Finding a lump in the scrotum often causes worry, but most scrotal masses are not cancerous. These lumps usually result from common, non-life-threatening conditions involving the fluid, veins, or tubes surrounding the testicle. Self-diagnosis is inadequate and should not replace a professional medical evaluation. Any new lump or change in the scrotum requires timely consultation with a healthcare provider to accurately determine the cause and ensure proper care.
Common Benign Causes of Scrotal Lumps
Spermatoceles (Epididymal Cysts)
A spermatocele is a fluid-filled sac that develops in the epididymis, the small, coiled tube located on the upper and back side of the testicle. This common, benign mass is often painless; nearly one in three people with testicles may develop one. The cyst is typically filled with clear or milky fluid that may contain sperm and can vary significantly in size. They may result from a blockage in one of the tubes that transport sperm from the testicle.
A spermatocele usually presents as a smooth, firm lump felt above or behind the testicle, separate from the testicle itself. Smaller cysts often cause no symptoms, but a larger spermatocele may lead to a feeling of heaviness or fullness. Treatment is generally unnecessary unless the cyst causes discomfort or pain.
Hydroceles
A hydrocele is a swelling caused by the accumulation of fluid in the thin sac surrounding the testicle. While common in newborns, it can also develop in older children and adults due to injury, inflammation, or infection. The fluid collection often makes the scrotum appear enlarged.
The primary symptom is typically a painless swelling of one or both testicles, though adults may experience a feeling of heaviness or minor discomfort. The size of some hydroceles can change throughout the day. Diagnosis often involves a physical exam and imaging to differentiate the fluid-filled sac from a solid mass.
Varicoceles
A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins in the legs. These swollen veins are part of the spermatic cord and can be felt as a mass, often described as feeling like a “bag of worms.” Varicoceles are common, usually occurring on the left side of the scrotum after puberty.
The enlargement is caused by poorly functioning valves inside the scrotal veins, allowing blood to pool and enlarge the vessels. Most varicoceles are asymptomatic. They can sometimes cause a dull ache or a heavy sensation, especially after exercise or prolonged standing. Discomfort is often relieved by lying down, which helps drain the blood.
Epididymitis and Orchitis
Epididymitis is the inflammation of the epididymis, and orchitis is the inflammation of the testicle; when both occur, it is called epididymo-orchitis. These conditions are typically caused by a bacterial infection, often a sexually transmitted infection in younger men or a urinary tract infection in older men. Symptoms usually develop quickly and include pain, swelling, and redness in the scrotum.
The pain intensifies and often spreads to the entire testicle and sometimes the groin. The scrotal skin may appear red, warm, and tender to the touch. Bacterial infections may also cause accompanying symptoms such as painful or frequent urination, or a discharge from the penis.
Urgent and Potentially Serious Conditions
Testicular Cancer
Testicular cancer is the most common solid tumor in males between the ages of 15 and 35. Early detection is important for a high cure rate. The primary sign is a painless lump or swelling found directly on the testicle, not separate from it. This mass is typically firm and fixed.
Other signs include a change in how the testicle feels, a feeling of heaviness in the scrotum, or a dull ache in the groin or lower abdomen. Unlike benign causes, a cancerous mass arises from the testicular tissue itself. If cancer is suspected, doctors may order blood tests for specific tumor markers, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG), to aid diagnosis.
Testicular Torsion
Testicular torsion is a medical emergency that occurs when the testicle rotates, twisting the spermatic cord and cutting off the blood supply. This leads to severe pain and potential damage if not treated quickly. Blood flow must be restored within four to six hours to save the testicle.
Symptoms include the sudden onset of severe scrotal pain, often accompanied by swelling, nausea, and vomiting. The affected testicle may also appear higher in the scrotum due to the twisting. Immediate medical attention is required for any sudden, intense scrotal pain, even if the pain temporarily subsides.
Inguinal Hernia
An inguinal hernia occurs when a portion of the intestine or fatty tissue pushes through a weak spot in the abdominal wall and descends into the groin. If large enough, it can extend into the scrotum, presenting as a lump or swelling. This lump may be more noticeable when straining or coughing and may disappear when lying down.
While often causing pressure or a bulge, an inguinal hernia becomes a surgical emergency if it becomes incarcerated (trapped tissue that cannot be pushed back). A strangulated hernia is more serious, occurring when the blood supply to the trapped tissue is cut off, causing severe pain, redness, fever, and a rapid heart rate.
Navigating Diagnosis and Medical Consultation
If a scrotal lump is discovered, seek medical consultation without delay, as conditions like testicular torsion require immediate intervention. Go to an emergency room immediately if you experience sudden, severe pain in the scrotum, especially if accompanied by nausea, vomiting, or fever. These symptoms suggest a possible testicular torsion or an acute infection requiring urgent care.
For lumps that are painless or developed slowly, schedule an appointment with a primary care physician or a urologist. The physician will perform a physical examination to assess the lump’s location, size, texture, and separation from the testicle. Describing when the lump first appeared and any associated changes will help the provider.
The most common diagnostic tool is a scrotal ultrasound, which uses sound waves to create detailed images of the internal structures. An ultrasound determines if a mass is solid (suggesting cancer) or fluid-filled (pointing toward a benign cause like a hydrocele or spermatocele). Blood tests may also be ordered to check for infection or measure tumor markers if cancer is suspected.