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.

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 gonorrhea 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.

Hydrocele

A hydrocele 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.

Varicocele

A varicocele 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 (tumor) 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.

Different causes of a testicular lump. 

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.

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 acetaminophen and ibuprofen. Treatment involves antibiotics if the cause is gonorrhea, 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.

Hydrocele

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

Varicocele

A varicocele 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.

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.

Prevention

To help prevent testicular lumps caused by STIs, it is important to practice 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.