Most lumps of the scrotum are not cancerous. However, testicular cancer is the most common cancer of young men. It's always best to have any scrotal lumps evaluated by your doctor for peace of mind, or treatment, if required.
Painless Scrotal Lumps
Epididymal cysts
Epididymal cysts are very common and can be found at any age. They are fluid-filled cysts that
grow from the epididymis and usually observed as a pea-sized lump at the top of the testicle, but
are also known to grow larger.
Epididymal cysts are not dangerous, and can usually be left alone.
If epididymal cysts grow larger and bothersome, they can be removed with a minor surgery. The
operation to remove epididymal cysts can cause scarring, which may affect the flow of sperm,
affecting fertility. This is why this surgery should be avoided in men who have not completed their families.
Epididymal cysts can be drained with a needle and syringe, but this is not recommended as the cyst
will return, and there is the danger of infection.
Hydroceles
A hydrocele is a build-up of fluid in the scrotum. Most develop for no apparent reason, are
harmless and can be left alone. In a small number of cases, a hydrocele is due to an underlying
problem with a testicle. An ultrasound scan can be done to rule out an underlying cause such as
cancer in the testis.
If the hydrocele is causing discomfort, it can be cured with a minor surgery. Draining the
hydrocele with a needle and syringe is possible, but the fluid almost always comes back. The
outcome from surgery is far superior to needle drainage.
Varicoceles
What is a varicocele?
A varicocele is a swelling of the veins above your testicles, also known as varicose veins. It’s relatively common, and usually happens on the left side of the testicles. Learn more about varicocele in greater detail here.
Varicoceles first appear at puberty and can sometimes cause discomfort.
In men who are subfertile, a varicocele may be a contributory cause.
Painful Scrotal Lumps
Epididymo-orchitis (inflammation/infection of the epididymis/testis)
What is epididymitis?
Epididymitis is a painful swelling or inflammation of the epididymis (a thin, coiled tube
connected to the testicles).
Your epididymis runs most of the way around your testicle, so
you’ll often feel pain in your testicles. It can be difficult to tell if the pain and swelling is
coming from your epididymis, your testicle, or both.
Epididymitis can spread to the
testis, at which point it is called epididymo-orchitis (EO)
EO happens after you’ve had a
viral or bacterial infection. If you’re younger, the most likely cause is a sexually transmitted
infection, such as chlamydia. If you’re older, epididymitis is often because of the bacteria that
cause urinary tract infections, such as E. coli.
Sometimes this condition can develop
after a vasectomy or an injury to your epididymis. It can happen to cyclists because of an injury
from the saddle, but this is rare.
What treatments are there for epididymitis?
EO is treated with antibiotics and pain-killers. Cold compresses often help with the swelling.
What is testicular torsion (twisting)?
Testicular torsion happens when a testicle twists in the scrotum. This cuts off the blood supply,
and causes swelling. Unless the condition is treated quickly, the testis can die.
Testicular torsion is most common in teenagers or young adults. Sometimes it happens
because the testicle is not securely attached to the wall of the scrotum, making it more likely to
twist and block the blood supply.
Torsion can be triggered by physical and sexual
activity. Sudden, severe testicular pain should be checked at the nearest hospital straight away
(even if it is in the middle of the night). The first few hours are vital if the testicle is to be
saved.
What treatments are there for testicular torsion?
Testicular torsion is a medical emergency, and needs immediate surgery to relieve the pain and to
save the testis.
The longer the testicle is without a blood supply, the lower the chance
of being able to save it. During surgery the other testicle should also be fixed in position to
stop it twisting.