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Testicular swelling - causes and therapy

Testicular swelling - causes and therapy

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Swollen testicles

Testicular swelling is not an independent disease, but a symptom that can have various causes. It is important to diagnose the underlying urological disease promptly. Those affected should therefore consult a doctor if they swell their testicles. Diseases associated with swelling of the testicles include testicular torsion, epididymitis, hydroceles, testicular trauma, testicular tumor or testicular inflammation.


Testicular swelling is caused by fluid accumulation in the area of ​​the testicles or epididymis, which affects one or both testicles at the same time. The latter are enlarged, which is accompanied by pain, but can also be painless. The skin of the scrotum is usually tight, possibly red and hot.


Testicular swelling can be based on various urological causes. To find out, going to a urologist is imperative.

Twisted testicle (testicular torsion)
Testicular torsion, also called testicular twist, is a urological emergency: testicles and spermatic cord rotate about their own axis. This creates a highly acute clinical picture, whereby the blood supply to the testicles is partially or completely cut off by the rotation. The blood builds up in the veins - the testicles are swollen, red and extremely sensitive to pressure. In addition, there are suddenly occurring, massive testicular pain that radiates into the lower abdomen, as well as nausea and vomiting. In the worst case, the testicle may die due to insufficient blood supply. If testicular torsion is suspected, the patient must go to a clinic as soon as possible. If the testicle is twisted, the affected person must be operated on no later than four to six hours after the onset of the first symptoms. The faster an operation takes place, the sooner the testicles can be saved.

This disease occurs primarily in infants, young children and adolescents and young men until the end of puberty. Testicular torsion is possible later, but the likelihood decreases with age.

Epididymitis (epididymitis)
The epididymis lies on the back of the testicle. The seeds are stored there. Epididymitis is usually one-sided. This creates intense pain that radiates into the inguinal canal, fever and a general feeling of illness. This is accompanied by testicular swelling and reddening. The disease is usually preceded by symptoms that are reminiscent of a urinary tract infection: urge to urinate with frequent voiding and burning when urinating. If chills occur, there is suspicion of an abscess.

Epididymitis can develop from a urinary tract infection. But pathogens of a sexually transmitted disease such as chlamydia or gonococci can also lead to this. Viruses, fungi or parasites may be responsible for the non-bacterial form. Another possible cause is an already existing urinary drainage disorder, as is the case for example with an enlarged prostate or a narrowing of the urethra.

With epididymitis, the way to the doctor is inevitable. The patient needs bed rest, cooling and high storage of the scrotum, medication with anti-inflammatory effects and possibly even antibiotics. If the pain is severe, long-term local anesthesia of the spermatic cord can help. An epididymitis must be completely cured because there is a risk of chronification and a related fertility disorder.

A hydrocele is also called a water break. This causes a generally painless testicular swelling, which can occur for no reason or as a result of testicular diseases, such as testicular torsion. If the hydrocele is very large, there is a feeling of pressure and tension.

Before or soon after birth, the testicles move down from the abdominal cavity into the scrotum. This leaves a small gap in the peritoneum, which normally closes until the end of the first year of life. If this does not happen, liquid can accumulate in this gap and a hydrocele can result. This can occur on both sides and usually regresses spontaneously. If the gap is not closed, there is a risk of inguinal hernia.
Other possible causes of a hydrocele are testicular inflammation, epididymitis or trauma. A water break is actually harmless, but if it persists, it should be operated on.

Testicular trauma
Testicular dreams usually arise from blunt violence, in connection with fights, kicks, sports injuries or traffic accidents. In addition to massive pain, testicular swelling is also common. Testicular trauma can tear the testicular sheaths. This causes massive hematomas (bruises). Surgery is often necessary here.

Malignant testicular tumors
Testicular tumors can be benign but also malignant, with the benign occurring very rarely. The most noticeable symptom of a testicular tumor is a painless swelling of the testicles. A hardness is noticeable when touching. Affected people also report heaviness and pain, blood in the sperm or swelling of the mammary glands (due to the change in hormones). All of this can indicate a malignant testicular tumor. However, the chances of a cure for testicular cancer are now very good. The earlier treatment is started, the better the chances of success. If a testicular tumor is suspected, a doctor should be consulted promptly.

Testicular inflammation
Testicular inflammation, commonly known as orchitis, usually has a viral cause. Bacteria as triggers are possible, but are less common. Orchitis can also result from trauma, e.g. in the context of an accident.

With viral diseases such as mumps, glandular fever, chickenpox, syphilis and malaria, testicular inflammation can occur as a concomitant disease. The bacterial form develops from urethritis or prostate inflammation.

Those affected suffer from swelling of the testicles, pressure sensitivity of the testicles, severe reddening of the scrotum (scrotum), strong feeling of illness and high fever. The disease absolutely requires bed rest, high camp and cooling of the testicles. In addition, the patients are given pain relieving and anti-inflammatory drugs. In the case of bacterial infection, antibiosis is necessary. Epididymitis often occurs at the same time as the testicular infection.

Because orchitis can lead to fertility problems, vaccination against mumps should be considered in young boys. This is usually done with the combined vaccine measles-mumps-rubella.


In summary, it can be said that testicular swelling, even if it is painless and without other accompanying symptoms, must be checked with a urologist as soon as possible. The disease may become chronic, lead to a fertility disorder or, in the worst case, a malignant tumor may be overlooked. (sw)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters


  • Jörg Baltzer; Klaus Friese; Michael A. Graf; Friedrich Wolff: Practice of gynecology and obstetrics: all practical knowledge in one volume; 321 tables, Georg Thieme Verlag, 2006
  • Richard E. Hautmann; Hartwig Huland: Urology, Springer Verlag, 2013
  • Alfons G. Hofstetter; F. Eisenberger: Urology for Practice, Springer Verlag, 2013
  • S. Kliesch: "Hydrocele, spermatocele and vasectomy", in: The Urologist, Volume 53 Issue 5, 2014, Springer
  • Dieter Jocham; Kurt Miller: Practice of Urology: Volume I, Thieme, 2007

Video: Diagnosing testicular torsion (December 2022).