Your Doctor Just Said 'Hydroceles'—Ask These 5 Questions

About 1 percent of adult men experience a hydrocele, which occurs when fluid collects around one or both testicles in the scrotum. Though typically harmless, the condition can be alarming because it causes your scrotum to swell. If your doctor diagnoses you with a hydrocele, here are some key questions to ask to help put you at ease.

Why do I have a hydrocele?

A hydrocele happens when fluid from the abdominal cavity leaks into the scrotum, forming a sac that feels like a small water balloon. Hydroceles are more common in infants (especially those born prematurely) and typically occur when a thin membrane that extends through the inguinal canal and into the scrotum fails to close properly during development.

Most of the time, there's no apparent cause of hydroceles in adulthood. Some possible causes may include:

• Cancer of the left kidney or testicles (rare)
• Generalized swelling in the lower half of the body
• Infections, including sexually transmitted infections (STIs)
• Inguinal hernia (intestine becomes trapped in the abdomen or scrotum)
• Inflammation of the testicles or epididymis
• Injuries
• Obstruction of the spermatic cord
• Surgery to the scrotum or groin area

Should I be worried about hydroceles?

In the vast majority of cases, hydroceles are not a cause for alarm. However, you should visit your doctor to evaluate any testicular changes and rule out potentially dangerous issues that need immediate attention. Painful injuries to the scrotum and lumps in the testicles can be critical and should be examined by a medical professional right away (especially testicular torsion, which is a medical emergency). A physical exam, ultrasound or X-ray and review of your medical history will help your doctor determine if there's anything to worry about.

How can you tell the difference between a hydrocele and a tumor?

Hydroceles are filled with fluid, and tumors are made up of cancer cells. When a doctor shines a bright light through a hydrocele, they'll be able to see some light filtering through the other side. Tumors are opaque because they're a solid mass. You shouldn't try this test at home, though, since it takes a trained eye to tell the difference.

Will a hydrocele interfere with sexual activity or fertility?

A hydrocele shouldn't affect sexual function or the ability to reproduce. However, if it enlarges or gets infected, severe complications may result.

Hydroceles are mainly composed of water, which doesn't transfer heat well. To maintain healthy sperm, testicles require a tightly temperature-controlled environment. This may be affected by the presence of a large hydrocele, especially when there are hydroceles on both testicles. Hydroceles can also place added pressure on the testicles and restrict blood flow.

If your hydrocele becomes painful or starts to interfere with sex, be sure to have it checked. Getting prompt treatment may help you avoid preventable fertility issues.

Do I need treatment?

Hydroceles don't necessarily require treatment unless they continue to grow in size, become uncomfortable or your doctor has other concerns, such as an infection. If you don't have negative symptoms, you can just leave it alone and wear extra support as needed.

If you choose to have treatment for hydroceles, surgery is the more permanent option. Your surgeon will make a small cut in the scrotum to drain the fluid. Then, they'll create a blockage between the abdomen and scrotum to prevent future hydroceles from forming.

You can visit your doctor for a less invasive option, called aspiration, in which the hydrocele is drained using a syringe. Unfortunately, you may need to repeat the process every few months since it's not a permanent fix. However, sometimes your doctor can inject a solution that stops the hydrocele from refilling, especially if you're not a good candidate for surgery. This is called sclerotherapy.

Ultimately, the decision on how to deal with a hydrocele is up to you. If you choose to have surgery, you can expect a minor, minimally invasive procedure that doesn't require an overnight hospital stay.

Don't be afraid to speak up

Unexpectedly waking up with a hydrocele can be worrisome. Fortunately, hydroceles are not uncommon and don't necessarily indicate a major medical concern. Visiting your doctor or a urologist to discuss your questions will give you peace of mind and help you determine the best course of action.