Scrotal Lymphedema

Scrotal lymphedema (skro-tel lim-fi-DEE-muh) is a buildup of fluid (lymph) in the soft tissues of your scrotum. It can also extend to the surrounding areas, including your penis. Your scrotum is the pouch of skin beneath and behind your penis that normally holds your testicles.

Scrotal lymphedema is a type of lymphedema, which is a chronic (long-lasting) condition that occurs after a blockage in or damage to your lymphatic system. Your lymphatic system is part of your immune system. It helps remove waste and toxins from your body and balance your body fluids. Often, the damage to your lymphatic system relates to cancer treatments or surgeries, filariasis or congenital urinary abnormalities.

Scrotal lymphedema is rare, especially in the United States. But healthcare providers and medical researchers aren’t sure exactly how often it occurs.

What parts of the lymphatic system are involved in scrotal lymphedema?

Your lymphatic system includes many different organs. But the following parts contribute to scrotal lymphedema:

• Lymph. Lymph is a clear fluid that circulates through your lymphatic system. It carries white blood cells (mainly lymphocytes) and helps to remove waste, bacteria and excess proteins from tissues.
• Lymph vessels. Lymph vessels are tubes that carry lymph through your body.
• Lymph nodes. Lymph nodes store white blood cells and filter lymph. You have lymph nodes all over your body. Most people have 10 lymph nodes in their groins (inguinal lymph nodes).

What are the symptoms of scrotal lymphedema?

The most apparent scrotal lymphedema symptom is an enlarged scrotum. Your scrotum can swell to many times its normal size. In some cases, it can reach the size of a grapefruit, basketball or larger. Healthcare providers sometimes call this giant scrotal lymphedema.

Other symptoms may include:

• Your scrotum and the surrounding tissues may initially feel soft or doughy due to fluid accumulation; they can become firmer over time as tough tissue (fibrosis) develops
• Chronic pain in the affected areas
• Repeated infections
• Difficulty walking or a complete inability to walk
• Difficulty urinating (peeing)
• Trouble with sexual function

In severe cases, scrotal lymphedema may cause a buried penis. Buried penis occurs when severe swelling (edema) causes the scrotal tissues to envelop the penis. This makes your penis appear hidden or absent.

What causes scrotal lymphedema?

In the U.S., most scrotal lymphedema cases occur due to a blockage or breakdown of the lymphatic system in your genital area. This prevents lymph from draining from the genital area.

Outside the U.S., lymphatic filariasis is the most common cause of scrotal lymphedema. Lymphatic filariasis is a parasitic infection that mosquitoes transmit.

Is scrotal lymphedema contagious?

No, scrotal lymphedema isn’t contagious. It isn’t a sexually transmitted infection (STI).

Who does scrotal lymphedema affect?

You may have an increased risk of developing scrotal lymphedema after treatment to cure cancer, including radiation therapy or surgery. You also have an increased risk if you have a body mass index (BMI) greater than 30 (have obesity).

What are the complications of scrotal lymphedema?

Possible scrotal lymphedema complications may include:

• Repeated bouts of cellulitis. Cellulitis is inflammation of the connective soft tissue beneath your skin. It can cause your skin to lose elasticity.
• Elephantiasis. Elephantiasis causes your skin to become large, thick and hard.
• Erysipelas. Erysipelas is a skin infection that affects the upper layers of skin (superficial skin infection). It causes sudden fever, discoloration (red, purple, brown, black) and swelling in the upper layers.
• Slower healing. It may take longer for wounds around your genital area to heal.
• Psychological effects. Scrotal lymphedema is a long-term condition that can affect your appearance and make walking difficult. This may cause low self-esteem, anxiety, depression and stress.

How is scrotal lymphedema diagnosed?

To diagnose scrotal lymphedema, a healthcare provider will begin with a physical exam and review your medical history. They may also order imaging tests. These help providers better understand the extent of the blockage. They also help rule out other conditions that can cause scrotal swelling. Imaging tests may include:

• Lymphoscintigraphy. During a lymphoscintigraphy, a provider will inject you with a small amount of a radioactive substance (radiotracer). They’ll track the radiotracer through your lymph system with a scanner. A blockage in your lymphatic system will stop the radiotracer and identify the location of the blockage.
• Magnetic resonance imaging (MRI). An MRI is an imaging test that helps identify a blockage in your lymph vessels. It uses a large magnet, radio waves and a computer to produce detailed images of the soft tissues in your genital area.
• Computed tomography (CT) scan. A CT scan uses a series of X-rays to take detailed images of your genital area and determine where a blockage is in your lymph vessels.

Can scrotal lymphedema be cured?

As of now, there’s no cure for scrotal lymphedema. However, treatment exists that can help reduce your symptoms and prevent swelling from getting worse.

How do you treat scrotal lymphedema?

Typically, healthcare providers first recommend complex decongestive therapy to treat scrotal lymphedema. Complex decongestive therapy may help reduce mild to moderate swelling, especially in the early stages. It includes:

• Cleaning your skin with antibacterial soap, warm water and a skin cleaner such as iodine or isopropyl alcohol
• Manually draining the lymph from your scrotum and the surrounding areas (a lymphedema therapist will lightly massage the area to move lymph out of the swollen area and toward functioning lymph vessels)
• Wearing special compression garments; the garments reduce fluid buildup by helping move lymph toward functioning lymph vessels
• Exercising; a lymphedema therapist will design an exercise plan for you that helps lymph circulate through lymph vessels

A provider may recommend surgery in severe cases of scrotal lymphedema that don’t respond to complex decongestive therapy. Testicular lymphedema surgery removes the mass and any affected tissue and covers the area with healthy skin (skin graft). The surgical team may include a urologist and a plastic surgeon. During the procedure, your team will generally:

• Give you general anesthesia so you will sleep and won’t feel any pain during the procedure
• Insert a thin, flexible plastic tube (catheter) into your urethra; the catheter protects your urethra and stabilizes your penis during the procedure
• Separate your penis from tough (fibrotic) scrotal tissue and remove any damaged (lymphedematous) skin and tissue
• If necessary, perform a liposuction; they’ll make tiny incisions in your genital area and use a surgical suction catheter to remove fat cells
• If necessary, perform a panniculectomy; a panniculectomy removes excess skin and fatty tissue around your genital area (pannus)
• If necessary, perform an escutheonectomy; an escutheonectomy removes the fat pad above your pubic area
• Replace damaged skin with healthy skin from another area of your body, usually your thigh

What are the potential complications or side effects of scrotal lymphedema surgery?

Most people respond well to scrotal lymphedema surgery. However, possible complications may include:

• Swelling
• Pain
• Reduced sensitivity in your scrotum, penis or the surrounding areas
• Unsuccessful skin graft

How soon after treatment will I feel better?

It depends on the severity of your scrotal lymphedema and the recommended treatment. With complex decongestive therapy, swelling may reduce within a week or two. If you have surgery to correct scrotal lymphedema, you should recover after about six weeks.

Your healthcare provider will give you an expected recovery timeline according to your situation.

Is there anything I can do to feel better?

Healthy eating habits may help you control scrotal lymphedema swelling. Your lymphatic system is more effective when you follow eating patterns that include plenty of fruits, vegetables, lean protein and whole grains. It’s also a good idea to:

• Limit your salt intake. Salt can increase the amount of fluid in your body. Fresh herbs, garlic, oregano, chili powder and dry mustard can season your food without causing fluid retention.
• Drink lots of water. Staying well-hydrated supports healthy circulation. It may also help improve lymphatic flow. You should try to drink 64 fluid ounces (eight 8-ounce glasses) daily.
• Talk to a healthcare provider. Cancer treatment often causes scrotal lymphedema. So, if you’re receiving cancer treatment, be sure to ask your oncologist about the chance that treatment can cause scrotal lymphedema.

Scrotal lymphedema can also affect you emotionally. It’s a good idea to talk about your feelings to trusted family members and friends. Ask a healthcare provider if they can recommend a therapist or scrotal lymphedema support group.

What can I expect if I have scrotal lymphedema?

There’s currently no way to reverse lymphatic system damage that causes scrotal lymphedema. That means scrotal lymphedema is a long-term condition. But proper treatment can help reduce your symptoms and improve and maintain your quality of life.

When should I see a healthcare provider?

Schedule an appointment with a healthcare provider if you have symptoms of scrotal lymphedema, especially if you’ve gone through cancer treatment. Without treatment, it can get worse and may cause other complications.

During your appointment, you may wish to ask the following questions:

• How do you know I have scrotal lymphedema?
• If I don’t have scrotal lymphedema, what other condition might I have?
• How severe is my scrotal lymphedema?
• What treatment do you recommend?
• What lifestyle changes should I make?
• Can you recommend a therapist, support group, dietitian or lymphedema therapist?

When should I go to the ER?

If you have scrotal lymphedema, go to the nearest emergency room if you have signs of an infection, including:

• A fever over 100.4 degrees Fahrenheit (38 degrees Celsius)
• Increased pain
• Warmth in the area
• Discoloration, including streaks that lead away from the area

Can scrotal lymphedema be prevented?

It may not be entirely possible to prevent scrotal lymphedema that cancer treatment may cause. However, proper treatment can help reduce swelling and minimize complications. The following tips can help lower the risks:

• Monitor your body. Alert a healthcare provider at the first signs of scrotal lymphedema. Going without treatment or waiting too long before starting treatment may lead to more serious problems that a provider can’t control.
• Take care of your skin. Keep your skin clean and moisturized to help prevent infection. As fluid builds up, it makes it easier for bacteria to grow.
• Call a healthcare provider at the first signs of an infection. Common infection signs include discoloration (red, purple or brown), pain, swelling, fever or discolored streaks under your skin.
• Make sure your body fluids can flow easily. Avoid putting pressure on your lower abdomen and groin. This may affect lymphatic drainage. Avoid constrictive garments, like tight clothing and elastic bandages.
• Limit or avoid exposing your genitals to heat. This includes hot showers or saunas. Extreme heat can increase your risk of scrotal lymphedema.
• Take part in slow, carefully controlled exercises. Follow an exercise plan that a lymphedema therapist designs for you.
• Maintain a healthy weight for you. A healthcare provider or dietitian can help you establish healthy eating patterns.