Swollen Balls: When Should I Talk to a Doctor?

Let's face it: some things are easier to bring up with your healthcare provider than others.

And all of us should learn to be comfortable talking with doctors about anything and everything to do with our body.

For most, there's going to be less hesitation to talk about a sprained ankle than, say, suddenly swollen balls. And yes, that can happen, not necessarily in a good way, either.

It's a condition called genital lymphedema, and there are certain procedures and risk factors, which can make men more susceptible. We'll look at what genital lymphedema is, what are some of the co-morbidities, and what kind of complications it can cause if you leave it untreated.

Why are my testicles swollen and what is genital lymphedema?

The body's lymphatic system operates via lymph fluid, a clear to yellowish substance transported by lymph vessels that passes through little filters—bean-shaped lymph nodes—that are distributed throughout the body. This system delivers immune cells to the bloodstream and filters out bacteria and certain proteins.

Lymphedema is a swelling that occurs when your body's lymph system has difficulty processing said fluid, causing build up. The scrotum and penis are especially susceptible to lymphedema because of gravity and the peculiarities of the male anatomy.

Primary lymphedema occurs when a person's lymphatic system develops abnormally, in which they can't process lymph fluid properly. Secondary lymphedema is more common and is caused by factors outside the body, such as certain treatments, removal of the lymph nodes and certain infections.

"Typically, in America, one of the biggest causes of genital lymphedema is cancer treatment," said Natalie Kruse, P.T., D.P.T., a senior physical therapist at the University of Iowa hospitals in Iowa City, Iowa. "So if you have lymph node removal, if you've had radiation or certain chemotherapies, it could cause that."

Who can develop genital lymphedema?

While the general mechanism of genital lymphedema is pretty well understood, it can affect different people to differing degrees; but the more damage done to the system, the more susceptible you are.

"Lymphedema can affect anybody who has impairments to the lymphatic system," Kruse said. "You can get lymphedema if you've had one lymph node removed or 20 removed. But if you've had a lot of lymph nodes removed, plus a lot of radiation, plus multiple surgeries in the area, you might be more at risk."

Other people who are more susceptible to developing genital lymphedema are people who have certain comorbidities such as diabetes, obesity, or people who have had any kind of recent pelvic, scrotal or groin surgery.

"An example that comes to mind would be someone who is an inpatient and has multiple comorbid conditions like diabetes and congestive heart failure," said Amy Pearlman, M.D., a men's health specialist and co-founder of Prime Institute in Fort Lauderdale, Florida. "So let's say they're admitted for acute congestive heart failure, they might have extra fluid on their body, and some of that fluid might end up in the scrotum."

What are the possible complications?

Genital lymphedema may sound like simply an uncomfortable, annoying and, perhaps, embarrassing condition. However, ignoring it can carry heavy consequences.

Because the lymph fluid can't circulate freely, it's unable to do its job properly and clear out any bacteria and infection, which leaves the area especially vulnerable to infection. Other complications include hygiene issues, mobility problems and difficulty fitting into your clothes—not to mention sexual health issues and feelings of shame or embarrassment.

"If tissue is not able to drain, then you just get pooling," Pearlman said. "And if you have an infection, you can't really treat it if there's no circulation. Tissue that has lymphedema is not healthy tissue. And tissue that's not healthy is more prone to become infected."

The skin in the area can go through certain changes if lymphedema is left untreated. You can develop a condition called cellulitis that causes redness and heat and, eventually, the skin can grow harder and develop a condition called fibrosis.

What's the treatment for genital lymphedema?

Pelvic floor therapists like Kruse often find themselves on the front lines of helping guys deal with lymphedema, which usually begins with manually trying to push that fluid out of there.

"There can be more of an acute phase where we're really working on it hard, focused more on management of that swelling so we can really reduce it," Kruse said. "Then there's more of a maintenance phase afterward where we're trying to maintain what they have. Maybe they have a little bit of swelling, or it swells with certain activities or at certain times of day, but we can really reduce it and help people get a good regimen going."

Management of genital lymphedema rests on four pillars: self-care, exercise, manual lymphatic drainage and compression. That means for best results, guys will want to reduce their sodium intake, be very conscious of hygiene and take good care of the skin in the area, manage their weight well, exercise regularly to help encourage blood and lymph fluid to circulate well, and doing manual lymphatic drainage and compression.

The patients who get the best results are almost always people who take a keen interest in doing some homework but, at first, Kruse will teach them how to do the last two pieces.

"Manual lymphatic drainage is a special sequence where we have to work on draining the lymphatic fluid," she said. "So you're manually massaging that area to help pump that back up. And then compression: there are certain compressions that you can use globally on the genital region, and you can also work on wrapping that area yourself. But it can be cumbersome. There's a lot of work we can do to help that region with compression, but it can be hard because everybody's different."

Conclusions

Genital lymphedema can be a challenging, chronic condition, but getting the help you need is the first step.

Pearlman recommends eliminating the possibility of infection first—if you have redness, swelling, or irritation accompanied by fever or chills, get to an emergency room. Apart from that, you can probably begin with seeing your general practitioner for diagnosis and advice on where to turn to get started treating it.

Do it right away, however. Complications can set in quickly with something as tricky as genital lymphedema.