Inguinal and Scrotal Inflammation

A lump or swelling found in the groin or scrotum is among the most common clinical presentation in both boys and men. Most lumps are either hernias or enlarged inguinal nodes. Inguinal herniations are more common than femoral herniations by a ratio of 4:1 (Swash 1995, 100). Within the scrotum, lumps could be a varicocele, a hydrocele of the tunica vaginalis, a hydrocele of the spermatic cord (spermatocele), a lipoma of the spermatic cord, a cyst of the epididymis, inflammation of the epididymus, or an enlargement of the testes (orchitis). It is necessary to get an accurate medical diagnosis however, to rule out the possibility of testicular cancer, or to determine the nature of a pathogenic agent. Inguinal and femoral hernias usually need corrective surgery.


Enlarged lymph nodes in the groin typically indicate a genitourinary tract infection such as prostatitis or urethritis, most often caused by gram negative bacteria such as a Escherichia coli, Staphylococcus saprophyticus, Klebsiella and Proteus. The treatment of inguinal lymphadenopathy is secondary to the treatment of the underlying pathogenic factor. In most cases the use of urinary tract disinfectants such as Pipsissewa (Chimaphila umbellata), Buchu (Barosma betulina), Bearberry (Arctostaphylos uva-ursi), and Cubeb (Piper cubeba), used along with urinary tract demulcents such as fresh Corn silk (Zea mays), Couch Grass (Agropyron repens), and Marshmallow root (Althaea mofficinalis), will resolve the issue. To improve lymphatic circulation lymphagogues such as Red root (Ceanothus americanus), Cleavers (Galium aparine), and Poke root (Phytolacca decandra) may be called for. Additional measures include the use of non-specific stimulants to immune function such as Echinacea (Echinacea angustifolia), Katuka (Picrorrhiza kurroa) and Wild Indigo (Baptisia tinctoria). Topical applications include astringents such as Witch Hazel bark (Hamamelis virginiana) and lymphagogues such as Poke root (Phytolacca decandra), the latter applied as an infused oil (1:3, fresh root), and covered with a hot washcloth, or used as a fomentation.


A varicocele is the tortuous dilation of the pampiniform venous complex of the spermatic cord, forming a soft, elastic swelling that can cause pain but are more often asymptomatic. Essentially, a varicocele is a varicosity of the spermatic vein, in which the blood flows backwards to engorge the vein. Varicoceles are more common in the left testicle because the left testicular vein connect to the renal vein at a right angle, whereas the right testicular vein drains directly into the vena cava. Varicoceles of the right testicular vein however, may indicate an obstruction of the vena cava. In regard to examination, a varicocele is apparent upon standing rather than lying down, and feels like a “bag of worms” superior to the testicle. Varicoceles account for roughly 30 – 40% of cases of male infertility, and occurs in about 15 – 20% of the population. Although the cause of the infertility is unknown, it is thought that the increase in testicular temperature from the enhanced blood flow may inhibit spermatogenesis and sperm motility. Varicoceles and can be diagnosed with examination, ultrasound, or venography (x-ray of testicles). (Swash 1995, 100-101; Berkow 1992, 1745; Junnila and Lassen 1998)

As varicoceles are essentially benign, it is worth treating them with holistic methods before using surgical methods. Further, holistic therapies can be used concurrently and after surgery to improve testicular circulation and prevent new varices from forming. The treatment of varicoceles is much the same as for the treatment of hemorrhoids and varicose veins, but with some important modifications. Pelvic decongestants such as Stone root (Collinsonia canadensis) and White Dead Nettle (Lamium album) are an important part of treatment, as are venous astringents such as Horse Chestnut (Aesculus hippocastanum) and Witch Hazel (Hamamelis virgininica). Botanicals particularly rich in flavonoids such as Hawthorn (Crataegus oxycanthoides), Bilberry (Vaccinium myrtillus) Gotu Kola (Centella asiatica), Bhumy Amalaki (Phyllanthus amarus) and Arjuna (Terminalia arjuna) can also be considered to repair endothelial permeability and increase capillary resistance. In situations of impotence and sexual debility gonadal trophorestoratives such as Dang Gui (Angelica sinensis), Kapikachu (Mucuna pruriens), Yin Yang Huo (Epimedium grandiflorum), or Ashvagandha (Withania somnifera) can be included in formulation. To enhance the effectiveness of a formula circulatory stimulants such as Rosemary (Rosmarinus officinalis) and Prickly Ash berry (Zanthoxylum americanum) should also be included. Topical treatment involves the use of cold water sitz baths, and venous astringents such as Horse Chestnut (Aesculus hippocastanum) tincture, 15% v/v in a hypoallergenic cream base, applied over the affected area twice daily. Useful supplements include bioflavonoids and oligomeric roanthocyanidins such as pycnogenol, as well as vitamins A, C, E, and zinc. Dietary shifts should reflect an increase in whole foods and fiber, with an emphasis upon fruits such as blueberries and vegetables like carrots and kale to ensure an optimum intake of flavonoids and other supportive nutrients.

Hydrocele, hematocele and spermatocele

A hydrocele is common intrinsic swelling of the scrotum resulting from an excessive accumulation of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis. In infants, a hydrocele is the result of the persistence of the processus vaginalis, a diverticulum of the peritoneal membrane. This defect typically closes spontaneously within the first year of life and requires no specific therapy. In adults, a hydrocele may be due to a diminished resorptive capacity of the lymphatic and venous vessels, from inflammation due to trauma or infection, or from testicular torsion or neoplasm. A hematocele is a solid mass of the tunica vaginalis comprised of blood, and is usually secondary to trauma. A spermatocele is a cyst of the epididymus or areas adjacent to the epididymus that contains dead sperm. Hydroceles and spermatoceles are easily distinguished from other scrotal masses by tensing the scrotal skin gently over the swelling and shining a bright light behind it. Both of these masses will transmit light, whereas a hematocele will not. The difference between a hydrocele and a spermatocele is that in the former the testis is not palpable separately from the swelling. In contrast, a spermatocele lies adjacent to the epididymis, superior and posterior to the testes, suggesting a “third testis.” In very large spermatoceles however, it may difficult to differentiate it from a hydrocele, in which case ultrasonography may help with the diagnosis.(Swash 1995, 100-101; Berkow 1992, 1745; Junnila and Lassen 1998)

Similar to varicoceles, hydroceles and spermatoceles are typically benign, and holistic methods may be utilized before surgery is resorted to. Many of the same methods of treatment utilized for a varicocele may be used in the management of hydrocele and spermatocele, but with the additional use of lymphagogues such as Red Root (Ceanothus americanus), Cleavers (Galium aparine) and Poke root (Phytolacca decandra). Serous tonics such as White Bryony (Bryonia dioica) may be of use, especially if there is some tenderness upon pressure. Gonadal restoratives such as Dang Gui (Angelica sinensis), Kapikachu (Mucuna pruriens), Yin Yang Huo (Epimedium grandiflorum) and Ashvagandha (Withania somnifera) are also indicated to restore proper function. Topically, a tincture of Poke root (Phytolacca decandra) infused in castor oil (10-20% v/v), or a Poke root castor oil infusion (1:3), with the addition of a few drops each of the essential oils of Chamomile and Lavender, may be applied locally.The management of acute pain associated with hydrocele can be helped by preparing an ice pack and applying it topically.


Epididymitis is an acute or chronic inflammation of the epididymis, a complication resulting from sexually transmitted diseases, ascending urinary tract infections, or prostatitis. It is the most common cause of scrotal swelling in postpubescent males. Pyuria, or leukocytes in the urine, is a laboratory feature of epididymitis, and the absence of pyuria makes the diagnosis of epididymitis unlikely. In males under the age of 35 the organism typically involved is Chlamydia trachomatis, but could be Neisseria gonorrhoeae. In prepubescent males and males over the age of 35, the most common cause of epididymitis is a bacterial infection of the urinary tract. Gram’s stain and culture should be obtained however, in order to rule out a sexually transmitted disease. If the test is positive for an STD, the patient’s sexual partner(s) should be treated as well. It should be pointed out that epididymitis can be tubercular in origin.Symptoms include difficult urination, fever, chills, groin pain, and a tender, swollen epididymus that may difficult to distinguish from the testis. (Swash 1995, 100-101; Berkow 1992, 1745; Junnila and Lassen 1998)

The treatment of epididymitis resembles some of the components in the treatment of pelvic inflammatory disease in women, emphasizing antimicrobial and urinary antiseptics, as well as soothing diuretics and anodynes. Important antimicrobial agents include Goldenseal (Hydrastis canadensis), Echinacea (Echinacea angustifolia), Wild Indigo (Baptisia tinctoria) and Sarsaparilla (Smilax spp.).Useful urinary antiseptics to include if the epididymitis is secondary to a urinary tract infection are Pipsissewa (Chimaphila umbellata), Buchu (Barosma betulina), Bearberry (Arctostaphylos uva-ursi), and Cubeb (Piper cubeba), used along with urinary tract demulcents such as fresh Corn silk (Zea mays), Couch Grass (Agropyron repens), and Marshmallow root (Althaea officinalis). Important anodynes in the genitourinary tract include Kava (Piper methysticum), Pasqueflower (Anenome occidentalis), and Henbane (Hyocyamus niger). If the condition occurs with hemorrhoids pelvic decongestants such as Stone root (Collinsonia canadensis) or Ocotillo (Fouquieria splendens) are called for. If the condition is more or less chronic in the absence of a urinary tract infection, the addition of gonadal restoratives such as Dang Gui (Angelica sinensis), Kapikachu (Mucuna pruriens), Yin Yang Huo (Epimedium grandiflorum), or Ashvagandha (Withania somnifera). Topical measures include scrotal ice packs and scrotal elevation with adhesive strips. King’s American Dispensatory recommends the topical application of an infusion of Tobacco (Nicotiana tabacum) in epididymitis, applied as a compress to relieve pain (Felter and Lloyd 1893)


Orchitis is an acute inflammation of one or both testicles, presenting as a sudden onset of testicular pain, high fever, abdominal pain, and nausea and vomiting. The testis is enlarged (about 2 – 3 times larger), swollen, and tender upon palpation. The causes of acute orchitis must be clearly established before treatment, as both testicular trauma and torsion require immediate surgery to prevent permanent damage to the testis. Without such an indication, orchitis may be a complication of a urinary tract infection, a sequela to gonorrhea, syphilis or tuberculosis, a complication of prostate surgery, and most commonly, the result of viral parotitis (mumps). In some cases, orchitis may be an autoimmune response to spermatozoa, more common in older men and after a vasectomy. Orchitis as a complication of parotitis occurs in about 20% of postpubescent men, presenting as a unilateral swelling of the testes that accompanies or follows the inflammation of the salivary glands. Some degree of testicular atrophy may ensue, and in about 4% of cases inflammation of both testes results in a loss of spermatogenesis, although androgenic activity is maintained. The swelling typically resolves on its own in about 7 – 10 days, and if the testes appear smaller than before the swelling, atrophy is indicated. The medical treatment of orchitis is based upon the causative factor. Chlamydia trachomatis is most often the organism implicated in non-viral orchitis, and other diseases such as tuberculosis, syphilis, or mycotic (fungal) infections are now rare. (Swash 1995, 100-101; Berkow 1992, 1745; Junnila and Lassen 1998)

The holistic treatment of orchitis utilizes supportive therapies such as bed rest, scrotal support and ice packs, antimicrobial therapies if infection is suspected, as well as antiinflammatory and analgesic therapies. The use of antimicrobials agents in herbal therapy are the same in orchitis as they are for a genitourinary tract infection,discussed previously under epididymitis. Important botanicals that have an anti-inflammatory and analgesic activity include Arnica (Arnica montana), White Bryony (Bryonia dioica), Kava (Piper methysticum), and Pasqueflower (Anenome pulsatilla),the latter in particular indicated in enlarged and painful testes, with no underlying major pathology (Moore 1990, 27). In cases of chronic orchitis in the aged gonadal restoratives are also indicated, and if accompanied with biliary congestion, a sense of pelvic heaviness, or hemorrhoids, pelvic decongestants and cholagogues such as Stone root (Collinsonia canadensis), Ocotillo (Fouquieria splendens) and Dandelion root (Taraxacum officinalis) are indicated. In addition to scrotal ice packs and scrotal support, topical therapies include a Arnica (Arnica spp.) as a lotion or liniment, containing the essential oils of Lavender and Roman Chamomile. Once again, Felter and Lloyd recommend an infusion of Nicotiana as a compress (1893).