Swollen testicles

Testicular lumps and swellings are quite common and can affect males of any age. They can be caused by an injury or an underlying medical condition, which leads to a build-up of fluid, inflammation or an abnormal growth. 

The swelling may cause no pain or it can be painful. If it is extremely painful, see a doctor urgently. Depending on the cause, a delay in treatment can cause the loss of your testicle as the tissue dies. 

A swollen testicle or a lump in your testicle isn’t usually a sign of a serious condition. However, testicular pain should always be checked by your GP as it can be a symptom of an underlying condition. In most cases, testicular lumps and swellings can be successfully treated.

Swollen, enlarged testicles can occur quickly or gradually over time. Common causes include:

• Chlamydia — a common sexually transmitted infection (STI) caused by bacteria, which is usually passed on by having unprotected sex
• Epididymo-orchitis — painful inflammation of the testicle and epididymis (the coil where sperm is stored), which can be caused by an STI, urinary tract infection (UTI) or, in boys, mumps
• Haematocele — a collection of blood around your testicle, which is usually caused by an injury
• Hydrocele — a build-up of fluid inside the scrotum (the loose pocket of skin surrounding your testicles), which can affect newborn male babies, boys and, most commonly, men over the age of 40
• Inguinal hernia — a painful swelling in the groin area which is eight times more likely to affect men than women
• Varicoceles — enlarged veins in the scrotum

Swollen, enlarged testicles can also be caused by spermatoceles or epididymal cysts. A spermatocele is an abnormal fluid-filled sac (cyst) in the epididymis, which contains sperm. Epididymal cysts are very similar but do not contain sperm. Both conditions cause testicular pain and a feeling of heaviness.

Rare causes of swollen testicles include: 

• Generalised oedema
• Infections — this includes the bacterial STI syphilis and infection with roundworms
• Rare inflammatory diseases — this includes Henoch-Schoenlein purpura and sarcoidosis
• Sebaceous cysts
• Skin cancer, specifically squamous cell carcinoma
• Skin conditions — this includes allergic skin rashes and hidradenitis suppurativa

If you’re experiencing agonising testicle pain, nausea, vomiting and abdominal pain, and your scrotum is swollen and tender, call 999 immediately. You may have a testicular torsion. This is when the testicle, inside the scrotum, twists and cuts off its blood supply. This is a very serious condition which is most common in young males aged 10-20.

Most lumps in testicles are epididymal cysts, which are most likely to develop when you’re middle-aged. 

A swelling or lump on a testicle is the most common symptom of testicular cancer. Testicular cancer is rare and is most likely to affect men in their early 30s. If you spot any change in the look or feel of your testicles, see your GP as soon as possible.

See your GP if you:

• Have a lump in your testicles, or an enlarged or sore testicle
• Notice a change in the shape or feel of your testicles
• Notice that one testicle has become bigger than the other

Your GP will examine your testicles and may shine a light onto your scrotum to check for excess fluid. If your GP suspects you have a hernia, they may ask you to cough. Your GP may also refer you for other investigations, such as blood tests, urine tests or an ultrasound scan.

After diagnosis, your GP may refer you to a consultant, such as a urologist, or to a genito-urinary medicine clinic.

At home

If the swelling or lump isn’t causing you any problems or testicular pain, treatment may not be needed. Warm baths may help reduce swollen testicles. In addition, avoiding strenuous activities, taking over-the-counter painkillers and wearing supportive underpants may relieve testicular pain.

Prescribed treatments

The treatment your GP or consultant recommends will depend on the cause of the lump or swelling affecting your testicle. If you’re diagnosed with a serious condition, such as testicular cancer, your doctor will arrange the necessary treatment. If an infection is causing your enlarged or sore testicle, your doctor may prescribe antibiotics.

Surgery

If you have troublesome varicoceles, your doctor may suggest surgery to reduce the swelling or remove the affected veins. 

A hydrocele can be surgically drained while an inguinal hernia can be repaired with a straightforward surgical procedure. 

Occasionally, surgery may be recommended to remove the lump on a testicle caused by an epididymal cyst.

Testicular torsion needs urgent surgery to restore blood flow to your affected testicle. Your testicular tissue will start to die if you don't receive treatment within a few hours.