Lumps in the scrotum

Most lumps found in the scrotum aren’t cancer. Cysts on the scrotum filled with fluid are very common, especially as you get older. Varicose veins within the testicles are also common.

It’s a good idea to get any lumps on the scrotum checked by a doctor to make sure they’re not cancer.

Male anatomy_Diagram
Hydroceles

What is a hydrocele?

A hydrocele is a swelling in the scrotum caused by a buildup of fluid around the testicles.

Hydroceles are usually painless, but they gradually increase in size and can become very large.

If you’re older, this is the most common cause of swelling around the testicles, although it can happen at any age and sometimes follows injury or inflammation.

If you’re younger, it’s possible that hydroceles are a sign of underlying testicular cancer, although it’s not very likely. An ultrasound scan can check for cancer in the testicles.

If you’re young, a hydrocele might happen when the link between the abdomen and the scrotum doesn’t close properly before birth or during  early development.

Hydroceles are not dangerous in themselves and the usual reason for treatment is because the size of the swelling becomes an inconvenience or because of an aching discomfort.

 

What treatments are there for hydroceles?

Hydrocele treatment involves a minor operation. It’s possible to drain the fluid with a syringe, but the fluid nearly always returns. Surgery has a better outcome than draining a hydrocele, because there’s a lower risk of the hydrocele coming back.

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.

Varicoceles first appear at puberty and can sometimes cause discomfort.

 

What treatments are there for varicoceles?

A varicocele can be treated by making a small incision in the groin to tie up the vein. Another option is to tie the vein inside the abdomen using keyhole surgery.

A more common option is to plug the source vein by threading a very small tube through it, then creating a block with a small plug or special glue.

Epididymal cyst

What is an epididymal cyst?

Epididymal cysts are very common and can happen at any age. They’re fluid-filled cysts (a tissue sac that can contain clear liquid or pus) that grow from the epididymis (a thin, coiled tube) of the testicle.

Usually, they look like a pea-sized lump at the top of the testicle, but they can become larger.

An experienced doctor can usually diagnose an epididymal cyst with a genital examination. If there is any doubt, the best test is an ultrasound scan.

Epididymal cysts aren’t dangerous, and they don’t mean you have a higher chance of cancer or any other problem. If they grow larger, they can cause bother or discomfort.

 

What treatments are there for epididymal cysts?

You can have a small operation to remove the cyst through an incision in the scrotum. The operation to remove an epididymal cyst can cause scar tissue to form, stopping the flow of sperm. This means that removing  an epididymal cyst can affect fertility, so if you still want to have children your doctor might advise you not to have this particular operation.

Epididymal cysts can be drained with a syringe under local anaesthetic. This isn’t usually recommended, because the cysts can return, and you have a risk of infection each time they’re drained.

Epididymitis

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 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?

Usually, epididymitis is treated with antibiotics, which sometimes need to be taken for up to six weeks.

Operations that remove the painful part of the epididymis don’t always work, and the pain can return. Removal of part of the epididymis will also stop sperm transporting from that testicle, making it difficult for you to have children.

Orchitis

What is orchitis?

Orchitis is an inflammation of the testicles.

The most common cause of orchitis is the mumps virus but it can be caused by other viruses and bacteria. Mumps can damage your ability to produce sperm, especially if you get it after the age of eight.

 

What treatments are there for orchitis?

The main treatment is rest and pain medicine. Antibiotics can be prescribed if the infection is caused by bacteria, such as E. coli. Antiviral treatment can be helpful for some people.

Testicular torsion

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 testicleis 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 testicleis 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.

Your doctor’s appointment

Things to think about before your appointment

  • When did you notice any swelling or lumps on your scrotum?

  • Are you experiencing any discomfort/pain in the scrotum or testicles?

  • If you have a lump, is it changing in size?

  • Did you have undescended testicles as an infant?

Email these questions to yourself to take into your doctor's appointment.