What is scrotal swelling in children?

The scrotum is the sac that holds the 2 testicles. Scrotal swelling is a common problem in baby boys and young boys. It can have many causes. These are usually divided into painless and painful scrotal swelling.

What causes scrotal swelling in a child?

Causes of painless scrotal swelling

Painless swelling can happen quickly. Or it may happen slowly over time. Causes can include:

• Hernia or hydrocele. These are the most common causes of scrotal swelling. They are caused by abnormal openings left behind after the testicles move into the scrotum during growth in the womb. A hernia is a bulge of intestine through the opening. A hydrocele is a buildup of fluid in the scrotum. About 1 in 10 baby boys have a hydrocele at birth. About 1 in 100 to 1 in 20 of all babies have a hernia at birth. They are more common in preterm babies.
• Varicocele. This is a painless swelling caused by enlarged veins in the scrotum. About 1 in 10 to 3 in 20 young boys have this problem. It’s more common on the left side of the scrotum.
• Other causes. Less common causes include idiopathic scrotal edema and tumors of the testicle. Idiopathic means it has an unknown cause. Tumors of the testicle are very rare in boys younger than age 15.

Causes of painful scrotal swelling

Painful swelling can also happen quickly. Or it may happen slowly over time. It’s less common but usually more serious, especially if it is severe and sudden. Causes can include:

• Testicular torsion. This is when a testicle twists on its cord. A twisted cord can cut off the blood supply. Pain is sudden and severe. This problem may need surgery within 6 hours to save the testicle. Testicular torsion happens in about 1 out of 4,000 boys. It’s most common in babies, and boys between ages 12 and 18. It can happen from a hit to the groin while playing or during sports.
• Torsion of testis appendage. This is when a small sac on the top of the testicle suddenly twists. This causes pain at the top of the testicle and scrotum. It’s common in boys between ages 8 and 12. This is treated with over-the-counter pain medicine such as acetaminophen or ibuprofen. 
• Epididymitis and orchitis. These are infections that can be caused by bacteria or viruses. Pain is less severe and happens more slowly than with torsion. Viral infection of the testicle (orchitis) can happen in young boys who have mumps. Epididymitis is an infection of the ducts near the testicle that store sperm. It’s often caused by bacteria. Symptoms include a feeling of heaviness, pain, and swelling in the scrotum. Sexually transmitted diseases such as chlamydia and gonorrhea can cause epididymitis. In older boys, it may happen from unprotected sex. In young boys, it may happen from a problem in the urinary tract.
• Zipper entrapment. If part of the scrotum, foreskin, or penis gets caught in a zipper, it can cause severe pain right away.
• Schönlein-Henoch purpura. This is a condition that may cause painful scrotal swelling in young boys. It also causes a rash, joint pain, stomach pain, and blood in the urine. Its cause is unknown.
• Other causes. Less common causes of painful swelling include other injuries, allergic reactions, and insect bites.

What are the symptoms of scrotal swelling in a child?

Symptoms vary depending on the cause. In addition to the swelling, your child may also have pain or other symptoms. Make sure your child sees his healthcare provider for a diagnosis.

How is scrotal swelling diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. He or she will give your child a physical exam. The physical exam will include an exam of the belly, the scrotum, and the testicles. Your child will likely have a urine test. A sample of his urine will be checked for signs of infection. Your child may also have an ultrasound or X-ray study. These are painless imaging tests that use sound waves or a small amount of radiation to show tissues in the body.

How is scrotal swelling treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Depending on the cause of your child’s scrotal swelling, treatment may include:

• Surgery. For testicular torsion, your child will usually need emergency surgery to save the testicle. Your child may also need surgery if he has a severe injury to the testicle. He may need emergency surgery if a hernia is trapped or strangulated. If the hernia is not trapped, the healthcare provider usually recommends elective surgery. Testicular cancer usually requires surgery.
• Medicine. If your child has a bacterial infection, he will be given antibiotic medicine. Testicular cancer in boys responds well to cancer medicines. But it may also require radiation treatment.
• Observation over time. Your child may not need treatment for conditions such as minor injury, mumps, a small hernia, hydrocele, idiopathic swelling, or Schönlein-Henoch purpura. Many of these can be watched to see if they go away on their own. The healthcare provider may give your child pain medicine and medicine to reduce swelling during observation for some of these conditions.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of scrotal swelling in a child?

Without treatment, a varicocele may over time lead to testicle damage and infertility.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Painful scrotal swelling
• Pain from injury to the testicles that lasts longer than an hour
• Symptoms that don’t get better, or get worse
• New symptoms

Scrotal swelling that is severe and starts suddenly is a medical emergency. Take your child to an emergency room right away.

Key points about scrotal swelling in children

• The scrotum is the sac that holds the 2 testicles. Scrotal swelling is a common problem in baby boys and young boys. It can happen quickly, or happen slowly over time.
• It can have many causes. These are usually divided into painless and painful scrotal swelling.
• Your child will likely have a urine test. A sample of his urine will be checked for signs of infection. Your child may also have an ultrasound or X-ray study.
• In some cases, your child may not need treatment. The swelling may just be watched over time, and may go away on its own.
• In other cases, your child may need treatment with medicine or surgery.
• Scrotal swelling that is severe and starts suddenly is a medical emergency.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.