Swollen Testicles: 9 Causes (& How to Treat)

A swollen testicle is a common sign of  an inguinal hernia, which occurs when the intestine exits through a weak point in the abdominal muscles and enters the scrotum. However, swollen testicles can also be caused by testicular torsion, epididymitis, a varicocele, or even testicular cancer.

Depending on the underlying cause, testicular swelling may present with other symptoms such as pain or discomfort, a feeling of heaviness or pressure in the scrotum, blood in the semen, fever or pain when urinating.

You should consult a doctor if your pain does not resolve with simple interventions, like analgesics or cold compresses. You should seek urgent medical attention if the testicular swelling presents with a fever, intolerable pain, and changes to skin color. 

What causes a swollen testicle?

Swollen testicles can occur as a result of:

1. Inguinal hernia

An inguinal hernia occurs when a portion of the intestines bulges through the abdominal muscles and into the scrotum. It causes significant swelling with mild and constant pain that does not go away. This pain usually worsens when getting up from a chair or bending forward. This problem is most common in children and young adults, however it can happen at any age. 

Learn more about the symptoms of an inguinal hernia and what can cause them. 

How to treat: You are advised to see a doctor to evaluate the hernia and determine the need for surgical intervention. If you think you may have an inguinal hernia, you should proceed to a hospital for immediate assessment, as there is a risk for serious complications like infection and intestinal cell death. 

2. Varicocele

A varicocele is associated with a dilation of one of the veins in the testicle, very similarly to what happens with varicose veins on the legs. It is one of the most frequent causes of infertility in men and is is most commonly seen in the left testicle. It usually does not cause any symptoms, although some men may report a slight discomfort or increased heat in the area. 

How to treat: Generally, treatment is not necessary. Severe pain can be assessed in a hospital setting and is usually treated with analgesics like acetaminophen. The doctor may recommend the use of special compression underwear to support the scrotum closer to the body, although some cases may require surgical repair. 

3. Epididymitis

Epididymitis is an inflammation of the vas deferens, which are the small tubes that transport sperm from the testicles. Swelling of these tubes can cause a small lump at the top of the testicle. This inflammation generally occurs due to a bacterial infection transmitted from unprotected anal sex, although there are other causes. Symptoms include intense pain, fever and chills. 

Learn more about what can cause a bump on the penis and what to do. 

How to treat: Epididymitis is treated with antibiotics, therefore it is important to see a doctor if you suspect an infection. The treatment usually involves an injection of ceftriaxone, followed by 10 days of oral antibiotics at home. 

4. Orchitis

Orchitis is an inflammation of the testicles that can be triggered by a viral or bacterial infection. It is normally caused by mumps, but it can also appear with a bacterial UTI or STI (like gonorrhea or chlamydia). In these cases, men may also report fever, blood in the semen and pain with urination.

How to treat: You should proceed to a hospital to start prompt treatment with antibiotics and/or anti-inflammatories. You can decrease discomfort in the meantime with cold compresses and rest. 

5. Hydrocele

A hydrocele is characterized by the growth of a fluid-filled sac in the scrotum. It is more commonly seen in babies, but it can also occur in men with direct trauma to the testicles, testicular torsion or epididymitis. 

Read more about hydroceles and the symptoms they can cause.

How to treat: Although most times hydroceles disappear within 6 to 12 months without any specific treatment, you should still proceed to a hospital for diagnosis and to rule out other more serious conditions. 

6. Testicular torsion

Testicular torsion occurs when the mains vessel that supplies blood to the testicles becomes twisted, resulting in a medical emergency. It is more common between the ages of 10 to 25 years old and can cause swelling and intense testicular pain. In some cases, the torsion is just partial, which causes a more mild pain or pain just with movement of the body. 

How to treat: You should proceed immediately to the hospital for surgical treatment to prevent complications like infertility.

7. Spermatocele

A spermatocele is a benign, fluid-filled cyst that can develop in epididymis, located above or behind the testicle. This cyst is associated with testicular swelling, pain, or a feeling of heaviness in the scrotum.

A spermatocele can emerge when sperm accumulates in a part of the epididymis, usually due to a blockage of the epididymal duct, or due to inflammation in the area.

How to treat: Generally, no specific treatment is necessary. However, it is important to consult your doctor and have regular follow-ups to monitor the growth of the cyst. Spermatocele that cause some discomfort can be managed with anti-inflammatories, while very intense pain may require surgical removal.

8. Testicular cancer

One of the first symptoms of testicular cancer is a bump on the testicle or a testicle that increases in size (which can look like swelling). In these cases, it is common not to experience pain, but to notice a change in shape or firmness in a testicle. Other factors that contribute to an increased risk for cancer are a positive family history and having HIV. 

How to treat: This cancer should be identified as early as possible to increase the chances of a cure. If you suspect you may have cancer, you should book a consult with a urologist for assessment, testing and diagnosis. 

Read more about the symptoms of cancer that you should not ignore. 

9. Fluid retention

Fluid retention, or edema, in the body is typically associated with swollen legs and a swollen abdomen, but it can also lead to testicular swelling. This phenomenon is often seen with congestive heart failure.

Congestive heart failure occurs when the heart can no longer pump blood efficiently, leading blood to back-up in the extremities. It is more common in older adults and people with high blood pressure, but it can also develop as a result of lifestyle habits, like alcohol abuse or smoking.

How to treat: Treatment for congestive heart failure should be monitored by a cardiologist, with specific measures depending on the underlying cause of the CHF. The doctor may order diuretic medications and advise lifestyle changes and regular exercise to help manage excessive fluid retention.