It has often been said that the human body is not perfectly symmetrical. This, however, does not stop the body from functioning as a well-oiled, complex machine.
Most men understand that one side of their scrotum does not look exactly the same as the other. Many find that one side may look slightly bigger and one testes may hang lower than the other. This usually falls within the spectrum of normal and should not be cause for alarm.
Sometimes, however, one side may be markedly larger than the other and this can be a sign of an underlying medical condition.
Common causes of scrotal swelling
Hernia
Sometimes there can be a weakness in the wall of the abdomen which allows for intestines and other abdominal contents to slide into the scrotum. This is known as an ‘inguinal hernia’.
Most of the time, the intestines slide in and out of the scrotum with minimal discomfort but once in a while, they can get trapped in the scrotum. When this happens, their blood supply gets compressed and the intestines fail to function properly and begin to die. This is a life-threatening condition.
In order to prevent the development of such complications, all hernias in the scrotum must be surgically corrected.
Fluid accumulation
The area around the testes may become filled with fluid in a condition known as a ‘hydrocele’. This is usually not a painful condition but it can become remarkably large.
Usually, in baby boys, it can resolve as the child grows but most adults need surgical intervention to drain the fluid.
Blood pooling
Blood usually only fills the scrotum after trauma or surgery to the area and usually, it resolves without intervention but sometimes it may need medical intervention.
Cysts
A cyst is a fluid-filled cavity. Occasionally, some of the structures in the scrotum may develop cysts. For example, the tube that carries sperm may get cysts.
These are usually small but can be multiple and are more foten than not painless. Most of the time, they do not need intervention unless they become considerably large or become associated with pain.
Enlarged blood vessels
Sometimes the blood vessels in the scrotal area may become enlarged and engorged with blood. This is known as a ‘varicocele’ and is very similar to varicose veins in the legs. It often makes the affected side feel as though it has a ‘bag of worms’.
Most men also complain of having a heavy sensation on the affected side. The main problem with this condition is that excess warmth caused by this enlarged blood vessels can affect the testicular environment and reduce fertility. It is, therefore, important to have this problem corrected as soon as it is noted.
Medical conditions
Sometimes, men with heart, kidney and liver failure may get swelling of the scrotum but it usually affects both sides and also involves the penis. Treatment of the underlying medical condition causes the swelling to reduce.
Testicular cancer
This is more common in younger men. They tend to occur more often in males with imperfectly descended testes. The positive thing about this cancer is that it has a very good survival rate with appropriate and early treatment.
Elephantiasis (worm infection)
This is a relatively common condition in the coastal areas. It occurs when there is infection of the body’s lymphatic system by parasitic worms.
Interestingly, these worms are transmitted by mosquitoes. In some cases, contact with specific types of soil can give a similar condition.
As the name suggests, the scrotum may swell to ‘elephant proportions’. Sometimes, it may become the size of a basketball.
The interesting social thing about this condition is that some men affected by this problem carry this disease with pride and avoid going for treatment as they feel their ‘super-sized’ assets make them superior to their peers.
Leading causes of pain in the scrotum
Testicular inflammation
This is usually as a result of infection with sexually-transmitted infections, tuberculosis and in children/adolescents, it can be due to mumps. It can also occur after surgical procedures involving the prostate or the urethra (canal that carries urine through the penis and out of the body).
Medically, inflammation of the testes is known as ‘orchitis’. Sometimes, the infection may spread to the tubes that carry sperm. The affected side usually becomes very painful, swollen and warm. Treatment of the underlying infection will clear the problem.
Testicular torsion
The testes usually have a cord which allows them to hang freely from the body in the scrotum. This cord has the blood and nerve supply to the testes.
Sometimes, this cord may twist on itself and cut the blood supply to the testes. This is an excruciatingly painful condition known as ‘testicular torsion’. The affected side becomes painful, swollen and warm.
If not corrected urgently, the lack of blood supply leads to death of the affected testes. It is, therefore, a surgical emergency which needs to be corrected within 6 hours of occurrence.
During this period, the cord can successfully be untwisted and the testes saved. Failure to reach a medical centre in time means the affected testes would have to be removed. Sadly, this is a fairly common outcome in Kenya.
The problem in our country is that the scrotum and its contents are still socially regarded as ‘private’ and most men will wait until their problem is at an advanced stage before seeking medical advice.
This usually results in unnecessary complications and mental anguish which could have been avoided had help been sought in good time.
