SCROTAL SWELLING.


Scrotal swelling is abnormal enlargement of the scrotum, the sac surrounding the testicles.
Scrotal swelling can occur in males at any age. The swelling can be on one or both sides, and there may be pain. The testicles and penis may or may not be involved.


One among these, the Testicular torsion is a serious emergency in which the testicle become twisted in the scrotum and loses its blood supply. If this twisting is not relieved quickly, the testicle may be lost permanently. This condition is extremely painful


Scrotal swelling  may cause by the following condition :

  1. Epididymitis
  2. Hernia
  3. Hydrocele
  4. Orchitis
  5. Varicocele
  6. Testicular lump
  7. Testicular torsion
  8. Injury
  9. Surgery in the genital area
  10. Testicular cancer
  11. Certain medical treatments
  12. Congestive heart failure

General Care:

  • Apply ice packs to the scrotum for the first 24 hours,
  • If the pain is severe, place a rolled-up towel between the legs just under the scrotum to help relieve pain and reduce swelling, but get medical attention to make sure it is not a testicular torsion.
  • Wear a loose-fitting athletic supporter for daily activities.
  • Avoid excessive activity until the swelling disappears.

(1). Epididymitis
Epididymitis is inflammation of your epididymis. The epididymis is a long curled tube inside your scrotum. It stores and carries sperm from your testicles to your penis. Acute epididymitis lasts for 6 weeks or less and becomes chronic if it lasts longer than 3 months.

Symptoms of Epididymitis.

  • Epididymitis may begin with a low-grade fever, chills, and a heavy sensation in the testicle area. The area becomes more and more sensitive to pressure.
  • Redness, pain, or swelling of your scrotum.
  • A burning feeling when you urinate or frequent urination.
  • Discharge from your penis or blood in your semen.
  • Pain while having sex or trouble having or keeping an erection.
  • Abdominal, back, muscle, or joint pain.
  • Nausea and vomiting.

Other symptoms include:

  • Blood in the semen
  • Discharge from the urethra (the opening at the end of the penis)
  • Discomfort in the lower abdomen or pelvis
  • Groin pain
  • Lump in the testicle
  • Pain during ejaculation
  • Pain or burning during urination
  • Painful scrotal swelling (epididymis is enlarged)
  • Tender, swollen groin area on affected side
  • Testicle pain that gets worse during a bowel movement

Epididymitis causes

  • Trauma: An injury to your scrotum by physical activities, like heavy exercise, physical training.
  • Sexual activity: Harsh Sexual activity as like in the prone video, multiple sex partners, sex without using condoms, and anal sex increase the risk of STIs, which may cause epididymitis.
  • Medical or health conditions: Conditions such as an enlarged prostate, cancer, or other conditions that cause pressure or restrict urine flow may increase your risk. This also includes diabetes or a weak immune system.
  • Vasectomy: During this procedure, the epididymis or the blood vessels and nerves around it may become inflamed.
  • Infection: Epididymitis is usually caused by the spread of a bacterial infection from the urethra, prostate, or the bladder. The most common infections that cause this condition in young heterosexual men are gonorrhea and chlamydia. In children and older men, E. coli and similar infections are much more common. This is also true in homosexual men.

Mycobacterium tuberculosis (TB) can cause epididymitis. Other bacteria (such as Ureaplasma) may also cause the condition.

  • Infections: These include urinary tract infections, sexually transmitted infections (STIs) those who have sex without condoms  with many partners, or infections that have spread from your prostate.

Diagnosis:-
Physical examination shows a red, tender, and sometimes swollen lump (mass) on the affected side of the scrotum.

There may be enlarged lymph nodes in the groin area (inguinal nodes), and a discharge from the penis. A rectal examination may show an enlarged or tender prostate.

These tests may be performed:

  • Complete blood count (CBC)
  • Doppler ultrasound
  • Testicular scan (nuclear medicine scan)
  • Urinalysis and culture (you may need to give several specimens, including initial stream, mid-stream, and after a prostate massage) for infection.
  • Tests for chlamydia and gonorrhea.

Treatment

Treatment involves in different modules for different health problems.  

For traumatic epididymitis or any inflammation, anti inflammatory herbal medicines were given to cure the tissue injury, if it is chronic some may have gangrene for which additionally anti gangrene medicines were given.

For  infectious epididymitis treatment involves with special herbal medicines in which the medications will be for controlling of  sexually transmitted diseases and inflammation, following this cures completely.
Bed rest, while elevating the scrotum and applying ice packs to the area, is recommended. It is very important to have a follow-up visit with your health care provider to find out whether the infection has gone away completely.

Possible Complications

  • Abscess in the scrotum- fluid filled condition.
  • Chronic epididymitis
  • Fistula on the skin of the scrotum (cutaneous scrotal fistula) which may results in hole formation and pus lekage.
  • Death of testicular tissue due to lack of blood (testicular infarction – means testis attack like heart attack)
  • Infertility

Acute pain in the scrotum is a medical emergency. It needs to be checked out by a health care provider immediately.

(2). Hernia


A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the belly wall that surrounds the muscle. This layer is called the fascia.
TYPES of  HERNIA

  • Femoral hernia is a bulge in the upper thigh, just below the groin. This type is more common in women than men.
  • Hiatal hernia occurs in the upper part of the stomach. Part of the upper stomach pushes into the chest.
  • Incisional hernia can occur through a scar if you have had abdominal surgery in the past.
  • Umbilical hernia is a bulge around the belly button. It occurs when the muscle around the belly button does not close completely.
  • Inguinal hernia is a bulge in the groin. It is more common in men. It may go all the way down into the scrotum.

Causes
Some persons have a family history of hernias.

Babies and children can get hernias. It happens when there is weakness in the belly wall. About 5 out of 100 children have inguinal hernias. They are more common in boys. Some children do not have symptoms until they are adults.

Any activity or medical problem that increases heavy  pressure on the tissue in the belly wall and muscles may lead to a hernia, including:

  • Chronic constipation and pushing hard (straining) to have a bowel movement
  • Chronic cough
  • Cystic fibrosis
  • Enlarged prostate, straining to urinate
  • Extra weight
  • Fluid in the abdomen (ascites)
  • Heavy lifting
  • Peritoneal dialysis
  • Poor nutrition
  • Smoking
  • Overexertion
  • Undescended testicles

DIAGNOSIS:
The health care provider can usually see or feel a hernia when you are examined. You may be asked to cough, bend, push, or lift. The hernia may get bigger when you do this.
The hernia (bulge) may not be easily seen in infants and children, except when the child is crying or coughing.


Ultrasound or CT scan may be done to look for a hernia.
If there is a blockage in the bowel, an x-ray of the abdomen will likely be done.


Treatment
Surgery is the only treatment that can permanently fix a hernia. So it’s better to contact a surgeon immediately to avoid seriousness.
No medicine will cure this problem.


Prevention

  • Use proper lifting techniques.
  • Lose weight if you are overweight.
  • Relieve or avoid constipation by eating plenty of fiber, drinking lots of fluid, going to the bathroom as soon as you have the urge, and exercising regularly.
  • Men should see their health care provider if they strain with urination. This may be a symptom of an enlarged prostate.

(3).Hydrocele
A hydrocele is a fluid-filled sack in the scrotum.

Causes
Hydroceles are common in newborn infants.
During a baby’s development in the womb, the testicles descend from the abdomen through tube into the scrotum. Hydroceles occur when this tube does not close. Fluid drains from the abdomen through the open tube and gets trapped in the scrotum. This causes the scrotum to swell.
Most hydroceles go away a few months after birth. Hydroceles may also be caused by:

  • Buildup of the normal fluid around the testicle. This may occur because the body makes too much of the fluid or it does not drain well. (This type of hydrocele is more common in older men.)
  • Inflammation or injury of the testicle or epididymis leads to formation of fluid around the testicles.

Symptoms:
The main symptom is a painless, swollen testicle, which feels like a water balloon. A hydrocele may occur on one or both sides.
Diagnosis:
You will have a physical exam. You  will find that the scrotum is swollen but not painful to the touch. Often, the testicle cannot be felt because of the fluid around it. The size of the fluid-filled sack can sometimes be increased and decreased by putting pressure on the abdomen or the scrotum.
If the size of the fluid collection changes, it is more likely to be due to an inguinal hernia.
Hydroceles can be easily seen by shining a flashlight through the swollen part of the scrotum. If the scrotum is full of clear fluid, the scrotum will light up.
You may need an ultrasound to confirm the diagnosis.


Treatment
Hydroceles are not harmful most of the time. They are treated only when they cause infection or discomfort.
In general surgery is not the best option for hydroceles because it will come back again
Best way is to follow a continuous treatment in herbal medicines to cure Hydroceles.


Possible Complications after surgery:-
Risks from hydrocele surgery may include:

  • Blood clots
  • Infection
  • Injury to the scrotum

(4). Orchitis

Orchitis is swelling (inflammation) of one or both of the testicles.


Causes:
Orchitis may be caused by an infection from many different types of bacteria and viruses.
The most common virus that causes orchitis is mumps. It most often occurs in boys after puberty. Orchitis usually develops 4 - 6 days after the mumps begins.
Orchitis may also occur along with infections of the prostate or epididymis.
Orchitis may be caused by sexually transmitted infection (STI) such as gonorrhea or chlamydia. The rate of sexually transmitted orchitis or epididymitis is higher in men ages 19 - 35.
Risk factors for sexually transmitted orchitis include:

  • High-risk sexual behaviors
  • Multiple sexual partners
  • Personal history of gonorrhea or another STD
  • Sexual partner with a diagnosed STD

Risk factors for orchitis not due to an STD include:

  • Being older than age 45
  • Long-term use of a Foley catheter
  • Not being vaccinated against the mumps
  • Problems of the urinary tract that occurred at birth (congenital)
  • Regular urinary tract infections
  • Surgery of the urinary tract (genitourinary surgery)

Symptoms:

  • Blood in the semen
  • Discharge from penis
  • Fever
  • Groin pain
  • Pain with intercourse or ejaculation
  • Pain with urination (dysuria)
  • Scrotal swelling
  • Tender, swollen groin area on affected side
  • Tender, swollen, heavy feeling in the testicle
  • Testicle pain that is made worse by a bowel movement or straining

Exams and Tests:
A physical examination may show:

  • Enlarged or tender prostate gland
  • Tender and enlarged lymph nodes in the groin (inguinal) area on the affected side
  • Tender and enlarged testicle on the affected side

Tests may include:

  • Complete blood count (CBC)
  • Testicular ultrasound
  • Tests to screen for chlamydia and gonorrhea (urethral smear)
  • Urinalysis
  • Urine culture (clean catch) -- may need several samples, including initial stream, midstream, and after prostate massage

Treatment:
Treatments may include:

  • Anti inflammatory herbal combination and specific herbal extract for infections. (in the case of gonorrhea or chlamydia, sexual partners must also be treated)
  • Pain killing herbal medicines.
  • Bed rest with the scrotum elevated and ice packs/ medicated oils applied to the area.
  • Avoid sexual contact to prevent spreading to partner and then to get re infection from your partner.
  • It is insisted ,that both the partner should get culture test and get medicines for the case of infections like gonorrhea or chlamydia

Mumps orchitis cannot be treated, and the outcome can vary. Men who have had mumps orchitis can become sterile.


Possible Complications
Some boys who get orchitis caused by mumps will have shrinking of the testicles (testicular atrophy).
Orchitis may also cause infertility.
Other potential complications include:

  • Chronic epididymitis
  • Death of testicle tissue (testicular infarction)
  • Fistula on the skin of the scrotum (cutaneous scrotal fistula)
  • Scrotal abscess

 

Prevention:
Getting vaccinated against mumps will prevent mumps-associated orchitis. Safer sex behaviors, such as having only one partner at a time (monogamy) and condom use, will decrease the chance of developing orchitis as a result of a STI (sexually transmitted infection).


(5).Varicocele
A varicocele is a widening (expansion  in breadth) of the veins along the cord that holds up a man's testicles (spermatic cord).


Causes:
A varicocele forms when valves inside the veins along the spermatic cord prevent blood from flowing properly. This causes the blood to back up, leading to swelling and widening of the veins. (This is essentially the same process that leads to varicose veins, which are common in the legs.)
Varicoceles usually develop slowly. They are more common in men ages 15 - 25 and are most often seen on the left side of the scrotum.
The sudden appearance of a varicocele in an older man may be caused by a kidney tumor, which can block blood flow to a vein. This is more common on the left side than the right.


Symptoms:

  • Enlarged, twisted veins in the scrotum
  • Painless testicle lump, scrotal swelling, or bulge in the scrotum

 Sometimes there  may not be symptoms.


Diagnosis:
Examination  of  the  groin area, including the scrotum and testicles. It may feel a twisted growth along the spermatic cord. (It feels like a bag of worms.)
However, the growth may not be able to be seen or felt, especially when you are lying down.
The testicle on the side of the varicocele may be smaller than the one on the other side.


Treatment:
Initially a  jock strap (scrotal support) or snug underwear may help relieve the pain or discomfort.
Herbal medicines for contraction of  veins and medicated oils for external application, decotion for washing of genitials.


Possible Complications:
Infertility is a complication of varicocele.

  • Atrophic testis
  • Blood clot formation
  • Infection
  • Injury to the scrotum or nearby blood vessel

 (6). Testicular torsion:

Testicular torsion is the twisting of the spermatic cord, which supports the testes in the scrotum. When this occurs, blood supply is cut off to the testicles and nearby tissue in the scrotum.



Causes:

Some men are more prone to this condition because of defects in the connective tissue within the scrotum. The problem may also occur after an injury to the scrotum that results in a lot of swelling or following heavy exercise or continuous heavy with high speed sexual activities.


It is most often found in persons who used to have sex for long duration with harsh heavy sexual activities with the use of sex stimulator or enhancer pills.  


The condition is more common during the first year of  married life and at the beginning of adolescence (puberty). However, it may happen in older men.


Symptoms:

  • Sudden severe pain in one testicle after having a harsh heavy sexual activity for longer duration with enhancer pills, this pain will develops within 6 to 12 hours after the strong sexual activity.
  • Swelling within one side of the scrotum (scrotal swelling)
  • Nausea or vomiting
  • Lightheadedness

Additional symptoms that may be associated with this disease:

  • Testicle lump
  1. Blood in the semen

Diagnosis:

  • Extreme tenderness and swelling in the testicle area
  • The testicle on the affected side is higher

You may have a Doppler ultrasound of the testicle to check the blood flow. There will be no blood flowing through the area if you have complete torsion. Blood flow may be reduced if the cord is partially twisted.


Treatment:
If it is treated within 6 hours, it can be cured by varma and application of medicated oils and herbal medicines.
Most of the time, surgery is needed to correct the problem. Surgery should be done as soon as possible after symptoms begin. If it is performed within 6 hours, most testicles can be saved.
During surgery, the testicle on the other side is often secured into place as well. This is because the unaffected testicle is at risk of testicular torsion in the future.


Possible Complications:
The testicle may shrink if blood supply is cut off for an extended time. It may need to be surgically removed.
Severe infection of the testicle and scrotum is also possible if the blood flow is restricted for an extended period.


Prevention
Take steps to avoid injury to the scrotum. Avoid harsh heavy speed sexual activity.


(7). Testicular Injury:
Testicular injury means a strong hit or slow continuous rapid hit may cause  an injury to the testicles resulting in an engorged swelling of testis seems like a hydrocele problem. Some time fluid may gets filled in the scrotum with infection.   


Causes:
Some men are more prone to this condition because of  strong hit or rapid continuous hit on the testis, it may happened during sports or accedients it may also occur because of  continuous heavy with high speed sexual activities.
It is most often found in persons who used to have sex for long duration with harsh heavy sexual activities with the use of sex stimulator or enhancer pills.  


Symptoms:

  • Sudden severe pain in one testicle after having  strong hit or rapid continuous hit on the testis or accidents or harsh heavy sexual activity for longer duration with enhancer pills, this pain will develops within 6 to 12 hours after the strong sexual activity.
  • Swelling within   the scrotum (scrotal swelling)
  • Nausea or vomiting
  • Lightheadedness

Additional symptoms that may be associated with this disease:

    • Testicle lump
    • Blood in the semen

Diagnosis:

  • Extreme tenderness and swelling in the testicle area
  • The testicle on the affected side is higher

You may have a Doppler ultrasound of the testicle to check the blood flow. There will be no blood flowing through the area if you have complete torsion. Blood flow may be reduced if the cord is partially twisted.


Treatment:
If it is treated within 6 hours, it can be cured by varma and application of medicated oils and herbal medicines.
Most of the time, surgery is needed to correct the problem. Surgery should be done as soon as possible after symptoms begin. If it is performed within 6 hours, most testicles can be saved.
During surgery, the testicle on the other side is often secured into place as well. This is because the unaffected testicle is at risk of testicular torsion in the future.


Possible Complications:
The testicle may shrink if blood supply is cut off for an extended time. It may need to be surgically removed.
Severe infection of the testicle and scrotum is also possible if the blood flow is restricted for an extended period.


Prevention
Take steps to avoid injury to the scrotum. Avoid harsh heavy speed sexual activity.
(a) .Testicle lump
A testicle lump is swelling or a growth (mass) in one or both testicles.
A testicle lump that does not hurt may be a sign of cancer. Most cases of testicular cancer occur in men ages 15 - 40, although it can also occur at older or younger ages.

Causes:
Possible causes of a painful testicle include:

  • A cyst-like lump in the scrotum that contains fluid and dead sperm cells (spermatocele)
  • Injury or trauma
  •  testicular infection

Treatment:
Treatment involves with herbal medicines which depends up on symptoms either there  testicular infection or  spermatocele.

 

(b). Blood in the semen:

Blood in the semen, called hematospermia, is blood that is either too small to be seen (microscopic) or visible in the ejaculation fluid.
Considerations:
Symptoms that may occur with this condition include:

  • Blood in urine
  • Fever or chills
  • Lower back pain
  • Pain with bowel movement
  • Pain with ejaculation
  • Pain with urination
  • Swelling in scrotum
  • Swelling or tenderness in groin area
  • Tenderness in the scrotum
  • Too much of masturbation.

Causes:
Blood in the semen is usually caused by inflammation of the seminal vesicles. It may also be caused by:

  • Blockage
  • Infection
  • Injury

It may be a sign of disease or a problem in the urethra, testicles, epididymis, or prostate.
Often, the cause cannot be found.


Treatment:
For minor injuries by resting, applying ice, medicated oils and herbs.  
For Infections can often be treated with anti microbial and anti-inflammatory herbal medicines.
Blockages of the urinary tract system are usually treated with special herbal medicine systems.
During the treatment time avoid sexual contacts and masturbation.