Finding an unexpected lump or change in the testicles often causes significant anxiety. Testicular lumps can range from common, harmless fluid collections to more serious conditions requiring immediate attention. This article provides information on the various possible causes. However, this information is not a substitute for a professional medical diagnosis. Since the nature of any scrotal mass cannot be determined through self-examination alone, seeking an evaluation from a healthcare provider is mandatory for proper diagnosis and management.
Common Non-Cancerous Lumps
Many scrotal lumps are benign, fluid-filled structures rather than solid masses. One frequent cause is a spermatocele, also known as an epididymal cyst. This cyst forms in the epididymis, the coiled tube behind the testicle that stores sperm. Spermatoceles are typically painless, smooth, and feel like a separate, firm lump located just above or behind the testicle. They are filled with fluid, often containing dead sperm, and usually do not impact fertility.
A hydrocele is another common finding, involving an accumulation of clear fluid surrounding the testicle within the scrotum. Unlike a spermatocele, a hydrocele usually causes general, painless swelling and a feeling of heaviness rather than a distinct small ball. In adults, hydroceles can develop due to injury, infection, or inflammation. They are often diagnosed using transillumination, where light shone through the scrotum reveals a transparent, fluid-filled space, distinguishing it from a solid mass.
Inflammatory and Infectious Causes
A lump accompanied by pain, redness, or fever often indicates an inflammatory or infectious process. Epididymitis, an inflammation of the epididymis, is a frequent cause of scrotal discomfort. It is usually caused by a bacterial infection, such as sexually transmitted infections (STIs) in younger men or urinary tract infections (UTIs) in older men. The inflammation causes swelling that feels like a lump or hardened area, often accompanied by pain that may begin gradually or suddenly.
The infection can spread to the testicle itself, a condition called orchitis, or a combination known as epididymo-orchitis. Orchitis causes the testicle to swell significantly, becoming tender, warm, and red, and may include a fever. Viral causes, such as the mumps virus, can also trigger orchitis. These conditions are characterized by acute symptoms, distinguishing them from painless cysts and fluid collections.
Structural and Vascular Issues
Some scrotal masses relate to the vascular system or tissue protrusion from the abdominal cavity. A varicocele is an enlargement of the veins within the spermatic cord, similar to varicose veins. It is often described as feeling like a “bag of worms” above the testicle and is more common on the left side. Varicoceles are usually soft and become more prominent when standing or straining, often shrinking when lying down. They can cause a dull ache, heaviness, or discomfort, and may sometimes be associated with impaired fertility.
An inguinal hernia is another non-cystic cause, occurring when a segment of the intestine pushes through a weak point in the abdominal wall and descends into the scrotum. This protrusion appears as a lump in the groin or scrotum that may disappear when the person lies down or is gently pushed back. An inguinal hernia is often associated with a bulge in the groin area and can cause warmth or heaviness. Evaluation is necessary to prevent complications like tissue entrapment.
Identifying Urgent Symptoms and Next Steps
Two conditions require immediate attention due to potential serious complications: testicular torsion and testicular cancer.
Testicular Torsion
Testicular torsion is a time-sensitive medical emergency where the spermatic cord twists, cutting off blood supply to the testicle. The primary symptom is the sudden onset of severe, excruciating pain, often accompanied by scrotal swelling, nausea, and vomiting. If treatment is delayed beyond four to six hours, the testicle may suffer permanent damage. Immediate emergency room visitation is paramount.
Testicular Cancer
Testicular cancer is the most serious concern for a solid mass, though it is less common than other causes. The typical presentation is a painless, firm lump or swelling on the testicle itself, sometimes accompanied by a feeling of heaviness. Unlike fluid-filled cysts, a cancerous mass is a solid area within the testicle that does not transilluminate. Any new, hard, or painless lump warrants prompt scheduling of a non-emergency appointment for definitive testing. If the lump is accompanied by sudden, severe pain, swelling, or vomiting, seek immediate emergency medical care to rule out torsion.