Lumps can develop in the scrotum, the loose sac or pouch of skin that encases the testicles. The scrotum's function is to keep a man's testes at a temperature slightly lower than the rest of the body, thus preserving his sperm count.
When a lump or mass appears in the scrotum, due to either a malignant or benign condition, a man can experience a number of symptoms that range from mild to severe. Pain and fever are the most common symptoms associated with lumps in the scrotum, with high fever having the potential to cause temporary sterility if not managed. A urologist can help diagnose the cause of lumps in the scrotum and determine treatment.
Conditions Associated with Lumps in Scrotum
Hematocele: Injuries to the testicles, such as car accidents or being hit in the groin, can cause blood to collect under the layer of protective membrane that covers the testicle. Often, the pool of blood develops into a hard mass that appears as a lump. Should the bulge grow in size, a man may experience discomfort and pain, along with these other symptoms:
- Discoloration or bruising of the testicle
- Blood in the urine
- Difficulty urinating
Hydrocele: Watery fluid can collect around one or both of the testicles, leading to swelling of the scrotum. The cause of most hydroceles is not known, but they can result from injury or surgery, as well as infection or inflammation of the testicles or epididymis (the tube behind each testicle where sperm mature). Men with this condition may experience:
- Redness of the scrotum
- Pain in the testicles and/or scrotum
- Pressure at the base of the penis
- A feeling of heaviness in the scrotal area
- Inconsistent swelling of one or both testicles (may be smaller in the day and larger at night)
Spermatocele: If the epididymis becomes blocked due to trauma or inflammation, a fluid-filled cyst can form within it. The fluid is often milky or clear and may contain sperm. Typically, a spermatocele causes no other signs or symptoms unless it has grown. If it does, the following symptoms may occur:
- Discomfort or pain in the affected testicle
- Pressure at the base of the penis
- Redness of the scrotum
- A feeling of heaviness in the affected testicle
- Swelling above and behind the testicle
Varicocele: This condition occurs when the veins within the scrotum swell. While the cause is unknown, experts believe varicoceles develop when the valves inside the veins prevent blood from properly flowing, thus causing a buildup that leads to dilation of the veins. Associated symptoms include:
- Pain and discomfort in the scrotum, from dull to sharp
- Low sperm production
- Decreased sperm quality
- Shrinkage of the testicles
- The varicocele disappears when lying down
Inguinal hernia: When tissue pushes through a weak spot in the groin muscle, it can pass into the scrotum and cause a lump. This condition may be brought on by increased pressure in the abdomen, straining during urination or bowel movements, heavy lifting, pregnancy, chronic coughing or sneezing, or excessive body weight. Related symptoms include:
- The appearance of a bulge after heavy lifting, straining, or coughing
- Tugging or burning sensation around the hernia
- Sudden pain, vomiting, or nausea
- Discomfort or pain in the groin
- A heavy feeling in the groin
- Pressure or weakness in the groin
- Swelling and pain around the testicles
Epididymitis, orchitis, and epididymo-orchitis: These conditions refer to inflammation of the epididymis, testicles, or both. All are commonly caused by a bacterial or viral infection that may or may not be sexually transmitted. Associated symptoms include:
- Tenderness and swelling of the epididymis, testicles, scrotum, or groin area
- Hematospermia (blood in the semen)
- Discharge from the penis
- Fever or chills
- Pain in the groin
- Pain during intercourse or ejaculation
- Pain during urination
- Heavy feeling the testicle
- Increased pain in the testicle after a bowel movement or straining
Testicular torsion: The testicle is suspended in the scrotum by the spermatic cord. If the testicle rotates, the cord may twist and cut off blood supply to the reproductive organ. Such a condition requires immediate medical attention to save the testicle. If untreated, the tissue within the testicle may die off, leading to its removal. The most common symptom is sudden and severe testicular or scrotal pain, but others include:
- Tenderness of the testis
- Discoloration and swelling of the testis or scrotum
- Nausea and vomiting
- Pain that radiates to the groin and/or flank
- A testicle is either at an unusual angle or is positioned higher than normal
Testicular tumor: Testicular cancer occurs when cells in the testicles grow out of control and cause a solid lump to form in one or both of the testes. Associated symptoms include:
- A lump in one of the testicles
- A feeling of heaviness in the scrotum
- Dull pain in the abdomen or groin
- A collection of fluid in the scrotum
- Pain in a testicle or the scrotum
- Tenderness or swelling of the breasts
- Testicular swelling with an associated hydrocele (a fluid-filled sac that surrounds a testicle and leads to swelling of the scrotum)
- A tender testis
- Redness of the scrotal skin
Diagnosing the Lumps in Scrotum
Because lumps in the scrotum can be caused by a variety of underlying conditions, the physician will ask about the patient's medical history and perform a physical exam to access the lump or swelling, or to look for signs of injury or discharge from the penis (which might indicate a sexually-transmitted infection).
Based upon this exam, the doctor may then request other tests, such as:
- Transillumination, in which a light is shone behind the testicles to look for solid masses.
- Blood tests to check for signs of an infection or chemicals that indicate a tumor (cancer) is present in the body.
- Urine tests to look for signs of infection (urinary tract infection).
- Bacterial culture of discharge from the penis to see if a sexually-transmitted infection is present.
- Imaging tests like ultrasound or MRI create images of the scrotum and testicle that can be used to identify injuries, twisting of the testicle, or unusual masses in the scrotum.
- Exploratory surgery calls for an incision to the scrotum and the use of retractors to move the skin back so that the connecting muscles, fat, and testicle within it can be viewed.