Why are my testicles swollen

Inflammation of the testicles and epididymis

Inflammation of the testicles (Orchitis) and the (more common) Epididymitis (Epididymitis) cause similar symptoms and can also merge into one another (Epididymo-Orchitis). Testicular inflammation occurs from puberty and in adulthood and is triggered by infections with bacteria or viruses (e.g. the mumps virus). The epididymitis, which is usually caused by bacteria, mainly affects older men with impaired emptying of the bladder, but also younger men in the case of sexually transmitted germs.

Both the symptoms and the therapy are identical for both diseases, which is why they are described together below. If treated early with antibiotics and anti-inflammatory drugs, the prognosis is usually good. If therapy is delayed or an infection with the mumps virus, infertility can remain.

Leading complaints

  • Very painful swelling of the testicles and / or epididymis, reddened skin of the scrotum
  • If the infection is advanced, fever and chills
  • With testicular inflammation: additional symptoms of the causative viral infection (e.g. swelling of the parotid gland in mumps)
  • With epididymis: additional symptoms of a urinary tract infection such as pain when urinating and frequent urination.

Note: Testicular pain in children is rarely caused by inflammation of the testicles or epididymides; Particularly in the case of sudden pain, usually in the morning hours, there is a suspicion of twisting of the testicles (testicular torsion), an immediate operative clarification is necessary.

When to the doctor

The next day at

  • the complaints mentioned as they gradually get worse.

Immediately at

  • sudden onset or worsening of the pain
  • high fever and chills (signs of blood poisoning)
  • Leakage of pus from the inflamed area or if the skin is darkened (signs of tissue damage)
  • always in children and young adults. You may have a twisted testicle (testicular torsion) that needs to be operated on immediately.

The illness

Disease emergence

Inflammation of the testicle occurs most often when pathogens get into the testicles via the blood, be it as part of an infection with viruses such as mumps, chickenpox or Pfeiffer's glandular fever or an infection with bacteria such as salmonella. Testicular inflammation in mumps is feared (Mumps orchitis): It typically occurs about 5 days after the onset of the disease, but only affects boys or men from puberty, every fourth bilateral and every tenth unilateral.

Epididymitis in a 29-year-old patient. The affected side of the scrotum is significantly enlarged, painfully swollen and extremely sensitive to pressure, the skin appears bright red, shiny and overheated.
Georg Thieme Verlag, Stuttgart

Epididymitis occurs when bacteria from the urinary tract or prostate spread to the epididymis, for example in the case of an acute urinary tract infection. In younger men, sexually transmitted germs such as chlamydia or gonorrhea pathogens (gonorrhea) often trigger epididymitis. In older men, epididymitis is usually associated with impaired emptying of the bladder and the formation of residual urine, in which bacteria can easily multiply. The most common reason for this is the enlarged prostate. As a result, those affected have to apply increased pressure when urinating, whereby the bacteria contained in the urine are "pressed" into the epididymis via the vas deferens.

Complications

If the pathogens encapsulate themselves, abscesses form. When germs enter the bloodstream, there is a risk of urosepsis. If the infection spreads further in the scrotum, in some cases Fournier gangrene develops, a life-threatening inflammation of the genital and perineal area that threatens tissue death.

Diagnostic assurance

The doctor first scans the testicles and epididymis and then examines them using ultrasound in order to rule out impending complications, such as abscess formation, at an early stage. He also tests the midstream urine for bacteria in order to rule out an accompanying or causal urinary tract infection.

In addition, the doctor determines inflammation levels in the blood such as B. CRP. If mumps orchitis is suspected, he will have serological tests carried out for mumps viruses and antibodies.

Differential diagnoses. In the case of severe testicular pain, the doctor must primarily rule out testicular torsion. A painless increase in the size of the scrotum, on the other hand, is found in testicular hydrocele, varicocele and testicular cancer.

treatment

Against a bacterial inflammation Antibiotics and anti-inflammatory pain relievers (NSAIDs) help at the same time reduce pain, which is often considerable, and have a decongestant effect. In young men with severe inflammation, doctors often prescribe cortisone to prevent infertility due to inflammatory, scarring occlusion of the two epididymal ducts.

In addition, bed rest, elevation of the testicle, and cooling are recommended. If the pain is very severe, the doctor will inject a local anesthetic into the area around the spermatic cord. In the event of a poor general condition and inadequate care at home, the sick person is admitted to the hospital because antibiotics can be administered via infusion and more intensive monitoring is possible in the clinic.

Treatment of epididymis: In order to relieve the symptoms quickly, the doctor prescribes strict bed rest and elevation of the testicles with gauze pads or a towel bandage, as shown here. If the pain is very severe, the doctor will also inject a local anesthetic. Cooling compresses and ointment dressings e.g. B. with Hirudoid® help to reduce the swelling of the inflammation. If the worst phase is over and you can get out of bed again, the person concerned should wear tight underpants, because drooping the diseased testicle hurts and hinders the lymphatic drainage. Ice compresses wrapped in towels (e.g. Coolpack®) are recommended for "outpatient" cooling.
Georg Thieme Verlag, Stuttgart

Is there a virus-induced testicular inflammation, e.g. B. mumps or chickenpox, the same advice applies, only antibiotics will not help. There are different assessments of whether antivirals should be taken instead. The administration of interferon, a substance that has an effect on the immune system, has not shown any clear benefit in several studies.

Forms as the inflammation progresses abscess, has to be operated on. In the worst case, the testicle is removed (orchiectomy).

If there is a significant amount of residual urine in the bladder (residual urine determination), the doctor inserts a suprapubic catheter through the abdominal wall into the patient's bladder under local anesthesia in order to restore the outflow of urine. This mostly only affects older patients.

Process control. It is important that the urologist scan the testicles and epididymis at regular intervals and assess them using ultrasound in order to detect abscess formation in good time. Signs of an uncomplicated course of the inflammation are a rapid decrease in temperature, swelling and pain.

forecast

After most testicular infections, there is temporarily limited sperm production for a few months. If the testicular cells are damaged - which affects 2–3% of people with mumps orchitis - sperm are produced too few or too slowly, resulting in infertility. The same applies to epididymitis. Inadequately treated, there is often a risk of chronic epididymitis, and sometimes also a blockage of the seminal ducts, which prevents the discharge of the sperm.

Your pharmacy recommends

What you can do yourself

  • The elevation of the diseased testicle, e.g. B. by means of a special carrying bag (jockstrap) or a testicular bench, is used to relieve the swollen scrotum from its own weight. For this reason, you should give preference to tight-fitting underpants (instead of e.g. boxer shorts) in the acute phase.
  • Cooling compresses, such as B. a washcloth soaked in cold (not ice-cold!) Water.

Prevention

Mumps orchitis can be safely avoided in childhood by vaccinating with the combination vaccine against measles, mumps and rubella in good time.

Authors

Dr. med. Martina Sticker, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:10


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.