A spermatocele is a common, fluid-filled mass found in the scrotum, often discovered during a self-examination or routine physical check-up. This benign condition frequently raises concerns about its potential to affect male reproductive capabilities. The primary question is whether a spermatocele can cause male infertility, which involves understanding the mechanics of sperm transport and the cyst’s anatomical location.
Defining Spermatocele
A spermatocele is a fluid-filled sac that develops within the epididymis, the small, coiled tube located on the upper and back side of the testicle. This cyst typically contains clear or milky fluid that may include sperm cells. Spermatoceles are generally painless and can vary greatly in size, sometimes growing large enough to cause a feeling of heaviness or fullness.
The epididymis collects and transports sperm from the testicle to the vas deferens. Experts believe spermatoceles form when one of the small tubes within the epididymis becomes blocked, causing fluid and sperm to accumulate in a localized sac. Because this growth is separate from the testicle itself, it does not increase the risk of testicular cancer. However, any scrotal mass warrants evaluation to rule out more serious conditions.
Direct Impact on Fertility
In the vast majority of cases, a spermatocele does not cause infertility or reduce a man’s reproductive function. Most spermatoceles remain small and do not interfere with sperm production or the overall process of sperm transport into the semen. The sperm generally bypasses the small cyst to travel through the rest of the epididymis and the vas deferens.
A rare exception occurs when the spermatocele grows to an unusually large size, potentially causing mechanical obstruction of the epididymis or the vas deferens. If the cyst is large enough to exert significant pressure, it could physically block the passage of sperm, resulting in a reduced sperm count or quality in the ejaculate. Even in these uncommon instances, the direct effect on fertility is less concerning than potential complications arising from treatment.
Diagnosis and Monitoring
Diagnosis typically begins with a physical examination of the scrotum. During this exam, the doctor feels for a distinct, smooth, and firm lump that is separate from the testicle itself. The mass is often found above or behind the testicle, which helps distinguish it from growths originating within the testicle.
To confirm the diagnosis and rule out a solid tumor, the provider may use transillumination. Shining a light through the scrotum illuminates the spermatocele because it is fluid-filled. If the diagnosis remains unclear, a scrotal ultrasound is the definitive test, using sound waves to create detailed images of the mass. If the spermatocele is small, painless, and not causing discomfort, the standard approach is watchful waiting, involving periodic monitoring rather than immediate intervention.
Treatment Options
Treatment is typically only considered for spermatoceles that cause persistent pain or grow to a size that interferes with daily life. For mild symptoms, initial management involves over-the-counter pain medications like ibuprofen or acetaminophen. There are currently no medications available that can eliminate or shrink the cyst itself.
The most common and definitive procedure for a symptomatic spermatocele is surgical removal, called a spermatocelectomy. This outpatient surgery involves making a small incision to separate the cyst from the epididymis while preserving the surrounding reproductive structures. Less common procedures include aspiration, which drains the fluid with a needle, and sclerotherapy, which injects a scarring agent to prevent recurrence. These less invasive methods carry a risk of damaging the epididymis, which could inadvertently lead to fertility problems.