Scrotal swelling occurs when a condition affecting the testicles, epididymis, or scrotal skin produces edema or a mass; the penis may be involved. Scrotal swelling can affect males of any age. It can be unilateral or bilateral and painful or painless.
The sudden onset of painful scrotal swelling suggests torsion of a testicle or testicular appendages, especially in a prepubescent male. This emergency requires immediate surgery to untwist and stabilize the spermatic cord or to remove the appendage.
If the patient isn’t in distress, proceed with the history. Ask about injury to the scrotum, urethral discharge, cloudy urine, increased urinary frequency, and dysuria. Is the patient sexually active? When was his last sexual contact? Does he have a history of sexually transmitted disease? Find out about recent illnesses, particularly mumps. Does he have a history of prostate surgery or prolonged catheterization? Does changing his body position or level of activity affect the swelling?
Take the patient’s vital signs, especially noting fever, and palpate his abdomen for tenderness. Then examine the entire genital area. Assess the scrotum with the patient in supine and standing positions. Note its size and color. Is the swelling unilateral or bilateral? Do you see signs of trauma or bruising? Are there rashes or lesions present? Gently palpate the scrotum for a cyst or a lump. Note especially tenderness or increased firmness. Check the testicles’position in the scrotum. Finally, transilluminate the scrotum to distinguish a fluid-filled cyst from a solid mass. (A solid mass can’t be transilluminated.)
With this disorder (common in some tropical countries), infection by a filaria worm obstructs lymphatic drainage, causing chronic gross scrotal edema and pain. Associated findings include other areas of pitting and, eventually, brawny edema (especially the legs), thickened subcutaneous tissue, hyperkeratosis, and skin fissures.
Located in the head of the epididymis, these cysts produce painless scrotal swelling.
This disorder produces an enlarged scrotal mass separated from the testicle. Other findings include palpable beading along the vas deferens, induration of the prostate or seminal vesicles, and pus or tubercle bacilli in the urine.
Key features of inflammation are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have high fever, malaise, urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
This rare, painless nodule—usually associated with benign tertiary syphilis—can affect any bone or organ. If it affects the testicle, it causes edema.
Herniation of bowel into the scrotum can cause swelling and a soft or unusually firm scrotum. Occasionally, bowel sounds can be auscultated in the scrotum.
Fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Swelling occurs quickly with this disorder and usually disappears within 24 hours. The affected testicle is pink.
Mumps, syphilis, or tuberculosis may precipitate this disorder, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Burns cause swelling within 24 hours of injury. Depending on the burn’s severity, associated findings may include severe pain, erythema, chafing, tissue sloughing, and maceration with a weeping exudate.
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
This usually painless cystic mass lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Most common before puberty, this urologic emergency causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of this small, pea-sized cyst severs its blood supply, causing a hard, painful swelling on the testicle’s upper pole.
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
Keep the patient on bed rest and administer an antibiotic. Provide adequate fluids, fiber, and stool softeners. Place a rolled towel between the patient’s legs and under the scrotum to help reduce severe swelling. If the patient has mild or moderate swelling, advise him to wear a loose-fitting athletic supporter lined with a soft cotton dressing. For several days, administer an analgesic to relieve his pain. Encourage sitz baths, and apply heat or ice packs to decrease inflammation.
Prepare the patient for needle aspiration of fluid-filled cysts and other diagnostic tests, such as lung tomography and computed tomography scan of the abdomen, to rule out malignant tumors.
A thorough physical assessment is especially important for children with scrotal swelling, who may be unable to provide history data. In children up to age 1, a hernia or hydrocele of the spermatic cord may stem from abnormal fetal development. In infants, scrotal swelling may stem from ammonia-related dermatitis, if diapers aren’t changed often enough. In prepubescent males, it usually results from torsion of the spermatic cord.
Other disorders that can produce scrotal swelling in children include epididymitis (rare before age 10), traumatic orchitis from contact sports, and mumps, which usually occurs after puberty.
Encourage the patient to perform testicular self-examinations at home. (See How to examine your testicles, page 705.)
Read excerpts from these other book chapters related to Scrotum rash:
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9 
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