What is a testicular lump?

Lumps are a common finding in the testicle or scrotal area that can be caused by swelling, fluid buildup, cysts, infection or inflammation. Most of the time, these lumps are not testicular cancer. However, they need to be assessed to exclude this rare cause.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Scrotal

The pouch of skin that contains the testicles; relating to the scrotum.

Testicle

The male reproductive organs that produce sperm and the hormone testosterone.

Causes

A testicular lump or lumps can be caused by a number of conditions related to the testicles and scrotum. These include:

Epididymo-orchitis

Epididymitis involves swelling of the epididymis, the duct leaving the testis. Orchitis is inflammation or swelling of the testicles. When both of these occur together the condition is known as epididymo-orchitis. This condition was commonly caused by the mumps virus when vaccination against mumps was less common. Today, it is more commonly caused by other viruses or bacteria, such as sexually-transmitted infections (STIs) including gonorrhoea and chlamydia. The symptoms of epididymo-orchitis are usually testicular pain and swelling (more commonly just on one side) and fever. Some men also experience symptoms of a urinary tract infection including painful and frequent urination, an urgent feeling of having to urinate and sometimes blood in the urine.

Torsion of the testis

Torsion, or twisting of the testis in the scrotum, can cause the blood supply to be cut off, leading to swelling of the testis. This is a serious condition and can be identified by a sudden pain in the testicle. It is usually only on one side and can also be associated with abdominal pain and nausea or vomiting. The skin overlying the testicle may become reddened and is usually very tender. It is important to have the testicle untwisted, which usually involves undergoing surgery. If the testicle is not untwisted, usually within 4-6 hours, it can die and will have to be removed.

Hydrocoele

A hydrocoele is a fluid buildup around the testes in the scrotum. These are usually painless at first, but can become large over time and lead to a dull ache. They can occur at any age, but are common among older men and can be caused by injury or inflammation.

Varicocoele

A varicocoele is the formation of varicose veins in the scrotum. This occurs when the veins around the testis become swollen and expanded. They are usually painless, although occasionally they can produce a heavy feeling in the scrotum. This can occur during puberty, usually on the left side and commonly affects three out of every 20 men. It can be associated with lowered fertility.

Epididymal cyst

A cyst is a fluid-filled sac. Epididymal cysts form in the epididymis, are about the size of a pea and can be felt by an experienced doctor. They are not dangerous, but in some cases the cysts can become larger and cause pain or discomfort.

Testicular cancer

Testicular cancer can show up as a firm mass (tumour) growing within the testicle. Usually there are no other symptoms, but in a minority of men there can be pain and swelling of the testicle.

Causes of a testicular lump.Different causes of a testicular lump. 

Infections

Entry into the body of microorganisms that can reproduce and cause disease.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Scrotum

The pouch of skin that contains the testicles; relating to the scrotum.

Testicles

The male reproductive organs that produce sperm and the hormone testosterone.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Sexually-transmitted infections

A viral or bacterial infection contracted through sexual intercourse or genital contact. Such an infection can lead to development of diseases such as chlamydia, gonorrhoea, genital herpes and AIDS.

Risk factors

Risk factors associated with some testicular lumps include:

  • Undescended testis at birth;
  • Unprotected sex leading to a sexually-transmitted infection, and;
  • Accidents (e.g., car, cycling or sport).

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Sexually-transmitted infection

A viral or bacterial infection contracted through sexual intercourse or genital contact. Such an infection can lead to development of diseases such as chlamydia, gonorrhoea, genital herpes and AIDS.

Methods for diagnosis

Your doctor will likely conduct a physical exam of the scrotum and testes to make a diagnosis. Other tests can include a blood cell count, urine analysis, STI tests and ultrasound.

Scrotum

The pouch of skin that contains the testicles; relating to the scrotum.

STI

A viral or bacterial infection contracted through sexual intercourse or genital contact. Such an infection can lead to development of diseases such as chlamydia, gonorrhoea, genital herpes and AIDS.

Types of treatment

Depending on the cause of the testicular lump, treatments can vary:

Epididymo-orchitis

Treatment for viral epididymo-orchitis is aimed at managing your symptoms using pain-relief medications, such as paracetamol and ibuprofen. Treatment involves antibiotics if the cause is gonorrhoea, chlamydia or another bacteria.

Torsion of the testis

Torsion, or twisting of the testis in the scrotum, is treated by surgery. There is a high risk of losing the testicle due to lack of blood flow if the problem is not rectified. This is best performed within six hours of the onset of pain.

Hydrocoele

A hydrocoele is a fluid buildup around the testes in the scrotum. This can be treated with a minor operation to remove the hydrocoele. Fluid can also be removed with a syringe, but is not always permanent and can lead to refilling.

Varicocoele

A varicocoele is the formation of varicose veins in the scrotum. If there is no discomfort, no treatment is necessary. Surgery can be performed if there is discomfort, or if it is associated with reduced fertility.

Epididymal cyst

Generally surgery is not required for pea-sized cysts, but is possible if the cyst becomes larger and uncomfortable.

Antibiotics

Chemical substances that kill or suppress the growth of bacteria.

Scrotum

The pouch of skin that contains the testicles; relating to the scrotum.

Testicle

The male reproductive organs that produce sperm and the hormone testosterone.

Prognosis

The presence of a testicular lump can be daunting. It is important to remember that most testicular lumps are not serious. In some cases, no treatment is required for the lump; it is something that you just live with. In other cases, antibiotics or minor surgery may be required.

Antibiotics

Chemical substances that kill or suppress the growth of bacteria.

Prevention

To help prevent testicular lumps caused by STIs, it is important to practise safe sex by wearing a condom with new sexual partners.

Testicular cancer cannot be prevented. Also, there are no routine screening tests for testicular cancer. Regular self-examination of the testes and getting acquainted with the way they normally feel may help you to detect any changes. However, self-examination has not conclusively been proven to detect cancers early or improve outcomes. If any abnormalities are detected, it is best to promptly see your doctor. 

STIs

A viral or bacterial infection contracted through sexual intercourse or genital contact. Such an infection can lead to development of diseases such as chlamydia, gonorrhoea, genital herpes and AIDS.