Hydroceles: Myths & Misconceptions

A hydrocele occurs when there is an accumulation of serosal fluid in the thin sheath that surrounds one or both testicles, resulting in swelling and inflammation. Although they’re sometimes painful, usually a hydrocele is more uncomfortable than harmful, and they often disappear on their own.

However, there are cases where a hydrocele can be a genuine cause for concern.

Here are a few of the common myths and misconceptions about hydroceles, along with some general facts that may help you to understand the condition.

Myth: Only infants develop hydroceles.

Reality: This condition is certainly more prevalent in infants, but adult men can get a hydrocele, too, particularly after age 40.

As a baby develops in the womb, a naturally occurring sac containing fluid surrounds each testicle. Typically, this sac closes off, and the fluid within gets absorbed into the body. However, if the sac fails to close on its own, the fluid remains in the scrotum, and a hydrocele can occur.

For infants, a hydrocele is common: It is present in 10 percent of newborns. In most cases, the hydrocele often disappears by the child’s first birthday, without intervention.

It is not uncommon, however, for men—particularly those over age 40—to develop a hydrocele. In such instances, a hydrocele frequently comes on the heels of some unrelated inflammation or injury to the scrotum.

Myth: A hydrocele is a standalone condition.

Reality: While it’s true that a hydrocele, especially in adult men, can sometimes seem to occur spontaneously, several conditions appear to be associated with it. And some conditions may exacerbate or even trigger the development of a hydrocele. These may include:

• Epididymitis or other inflammation. Epididymitis, which is inflammation in the epididymis—the coiled tubes at the upper back and sides of the testes—is sometimes the cause of a hydrocele.
• Infection. A sexually transmitted infection (STI) can sometimes trigger the formation of a hydrocele.
• Inguinal hernia. An inguinal hernia, in which a loop of intestine protrudes through a weak spot in the lower abdominal wall into the scrotum, can sometimes cause a hydrocele to form.

Myth: A hydrocele is always benign.

Reality: An untreated hydrocele can be associated with serious underlying testicular conditions.

While the emphasis in any discussion of a hydrocele is usually on the fact that infants get them regularly and they usually go away naturally on their own, there can be complications. In addition, in adult men especially, a hydrocele can be associated with tumors or infection, which can cause a decline in sperm production and function.

And please note: In the case of an inguinal hernia that triggers a hydrocele, know that a section of the intestine that gets trapped on the wrong side of the abdominal wall—that is, actually in the scrotum—can be life-threatening if left untreated.

Myth: A hydrocele remains the same until it goes away.

Reality: Hydroceles can swell and they can recede. Also, a hydrocele’s fluid will often remain in the scrotum after the sac containing it closes, at least until it is reabsorbed into the body.

However, sometimes the fluid can recede into the body cavity—for instance, when the scrotum is compressed—then flow back into the scrotum again. It may not work quite like the ocean tides, but the effect can be similar, with the man’s testicle size appearing to grow and shrink over the course of a day.

Myth: Since a hydrocele usually goes away on its own, I don’t need to seek medical intervention.

Reality: You should schedule a visit with your doctor if you believe you may have a hydrocele, and examination and treatment may be necessary. Certainly, if a hydrocele won’t go away for two years, or it grows larger or causes pain, some interventions may include:

• Support. Wearing a support device, like a jockstrap, can sometimes help ease the discomfort of a hydrocele.
• Hydrocelectomy. Under general anesthesia, the doctor makes an incision in the man’s scrotum and drains the hydrocele using suction. The surgeon will close the hydrocele sac and close the communication to the canal between the abdominal cavity and scrotum.
• Needle aspiration. If you’re at risk for surgical complications, sometimes the doctor will opt for using a long needle to drain the hydrocele and, in some cases, inject medication directly into the sac to prevent it from refilling.

A hydrocele is a largely benign condition, but one can grow to an unmanageable size, become painful, cause infections and even cause other complications. If you notice a swelling in one or both testicles, it’s best to get your doctor to make an examination.