When a man finds that one or both of the testicles are swollen, this causes major discomfort. Should you worry if this happens? What is the significance of such a swelling? This week, we will discuss lumps and swelling of the testicles.

Testicular cancer

Fortunately, cancer in the testicles is uncommon and rarely seen among men of African descent. It is significant because it occurs in young men aged 15 to 35 years. Usually, the man or his partner finds a painless lump in the testicle. If the man notices swelling of his breasts as well as a lump or enlargement in his testicle, he should visit a doctor immediately. Testicular cancer is highly treatable if detected early. All men should examine their testicles once monthly for early detection of an unwanted lump.

Cysts

The head of the epididymis is found on the top of the testicle with its body and tail slung behind the testicle. Swelling of the epididymal head is called spermatoceles and contain sperms and debris. Epididymal cysts contain clear fluid and is found anywhere in the epididymis. These cysts can be multiple and are usually harmless.

Twisting of the testicles

A sudden painful swelling of a testicle may be due to torsion or twisting of the spermatic cord which connects the testicle to the body. The torsion results in diminished blood flow to the testicle and, if sustained, will result in its destruction and subsequent loss of fertility. It tends to occur in young men, 12 to 18 years of age. The torsion is usually one-sided but can occur on both sides at the same time.

Infections

The most common cause of swelling with pain in the testicles is a sexually transmitted infection. This is common in young adult males. Sometimes, the infection may arise from a urinary tract infection. These infections require treatment with the appropriate antibiotics.

Venous swellings

Varicosities or tortuous swellings of the tiny veins within the spermatic cord are named varicoceles. They tend to occur more on the left side and are caused by incompetent valves in the internal spermatic vein. It has been noted that one-third of infertile men have varicoceles. Treatment of the varicocele does not guarantee fertility.

Hydrocele

Usually, a tiny amount of fluid will surround the testicle. An increase in this fluid is called a hydrocele. It is a painless swelling, but causes discomfort if allowed to get too large. It occurs as a congenital problem in infants but in older men is caused by trauma, infections and possible tumours.

Hernias

Inguinal hernias may extend into the man's scrotum, thus causing a swelling. However, there is no connection with the testicles and they are not true testicular swellings. They can be identified by the man because they often contain intestine and make bowel sounds. When he lies flat, this swelling can be reduced but returns when he is upright.

Take-home message

All unusual swellings in a man's testicles should prompt a visit to the health centre for an examination. The health practitioner will advise you what to do!

Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians; email: yourhealth@gleanerjm.com.