A spermatocele is a common condition, often discovered incidentally during a physical exam or self-examination. These growths are generally benign, noncancerous cysts that form within the male reproductive system. The primary goal of this information is to address whether these cysts resolve naturally and to guide individuals on monitoring and management.
What is a Spermatocele?
A spermatocele, also known as a spermatic or epididymal cyst, is an abnormal sac filled with fluid that develops on the epididymis. The epididymis is a coiled tube located on the upper and back side of the testicle, responsible for storing and transporting sperm. The cyst itself is typically smooth, soft, and feels distinctly separate from the testicle.
The fluid contained within a spermatocele is usually clear or milky and may include sperm, which gives the cyst its name. While the exact cause is not always clear, the condition is thought to result from a blockage in one of the small tubules within the epididymis, causing fluid to accumulate. Spermatoceles are almost always benign and do not increase the risk of testicular cancer. They are distinct from other scrotal masses, such as hydroceles.
Natural Course and Likelihood of Resolution
The core question is whether a spermatocele will simply disappear over time. Spontaneous resolution of a spermatocele is considered rare, meaning that once the fluid-filled sac has formed, it typically persists. Spermatoceles are generally stable and may remain unchanged in size for many years.
In uncommon instances, the body may absorb the collected fluid, leading to a reduction in the size of a small spermatocele. However, relying on this natural reduction is not a standard expectation for management. Since most spermatoceles are small and cause no symptoms, they often require no intervention and are simply monitored.
Monitoring the Condition and When to See a Doctor
Because a spermatocele rarely resolves on its own, the standard approach for a small, asymptomatic cyst is often observation, sometimes called “watchful waiting.” This involves routine self-examinations and periodic checks by a healthcare provider. Performing a monthly testicular self-exam is recommended to become familiar with the normal feel of the scrotum and detect any changes promptly.
Any scrotal mass should always be evaluated by a doctor to rule out more serious conditions, such as testicular cancer. A physical examination is the first step. A doctor may use transillumination, shining a light through the scrotum, to determine if the mass is fluid-filled. An ultrasound is often ordered to confirm the diagnosis, which also confirms that the testicle itself is healthy.
Immediate medical attention is necessary if you experience an acute onset of symptoms, as this can indicate a different underlying issue. Signs requiring prompt evaluation include sudden, severe testicular pain, rapid increase in mass size, or accompanying signs of infection like fever or redness. For a spermatocele, symptoms that prompt a return to the doctor include persistent pain, discomfort, or a significant feeling of heaviness or fullness.
Surgical and Non-Surgical Management
Treatment for a spermatocele is generally reserved for cases where the cyst causes significant discomfort, pain, or has grown large enough to cause cosmetic concern. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can often manage mild discomfort. When symptoms become bothersome and pain medication is no longer effective, surgical removal is typically the recommended course of action.
The standard surgical procedure is a spermatocelectomy, usually performed on an outpatient basis using local or general anesthesia. The surgeon makes a small incision and carefully removes the cyst from the epididymis. A less common, non-surgical approach is aspiration, where a needle is used to drain the fluid. This may be followed by sclerotherapy, which involves injecting a chemical agent to cause scarring and prevent fluid re-accumulation. Both aspiration and sclerotherapy have a higher rate of recurrence compared to surgical excision and carry a risk of damage to the epididymis, which is a consideration for fertility.