Why has my scrotal size increased?

Q: I am a 23 years old male. I have noticed that my scrotal size has increased during the last three months. The size of my penis is normal. It looks really odd when I ride a bike or sit. What can the reasons for this?

A:You have noticed an increase in your scrotal size for last 3 months, which seems to be painless. An increase in scrotal size due to acute inflammation, epididymo-orchitis, is painful and hence unlikely. Most common cause of a painless scrotal swelling is collection of fluid around the testis called hydrocele. It is important, however, to exclude solid neoplastic enlargement of testis, which would also be painless and would fit in with a short duration like yours. A clinical examination with or without sonopraphy would establish the direction for further workup and management.