What is the scrotum?
The testes (balls) hang outside the body in a bag of skin called the scrotum, which lies just behind the penis. Although they should be about the same size and weight you usually find that one ball hangs lower than to other. This stops them from bumping against each other.
There are a number of problems associated with the scrotum which can arise, these are listed below. As with any medical concern, it is important that if you notice any unusual changes or experience any pain, seek your doctor's advice as soon as possible. Most conditions can be successfully treated if they are reported early enough.
Fertility
Whereas women's fertility ends with the menopause, it is possible for men to remain fertile throughout their lives. Men's sperm is contained in the semen, and is created in the testicles. Anything which affects the testicles therefore can affect sperm production and the ability to have children.
Any procedure which removes one testicle would lessen the amount of sperm produced, but fertility would remain. Removal of both testicles would obviously make a man infertile. When infertility is a possible outcome of any condition, it may be worth considering have sperm saved in a sperm bank for later use.
Other lumps, swelling, aches and pains
Many different conditions produce similar feelings in the scrotum – pain, ache, swelling, discharge from the penis or urination problems. Any persistent condition should be reported to your doctor for investigation. The cause may be easily identified and treated. More serious conditions are more successfully treated the earlier they are dealt with.
Blue Balls
"Blue Balls" sounds like a very unlikely condition, but the testicles do not actually turn blue. It is used to describe a non-serious condition. If sexual stimulation of the penis continues for a lengthy period without the relief provided by coming, then ache can result from the congestion of blood in the genitals and pelvis. Relief will come either with ejaculation or shortly after stimulation has ended.
Epididymitis
Epididymitis is the inflammation of the epididymis (a tube inside the penis). It can be caused by the spread of an already existing infection in the urinary tract or the prostate. In men under 40, it tends to be caused by a sexually transmitted infection (STI). The best way to avoid any STI is to practise safe sex and use a condom, this will significantly reduce the risk of catching most infections.
Hernia
Hernia occur when part of the gut is forced through a weak spot in the abdominal wall and into the scrotum. This can be a result of frequent straining, perhaps when constipated.
Hydrocele
Hydrocele is the gathering of fluid around the testicle, causing swelling, and can result from either an infection or from a physical injury to the scrotum. It can also happen in older men for unknown reasons.
Orchitis
Orchitis, another inflammation of the testicle, can also result from infection or injury but the most common cause is as a side effect of mumps. Orchitis, in some cases can result in infertility.
Spermatocele
Spermatocele is a small cyst containing sperm. It is usually located above and behind the testicle. Unless it becomes uncomfortable, it usually does not require any treatment.
Varicocele
Varicocele is the enlargement of the veins above and behind the testicles which drain blood from the scrotum. They can become tangled and this results in an aching pain. Lying down can help the blood drain and you may notice a decrease in the swelling by trying this. Varicocele can also result in infertility.
Testicular Cancer
Testicular cancer is a relatively rare condition, but it is the most common cancer found amongst men aged 20 to 35 years. Fortunately, it is also one of the most successful to treat. Like any cancer, the earlier it is detected, the more successful treatment tends to be. With early detection almost 90% of cases can be cured, but even later on the cure rate can be as high as 80%.
All men should undertake regular self-examination of the testicles, but this especially applies to those men who have a family history of testicular cancer or who have experienced conditions such as undescended testicle, mumps orchitis or hydrocele. For advice on how to examine yourself see the male self-examination section of the website.
Remember if you do find a lump, not all of them are cancerous, and if you do find out you have testicular cancer there are a number of successful treatments on offer. Chemotherapy or radiation therapy might be used, depending upon the kind of cancer found and how much. With cancer that has not spread, treatment will usually involve the surgical removal of the affected testicle. If the cancer has spread, then more involved therapy will have to be used, and these are best discussed with your doctor or specialist.
Torsion
A bump or blow (also known as "trauma") to the testicles can result in severe pain and feelings of sickness, and may even result in actually vomiting. Highly unpleasant as this experience is, it should pass quite quickly as the effects of the blow wear off. It is best to lie down and try to relax if this is possible, until the sensations pass. If the pain, and swelling, continues then you might require some medical attention in case the injury is more serious.
Torsion usually affects younger boys and requires emergency treatment. Its cause may not always be the result of a physical injury, but the sensations are the same as that as a blow to the testicles. However with torsion the feelings develop very quickly and continue. It results from a twisting of the blood vessels supplying a testicle. If the condition is not treated within about 6 hours the affected testicle will be permanently damaged and may have to be removed.
Undescended Testicle
This is a condition (known as cryptorchidism) which mostly affects the new born or the very young. At birth, one or both testicles in a small number of males are not yet in the scrotum. Many cases resolve themselves within about a month, with the testicle(s) dropping from the groin but those which do not may require surgery.
The longer the condition continues, the more of a problem it becomes, with removal of testicle possibly being required if not treated by age 10.
