Understanding scrotal masses: Lumps on testicles

December 2, 2021
Healthcaretoday, Dr Goh Eng Hong, Urologist, Prince Court Medical Centre, Testicular health, Scrotal masses, Men's health, Testicular lumps, Epididymitis, Hydrocele, Testicular cancer, Men's health matters, Testicle self examination, Infertility,
A lump on a testicle is a growth that can develop on or around the testicle (testis). While most testicular lumps are benign, some can affect fertility or indicate a serious condition such as testicular cancer.
By Dr Goh Eng Hong,
Consultant Urologist, 
Prince Court Medical Centre, Kuala Lumpur. 
​​Lumps or swelling on the testicles, medically referred to as scrotal masses, are common and usually benign. However, they can sometimes signal more serious conditions, including cancer. Understanding the nature of these lumps, their potential causes, and when to seek medical attention is crucial for men’s health.

What is a lump on the testicle?
A lump on a testicle is a growth that can develop on or around the testicle (testis). The testicles, which are walnut-shaped sex glands located in the scrotum behind the penis, are responsible for producing sperm and the hormone testosterone. While most testicular lumps are benign, some can affect fertility or indicate a serious condition such as testicular cancer.

Men may discover a lump during a self-exam or it may be noticed by a partner during sexual activity.

Where can a lump appear?
The location of a lump can vary depending on its cause. A scrotal mass can appear on any area of the testicle or in the surrounding region.

How common are testicular lumps?
Testicular lumps are relatively common. Most lumps found on or around the testicles are not cancerous. However, it is essential to consult a healthcare provider for an accurate diagnosis and appropriate treatment.

Possible causes of testicular lumps
The most common causes of testicular lumps include:
  • Epididymitis: Inflammation of the epididymis, a tube that stores and transports sperm.
  • Hydroceles: Fluid accumulation in the scrotum causing swelling.
  • Inguinal hernia: Abdominal tissue bulging through an opening in the abdominal wall, leading to a groin bulge.
  • Orchitis: Inflammation of one or both testicles due to bacterial or viral infection.
  • Spermatoceles: Cysts in the epididymis that may contain fluid or sperm.
  • Testicular cancer: The presence of cancer cells in the testicular tissue.
  • Varicoceles: Swollen veins within the scrotum.

Symptoms associated with testicular lumps
Symptoms can vary based on the underlying cause and size of the lump. Some lumps may cause few or no symptoms, while others can lead to:
  • Shrinking of the testicle (testicular atrophy)
  • Pain or dull ache in the testicles or scrotum
  • Swelling in the testicles or scrotum
  • A feeling of heaviness in the scrotum
  • Blood in semen (hematospermia)
  • Fever or chills
  • Pain during urination (dysuria)
  • Nausea and vomiting

Certain conditions that result in testicular lumps may also impact fertility.

Characteristics of testicular cysts and cancer
  • Testicular cysts: Typically feel like small, hard lumps.
  • Testicular cancer lumps: Generally feel hard to the touch.
  • Warning signs of testicular cancer

Key warning signs include:
  • A noticeable lump on the testicle
  • Swelling or enlargement of the testicle
  • Persistent pain in the testicle or scrotum
  • A feeling of heaviness in the scrotum

Diagnosis and treatment of testicular lumps
Diagnosis typically involves a thorough medical history review, physical examination, and possibly several tests, including:
  • Testicular ultrasound: A non-invasive imaging test to identify the lump's location and rule out conditions like hernias or cancer.
  • Blood tests: To check for infections or inflammation.
  • Urinalysis: Examining urine for signs of infection or other abnormalities.

Treatment depends on the cause of the lump:
  • Antibiotics for infections
  • Surgery for hernia repair or to remove a mass
  • Radiation or chemotherapy for testicular cancer
  • Orchiectomy (removal of one or both testicles) in severe cases

Complications of untreated scrotal masses
While most testicular lumps are harmless, untreated conditions like epididymitis and orchitis can lead to:
  • Abscess formation
  • Fluid buildup in the scrotum
  • Testicular shrinkage
  • Infertility
  • In the case of testicular cancer, untreated cancer can be fatal.

Prevention and self-examination
While some causes of testicular lumps cannot be prevented, regular self-exams (pix above) can help detect changes early. Perform a testicular self-exam monthly to check for lumps or abnormalities.

To reduce the risk of infections, consider:
  • Using condoms during sexual intercourse to prevent STIs.
  • Getting vaccinated against infections that can lead to scrotal masses.

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