Sometimes the pain can spread to the lower belly or back. Hydroceles can have many causes. They are usually harmless and rarely need to be treated. Hydroceles are often diagnosed with ultrasound exam of the testicle and scrotum (see our document Imaging Tests for more information about ultrasound).
In this condition, the veins within the scrotum get very large (dilate). This can cause swelling and lumpiness around the testicle. It has been described as the scrotum feeling like a “bag of worms.” It’s usually painless, but it may cause a feeling of heaviness in the scrotum. Varicoceles can be diagnosed by a physical exam or with an ultrasound exam of the testicle and scrotum (see our document Imaging Tests for more information about ultrasound). They do not usually need to be treated.
This is a fluid-filled sac much like a hydrocele, but the fluid inside contains sperm cells. It’s usually a small, painless lump in the scrotum that is not connected to the testicle. These cysts are very common, and rarely need to be treated. They are often diagnosed with an ultrasound exam of the testicle and scrotum (see our document Imaging Tests for more information about ultrasound).
Hernias are caused by defects in the muscles of the lower belly (the abdominal wall). These defects can allow structures in the belly, such as a loop of intestine, to enter the scrotum. There may be a slight lump or bulge in the groin or scrotum. The lump from a hernia may be easier to see or feel when standing up. It’s sometimes painful, especially when bending over, lifting something heavy, coughing, or straining to pass urine or have a bowel movement.
Most of the time a hernia isn’t dangerous, but your doctor might recommend surgery to repair it, especially if it is painful or getting larger. Surgery can help prevent a problem called strangulation. This is when a part of the intestine gets trapped in the groin, cutting off its blood supply. This causes severe pain, nausea, and vomiting, and needs to be treated right away because it can be life threatening.
Kidney stones are small crystals that form in the kidneys and can become lodged in the tubes leading to the bladder (the ureters). They can cause severe pain, most often in the back or belly. This pain can extend down to the scrotum. Many men also have nausea and vomiting. Blood is often found in the urine, but it might not be seen with the naked eye. Large stones may need to be removed using surgery or other procedures.
Last Medical Review: 01/20/2015
Last Revised: 01/29/2015