An epididymal cyst is a fluid-filled bump that grows in the tube behind the testicle. It is benign, not cancer.1Children’s Hospital of Philadelphia. Epididymal Cyst and Spermatocele These cysts are very common, especially from middle age, and they often show up on both sides.2International Journal of Science and Research (IJSR). Case Series on Bilateral Epididymal Cyst For most men, the real treatment decision is whether to do anything at all, because most cysts never cause trouble.3Ramsay Health Care. Epididymal Cyst Removal | Urology Any new lump should still be checked by a doctor, though, because touch alone cannot rule out a tumor.4Roswell Park Comprehensive Cancer Center. Testicular cyst versus cancer?
What Causes an Epididymal Cyst
The epididymis is a coiled tube on the back of each testicle that stores and carries sperm. Small tubes carry sperm from the testicle into it on the way to the tube that carries sperm out of the scrotum.5Edward Calleja. Epididymal Cyst and Spermatocele A blockage in those small tubes can make sperm and fluid pool until they form a sac.6Edward Calleja. Epididymal Cyst and Spermatocele Cysts usually appear gradually, over months or years.
A cyst that holds sperm is called a spermatocele, while one holding only clear fluid is an epididymal cyst.7Children’s Hospital of Philadelphia. Epididymal Cyst and Spermatocele They are essentially the same harmless lump with different contents.8Children’s Hospital of Philadelphia. Epididymal Cyst and Spermatocele
Not every cyst comes from a single blockage. Many reflect gradual wear-and-tear changes in the epididymis tissue.9International Journal of Science and Research (IJSR). Case Series on Bilateral Epididymal Cyst So they become more common with age and often appear in several places or on both sides.10International Journal of Science and Research (IJSR). Case Series on Bilateral Epididymal Cyst11PubMed Central. Epididymal Cysts: Are They Associated With Infertility?
A rare inherited condition, von Hippel-Lindau disease, causes many tumors in the body, including solid growths in the epididymis.12PubMed Central. Epididymal cystadenomas in von Hippel-Lindau disease showing increased activity on 68Ga-DOTA-TATE PET/CT About half of men with this condition develop such growths, often on both sides.13PubMed. Epididymal cystadenomas in von Hippel-Lindau disease Those are solid growths, though, and they don’t explain the ordinary cysts most men have. Most men with a cyst never learn exactly what caused it, and doctors usually don’t search for a cause because the answer wouldn’t change the care.
Masturbation and sex have no proven link to them. They are not a sexually transmitted infection, they are not a sign of poor hygiene, and they do not turn into cancer.
What It Feels Like and Whether It Causes Symptoms
Most cysts cause no symptoms and are found by chance, often while showering or during an exam for something else.14Children’s Hospital of Philadelphia. Epididymal Cyst and Spermatocele The cyst is usually about the size of a pea and feels separate from the testicle.15Children’s Hospital of Philadelphia. Epididymal Cyst and Spermatocele It feels soft and slightly squishy, and often sits at the top or bottom of the testicle.16Patient. Epididymal cyst Spermatoceles tend to sit above the testicle, at the head of the epididymis.17Children’s Hospital of Philadelphia. Epididymal Cyst and Spermatocele
A cyst usually doesn’t affect exercise, urination, or ejaculation, and it rarely gets infected.18Patient. Epididymal cyst A bigger one can cause heaviness, discomfort, or mild pain with activity.19Urology Partners of North Texas. Spermatocele (Epididymal Cyst) Diagnosis & Treatment | DFW | UPNT Most stay about the same size for long stretches, though some slowly enlarge over years.
To check at home, try a warm shower, when the scrotum is relaxed. Roll each testicle gently between your thumb and fingers. The epididymis itself feels like a soft, ridged band along the back of each testicle, and that is normal. Compare with the other side. A cyst feels like a distinct, smooth, round bump on that band, beside the testicle, while a worrying lump is usually in the testicle itself. Note the size so you can report any change.
Some signs call for quick action. Sudden severe pain with swelling needs emergency care, since it can mean a twisted testicle. A hard lump in the testicle needs a doctor within days. Fever, redness, or a lump that grows fast should be checked soon.
How Doctors Confirm It Isn’t Cancer
A doctor first checks the lump’s size, texture, and location.20Roswell Park Comprehensive Cancer Center. Testicular cyst versus cancer? Shining a light through the scrotum makes fluid lumps glow while solid ones don’t.21Metrovan Urology. Hydroceles, Spermatoceles & Epididymal Cysts Position helps too: cysts sit behind the testicle and may push it forward, while fluid collecting around the testicle itself, called a hydrocele, surrounds it instead.22Metrovan Urology. Hydroceles, Spermatoceles & Epididymal Cysts An exam alone cannot rule out cancer, though.23Roswell Park Comprehensive Cancer Center. Testicular cyst versus cancer?
A scrotal ultrasound is the standard follow-up and helps guide treatment.24PubMed Central. Cystic lesions and scrotal fluid collections in adults: Ultrasound findings A cyst shows up as a clear, dark, smooth-edged sac.25ECR. Sonographic findings of epididymal masses Ultrasound can’t tell a cyst from a spermatocele, which rarely matters.26ECR. Sonographic findings of epididymal masses Large cysts with inner walls can look like a hydrocele.27ECR. Sonographic findings of epididymal masses Ultrasound also shows whether the lump lies outside the testicle, which makes cancer much less likely.
The visit itself is simple. Expect a brief, private exam, lying or standing. The ultrasound is painless, uses gel, takes about 15 to 20 minutes, and involves no radiation. Results are often explained the same day.
Most Cysts Need No Treatment
Monitoring without treatment is the usual first option for cysts causing few or no symptoms.28Ramsay Health Care. Epididymal Cyst Removal | Urology It can involve periodic exams and an occasional ultrasound to track size.29lkyurology.com. Epididymal Cyst Treatment Singapore | Expert Urology Care That works because many cysts stay stable for years.30lkyurology.com. Epididymal Cyst Treatment Singapore | Expert Urology Care In children followed over time, cysts didn’t grow, and about 1 in 8 disappeared completely.31PubMed Central. Epididymal cysts in children: frequency, clinical characteristics, and management strategies Feel the area occasionally and note whether it seems larger or tender, and report growth or new pain at check-ups.
A growing cyst isn’t a sign it has become dangerous, but it may eventually get big enough to bother you. Doing nothing now doesn’t close off treatment later, since drainage or surgery remains available.
Treatment is about comfort, not safety. Persistent pain or a size that bothers you are the usual reasons to act. Children whose pain continues, or whose cysts don’t shrink, may need surgery.
Snug supportive underwear or an athletic supporter can ease a dragging ache.32Ramsay Health Care. Epididymal Cyst Removal | Urology Over-the-counter pain relievers such as acetaminophen or ibuprofen can help.33Mayo Clinic. Spermatocele – Diagnosis and treatment Avoiding activities that trigger discomfort may help too.34Ramsay Health Care. Epididymal Cyst Removal | Urology These steps don’t shrink the cyst.35Ramsay Health Care. Epididymal Cyst Removal | Urology
If you use ibuprofen, take short courses at label doses and take it with food. Ask a doctor first if you have stomach, kidney, or heart problems.
Draining and Sealing the Cyst
One option, called sclerotherapy, drains the fluid with a needle, then injects a liquid that makes the cyst walls stick together. With alcohol, about 3 in 4 cysts resolved after one session and about 85% after up to two.36PubMed. Aspiration and sclerotherapy of hydroceles and spermatoceles/epididymal cysts with 100% alcohol Over several years of follow-up, about 94% succeeded with repeat treatments.37PubMed. Long-term experience with sclerotherapy for treatment of epididymal cyst and hydrocele Results do vary, though. One spermatocele series cured fewer than a third outright.38PubMed. Percutaneous aspiration and sclerotherapy for treatment of spermatoceles Complications are usually mild.39PubMed. Aspiration and sclerotherapy of hydroceles and spermatoceles/epididymal cysts with 100% alcohol
Draining alone leaves the lining that makes the fluid, so the sac usually refills over weeks or months. The injected liquid irritates the lining so the walls stick together and leave no space to refill.
The procedure is done under local anesthetic in a clinic. It takes minutes, and you go home the same day. Some soreness for a few days is common, and the cyst may refill and need a second session.
It suits a man whose cyst causes bothersome symptoms and who doesn’t plan to have children. The sealing liquid may scar nearby tubes, so men who want children should discuss surgery instead. A single, well-defined cyst is easier to treat than many small ones, and the doctor usually confirms with ultrasound that the lump is a simple fluid sac before suggesting it.
Surgery to Remove the Cyst
Pain is the most common reason for surgery.40PubMed. Microsurgical spermatocelectomy: technique and outcomes of a novel surgical approach Microsurgery under magnification can remove the cyst while lowering the risk of damaging the epididymis or reducing sperm count.41PubMed. Microsurgical spermatocelectomy: technique and outcomes of a novel surgical approach Men hoping for children should ask about this approach.42PubMed. Microscopic single-tubule technique for spermatocelectomy in cases of spermatocele: a rarely used surgical method and ıts outcomes
The surgeon makes a small cut in the scrotum, separates the cyst from the surrounding tissue, and removes it. The cut is usually closed with dissolving stitches, so nothing needs to be removed later. The operation is short and typically done as a day procedure, usually under general anesthesia. Afterward, wear supportive underwear and use ice packs early. Avoid heavy lifting and sport for about two weeks. Call your surgeon for fever, growing swelling, or worsening pain.
Almost everyone has scrotal swelling and bruising for several days.43British Association of Urological Surgeons. Removal of an Epididymal Cyst Recurrence, a blood collection, or infection each occur in between 1 in 10 and 1 in 50 men.44British Association of Urological Surgeons. Removal of an Epididymal Cyst Chronic pain, reduced fertility, or testicle shrinkage each occur in between 1 in 50 and 1 in 250.45British Association of Urological Surgeons. Removal of an Epididymal Cyst In one hospital series of benign scrotal operations, about 1 in 4 had some complication.46PubMed. Complications and risk factors in elective benign scrotal surgery The long-term outlook for most is good.47PubMed Central. Case Report: Adolescent epididymal cysts: three management approaches including a rare synchronous epididymal cyst and testicular torsion Since the risks are real, surgery suits only a cyst that truly bothers you.
Will an Epididymal Cyst Affect Fertility
Cysts were just as common in fertile as in infertile men.48PubMed Central. Epididymal Cysts: Are They Associated With Infertility? Men with cysts had normal sperm counts, movement, shape, and hormone levels.49PubMed. Epididymal Cyst Lesions Are Not Associated With Impaired Semen Parameters Among Men Presenting for Fertility Evaluation Size, and whether cysts were on one or both sides, made no difference.50PubMed. Epididymal Cyst Lesions Are Not Associated With Impaired Semen Parameters Among Men Presenting for Fertility Evaluation So a cyst found during a fertility check usually isn’t the cause of trouble.
Most cysts are small and affect only a tiny part of the tube, leaving the rest open. Because the other side usually works normally, one cyst rarely changes the overall flow of sperm.
If a couple has been trying to conceive without success, a semen analysis is the usual first test. It measures sperm count, movement, and shape, which tells more than the lump itself. A normal result suggests the cyst is not a factor, and an abnormal one points to looking for other causes.
Treatment is the bigger consideration. Mention plans for children before any procedure, and ask about microsurgery or sperm banking if you’re concerned. A semen test before and after surgery can show whether anything changed.