Finding a bump or swelling in the scrotum can cause immediate concern, which is understandable given the location and the sensitive nature of the body part. While any lump warrants professional attention, the cause is often a common, non-life-threatening condition. The scrotum houses the testicles and a network of blood vessels and tubes, making it susceptible to various changes, from fluid build-up to inflammation. This article explores the different reasons a mass might appear, but it is not a substitute for a medical diagnosis from a healthcare provider.
Common Benign Scrotal Masses
Many scrotal masses are entirely benign, meaning they are not cancerous and pose no serious threat to overall health. One frequent cause is a hydrocele, which is an accumulation of fluid around the testicle within the tunica vaginalis. This condition typically presents as a painless swelling that may feel like a water balloon and can fluctuate in size throughout the day. Hydroceles are common in adults over 40 and often resolve without intervention, though a large one may require drainage or surgical removal if it causes significant discomfort.
Another common finding is a spermatocele, also known as an epididymal cyst, which is a fluid-filled sac that forms in the epididymis. The epididymis is the coiled tube located behind the testicle that stores and transports sperm. Spermatoceles are generally painless, slow-growing, and contain a milky fluid mixed with sperm cells.
A varicocele involves an enlargement of the veins inside the scrotum, similar to varicose veins found in the legs. These enlarged veins can sometimes be felt as a soft mass above the testicle, often described as feeling like a “bag of worms.” Varicoceles most often occur on the left side and may lead to a dull ache or heavy sensation that worsens over the course of the day. These conditions, along with minor skin issues like ingrown hairs, are the most likely reasons for a newly discovered bump.
Acute and Urgent Causes of Testicular Pain and Swelling
While many masses are slow-growing and painless, any bump accompanied by severe, sudden pain may signal a medical emergency requiring immediate attention. Testicular torsion is the most time-sensitive condition, occurring when the spermatic cord twists, cutting off the blood supply to the testicle. This event causes an abrupt onset of severe pain, often accompanied by swelling, nausea, and vomiting. The survival of the testicle depends on restoring blood flow quickly, ideally within a few hours of the pain starting. Immediate surgical intervention is necessary to untwist the cord and secure the testicle to prevent future twisting.
Infections are another source of acute swelling and pain, commonly presenting as epididymitis or orchitis. Epididymitis is inflammation of the epididymis, often caused by a bacterial infection, which may include sexually transmitted infections or urinary tract infections. This condition typically causes a gradual increase in pain, tenderness, and swelling, sometimes accompanied by a fever. Orchitis is inflammation of the testicle itself, which can occur alone or as a progression of epididymitis.
An inguinal hernia can also present as a bulge or mass that extends into the scrotum, sometimes causing pain, especially when straining or coughing. This condition occurs when fatty tissue or a part of the intestine pushes through a weak spot in the abdominal wall near the groin. While usually not immediately dangerous, a hernia can become trapped or “strangulated,” requiring urgent surgical repair.
Testicular Cancer: Symptoms and Screening
Testicular cancer often presents differently than the painful conditions of infection or torsion. The most common sign is the development of a firm, usually painless lump or a change in the size or texture of the testicle. Unlike fluid-filled masses, this mass is typically solid and originates within the testicle itself.
Other symptoms can include a feeling of heaviness in the scrotum, a dull ache in the lower abdomen or groin, or an enlargement or tenderness of the breast tissue. Testicular cancer is the most common cancer in young men, affecting those between the ages of 15 and 35 most often.
A history of having an undescended testicle, known as cryptorchidism, significantly increases the risk of developing testicular cancer. Other risk factors include a family history of the disease and having had cancer in the other testicle previously. While there is no formal routine screening test recommended, awareness through self-examination is important for early detection.
What To Do Next: Seeking Medical Evaluation
Regardless of whether a scrotal mass is painful or painless, seeking medical evaluation from a healthcare provider is a necessary next step. Immediate emergency medical attention is necessary if the lump is accompanied by sudden, severe pain, or if you experience a fever, nausea, or vomiting.
The diagnostic process typically begins with a thorough physical examination, where the provider can assess the mass’s location, size, and consistency. To gain a clearer view, an ultrasound is the most common imaging test ordered, which uses sound waves to create a detailed image of the scrotal contents. This technology can accurately differentiate between a fluid-filled cyst, a tangled group of veins, or a solid mass within the testicle, which helps guide the treatment plan.