Discovering a lump on a testicle often causes concern. While many testicular lumps are benign (non-cancerous), some can indicate serious issues, including medical emergencies or cancer. Therefore, a professional medical evaluation is always recommended to identify the cause and ensure appropriate care.
Common Non-Cancerous Testicular Lumps
Epididymal cysts, also known as spermatoceles, are painless, fluid-filled masses that develop in the epididymis, a coiled tube at the back of the testicle that stores and transports sperm. These cysts vary in size and may contain a whitish, cloudy fluid, sometimes containing sperm cells. They are often detected during self-examination or a physical, feeling like a soft lump separate from the testicle. Most do not require treatment unless they cause discomfort or grow significantly; surgical removal (spermatocelectomy) may then be considered.
Varicoceles are enlarged veins within the scrotum, similar to varicose veins in the legs. These typically form during puberty and are more common on the left side due to anatomical differences. They often cause mild symptoms or none, though some experience a dull ache, heaviness, or swelling that might lessen when lying down. Diagnosis involves a physical examination, often while standing and performing the Valsalva maneuver, and an ultrasound can confirm enlarged veins. Treatment is generally not needed unless there is persistent pain or infertility concerns. Options include pain relief or surgical repair.
Hydroceles are benign lumps caused by fluid accumulation in a sac around the testicle. While common in infants and often resolving on their own within the first year, hydroceles can also occur in older individuals due to injury or infection. The main symptom is swelling, which may fluctuate in size and sometimes cause heaviness or mild discomfort. Diagnosis involves a physical exam, where a doctor might shine a light through the scrotum to observe clear fluid. An ultrasound is sometimes used for confirmation or to rule out other conditions. If a hydrocele is bothersome, becomes large, or persists, surgical drainage or removal of the sac may be recommended.
Epididymitis, inflammation of the epididymis, can cause a testicular lump with pain and swelling. This condition often results from bacterial infections, including sexually transmitted infections (STIs) like gonorrhea or chlamydia, or urinary tract infections. Symptoms include pain and tenderness in the testicle, which can spread to the groin, along with scrotal redness, warmth, and sometimes fever or chills. Diagnosis involves a physical examination, urine tests, and sometimes STI screening or an ultrasound to assess blood flow and rule out other causes. Treatment for bacterial epididymitis involves antibiotics, often for one to two weeks, along with rest, scrotal support, and pain relievers to manage discomfort.
An inguinal hernia can manifest as a lump in the scrotum or groin. This occurs when a portion of the intestine or other abdominal tissue protrudes through a weak spot in the abdominal muscles, often into the inguinal canal. Symptoms include a visible bulge that becomes more noticeable when standing or coughing, pain, discomfort, and a feeling of pressure or heaviness.
In men, large hernias can extend into the scrotum, causing swelling and pain around the testicles. Diagnosis is made through a physical examination, where the doctor checks for a bulge while the patient coughs or strains. While small, asymptomatic hernias might be monitored, larger or painful ones require surgical repair to push the tissue back into the abdomen and reinforce the weakened muscle wall.
Understanding Testicular Cancer
Testicular cancer, though relatively uncommon, is a serious condition often presenting as a painless lump in the testicle. It is the most frequently diagnosed cancer in males between the ages of 15 and 35. Other signs include swelling, a feeling of heaviness in the scrotum, or a dull ache in the groin or lower abdomen. Early detection significantly improves the prognosis, with cure rates approaching 100% when the cancer is confined to the testicle.
Risk factors for testicular cancer include a history of an undescended testicle (cryptorchidism), a personal or family history of the disease, and certain ethnic backgrounds, with younger white men having a somewhat higher risk. When a lump is suspected, diagnosis involves a physical examination to assess for abnormalities. An ultrasound visualizes the testicles to determine if a lump is solid (suggesting cancer) or a benign fluid-filled cyst.
Blood tests also check for specific tumor markers like alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-HCG), and lactate dehydrogenase (LDH), which can be elevated with testicular cancer. If cancer is strongly suspected, the affected testicle is surgically removed via an orchiectomy, serving as both a diagnostic and therapeutic step. Unlike many other cancers, a scrotal biopsy is avoided to prevent potential spread of cancer cells. Treatment often involves surgery, and depending on type and stage, may include chemotherapy or radiation therapy.
Recognizing Testicular Torsion
Testicular torsion is an acute medical emergency where the spermatic cord twists, cutting off blood supply to the testicle. This can lead to irreversible damage if not treated promptly. The condition occurs most frequently in neonates and males between 12 and 18 years of age, though it can affect individuals at any age.
The hallmark symptom is sudden, severe pain in one testicle. This pain can be accompanied by scrotal swelling, redness or darkening of the skin, nausea, and vomiting. The affected testicle may also appear higher in the scrotum than the other.
A physical examination often reveals an absent cremasteric reflex, where lightly touching the inner thigh does not cause the testicle to contract. Given its time-sensitive nature, diagnosis is often clinical, based on symptoms and physical findings. Immediate surgical exploration is typically recommended without delay for imaging studies.
Surgical intervention (orchiopexy) involves untwisting the testicle to restore blood flow and stitching it to the inner scrotal wall to prevent future occurrences. The chance of saving the testicle significantly decreases after six hours of blood flow deprivation, underscoring the urgency of medical attention.
When to Seek Medical Care and What to Expect
Any new lump, swelling, or change in the testicles warrants prompt medical evaluation. Consult a healthcare provider, such as a general practitioner or a urologist, as soon as you notice any testicular abnormalities. Early assessment is important for an accurate diagnosis and timely intervention, regardless of whether the cause is benign or more serious.
During your appointment, the healthcare provider will begin with a physical examination of your scrotum, testicles, and groin. This helps assess the lump’s size, location, characteristics, and any associated tenderness or swelling. Depending on physical exam findings, additional diagnostic tests may be ordered.
A scrotal ultrasound is a common imaging test that uses sound waves to create detailed images, helping differentiate between fluid-filled cysts and solid masses. Blood tests may also be performed to check for specific markers or signs of infection. Based on these evaluations, your healthcare provider will discuss the diagnosis and recommend the most appropriate course of action, ranging from observation and medication to surgical intervention.