I feel a heaviness in my underwear and I know it’s not normal… Stepping out of the shower, you take the time to stand naked in front of the mirror for a long-overdue self-exam of your testes. And sure enough, you notice your balls are much bigger than usual.

Medically reviewed by Endo-Urologist Malek Meskawi on 08/08/2022

The medical term used when this occurs is scrotal swelling or scrotal masses, an abnormality in the pouch of skin called the scrotum, located behind/above your penis. The scrotum contains your testicles and related structures that produce, store and transport sperm; they are also your body’s main source of male hormones (testosterone).

Scrotal swelling may be painless or very painful. Although it can be alarming, most causes are benign and highly treatable. In very rare cases, scrotal swelling may indicate cancer. It is therefore essential to have any swelling checked out by your doctor.

What are the causes of painless scrotal swelling, aside from testicle tumors?

• Hydrocele or hernia, the most common causes of scrotal swelling
• Varicocele, a painless swelling caused by enlarged veins in the scrotum
• Idiopathic scrotal swelling, a less common cause

Hydrocele

A hydrocele is a painless buildup of watery fluid around one or both testicles that causes your scrotum or groin area to swell. This swelling may be unsightly and uncomfortable, but it usually is not painful and generally is not dangerous. Although hydroceles are common in newborns, they can also occur at any age in later life and may be the result of an injury or infection.

A hydrocele is usually diagnosed by an examination of your scrotum, which may appear enlarged and are treated only when they cause pain or embarrassment or when they decrease the blood supply to the penis (rare).

Hernias

An inguinal hernia occurs when tissue, such as part of your intestine, protrudes through a weak spot in your abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object. However, many hernias do not cause pain.

Not necessarily dangerous, if it doesn’t improve on its own, your doctor is likely to recommend surgery if it is painful or enlarging. Hernias are also more common among men with obesity, as the extra weight puts pressure on the weak spot in the groin. In rare cases, the intestines can become strangled in a hernia and this is manifested by sudden pain. In this case, it is important to consult the emergency service closest to your home.

Varicocele

A varicocele is an enlarged, twisted vein in your scrotum, most often on the left side. It’s similar to a varicose vein you might see in your leg. Most varicoceles develop over time, are easy to diagnose and many don’t need treatment. If a varicocele causes symptoms, it often can be repaired surgically. 

Idiopathic swelling

Idiopathic swelling refers to swelling for which your doctor has been unable to identify a reason. This is more common among children, but it can affect men of any age. This type of swelling may appear suddenly. It is painless and usually goes away on its own within around 3–6 days.

Get checked out by a doctor

He/she will ask you questions about your medical history and will examine you and order some tests. All the information and clues are used together to decide on the nature of your testes problem. In some cases, you may be referred to a urologist. Everyone will work to diagnose the cause of the swelling and recommend appropriate treatment options for you.

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