About the Scrotum
The testicles are the male sex organs and produce spermatocytes and testosterone. They lie outside the body encased in a sac, called the scrotum, which hangs behind the penis. Several disorders exist that can cause the scrotum to swell to abnormal proportions. If untreated, long-term massive scrotum enlargement can lead to serious reproductive and excretory complications.
An inguinal hernia is a protrusion, usually of the small intestine, through the abdominal wall into the inguinal canal; they generally occur at weak spots or tears in the abdominal muscles. Often this protrusion enters the scrotum. This can cause fluid to collect in the scrotum and result in enlargement of the area surrounding the testes. This massive scrotum enlargement is most often coupled with severe pain. Surgical intervention is required to fix severe inguinal herniation.
Orchitis is a condition which results in swelling of the testicles. The resulting scrotal swelling can develop into extreme enlargement. Orchitis is caused by bacterial or viral infection, the most common of which is the mumps. Other causes of orchitis include infections of the prostate or epididymis, the tube connecting the testicles and vas deferens where sperm cells mature, contraction of a sexually transmitted infection (STI) or a rare disease called brucellosis. It is usually treated with antibiotics and other medications.
Lymphatic Filariasis, or elephantiasis as it is commonly known, is the result of parasitic worms spread by mosquito bites in tropical and subtropical areas. The development of the disease is somewhat of a mystery. This is for two reasons. Disease contraction usually occurs during childhood, though symptoms do not develop until adulthood. Also, individuals that do not manifest physically observable symptoms usually have lymphatic pathologies and kidney damage.
Those who do show physical symptoms may show extreme enlargement of arms, legs or scrotum. In women, massive enlargement of the vulva and breasts is possible. In communities affected by the disease, physical symptoms may develop in as much as 10 percent of the population.
A proper treatment is still being worked out, but diethylcarbamazine (DEC) has been shown to be effective in killing the parasites. This with the drug albendazole has been shown to remove the parasite from the blood stream for a year following treatment.
Hydrocele is a collection of fluid inside the scrotum. It may be associated with either one or both of the testicles and is most often painless. They are common in newborn males, but are generally the result of inflammation in the reproductive system, trauma or an obstruction of the spermatic cord—the structure that contains the vas deferens, blood vessels and nerves which runs from the testicles to the abdomen—in men. In severe cases which may affect other anatomy, are painful or embarrassing, a minor out-patient surgical procedure is performed to drain the fluid.
Men with an inherited trait have a condition in which the testicles may rotate within the scrotum. This causes the spermatic cord to become twisted. When it becomes twisted to the point of developing pain and diminishing or cutting off blood flow, it is known as testicular torsion. Often symptoms present following physical activity, injury or sleep. The reduction in blood flow causes pain in the scrotum and swelling, which can be severe. Surgery under general anesthesia is the recommended treatment for testicular torsion, though it is sometimes possible to manually rotate the affected testicle.
Among several other symptoms, such as a feeling of heaviness in the scrotum, dull aching or presence of a lump, scrotal enlargement may be a symptom of testicular cancer. It is a rare form of cancer compared to other forms, but is the most common form of cancer in men age 15 to 34. Treatments for this type of cancer vary based on the stage of the cancer and the patient’s general health. The first step is usually surgery to remove the testicle and/or the lymph nodes in the groin. In more advanced stages, chemotherapy or radiation therapy are options.
Lymphedema is a condition which usually occurs in the arms or legs, however should lymph vessels in the pelvis become blocked, lymph fluid and tissue can collect in the scrotum. The collection of fluid and tissues can cause massive scrotum enlargement which impairs the patient’s ability to walk. Many patients with this condition are obese. Surgery is the recommended treatment in order to remove the fluids and tissues.
Mayo Clinic: Inguinal Hernia
University of Maryland Medical Center: Orchitis-Overview
World Health Organization: Lympatic Filariasis
Cleveland Clinic: Hydrocele and Spermatocele
Mayo Clinic: Testicular Torsion
Mayo Clinic: Testicular Cancer
WebMD: Testicular Cancer-Symptoms
The Center for Reconstructive Urology: Scrotal Lymphedema
Mayo Clinic: Lymphedema