Scrotal masses

Overview

Scrotal masses are lumps or swelling in the scrotum, the bag of skin that holds the testicles.

Scrotal masses might be:

• A buildup of fluids.
• The growth of irregular tissue.
• Swollen, inflamed or hardened parts inside the scrotum.

It's key to get a scrotal mass checked by a health care professional, even if you don't have pain or other symptoms. Some masses could be cancer. Or they could be caused by another medical condition that affects the health of the testicles and how well they work.

Each month, check your scrotum for any changes. Also get the area checked during regular health checkups. This can help you spot masses early, when many treatments work better.

Symptoms

Male reproductive system Enlarge image

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Male reproductive system

Male reproductive system

The male reproductive system makes, stores and moves sperm. Testicles produce sperm. Fluid from the seminal vesicles and prostate gland mixes with sperm to make semen. The penis ejaculates semen during sexual activity.

Symptoms of scrotal masses vary. Some cause pain and others don't. It depends on the cause. Symptoms of a scrotal mass might include:

• An unusual lump.
• Sudden pain.
• Dull aching or a feeling of heaviness in the scrotum.
• Pain that spreads all over the groin, stomach area or lower back.
• A tender, swollen or hardened testicle or epididymis (ep-ih-DID-uh-miss). The epididymis is the soft, comma-shaped tube above and behind the testicle that stores and transports sperm.
• Swelling in the scrotum.
• A change in color of the skin of the scrotum.
• Upset stomach or vomiting.

If an infection causes a scrotal mass, symptoms also might include:

• Fever.
• Needing to pee often.
• Pus or blood in the urine.

When to see a doctor

Get emergency medical care if you have sudden pain in your scrotum. Some problems need to be treated right away to help prevent permanent damage to a testicle.

See a health care professional if you notice a lump in your scrotum or other unusual changes. Get a checkup even if you have a mass that isn't painful or tender.

Some scrotal masses are more common in children. See your child's pediatrician or other health care professional if:

• Your child has symptoms of a scrotal mass.
• You have any concerns about your child's genitals.
• A testicle is "missing." Sometimes, a testicle doesn't move down from the stomach area into the scrotum before birth. This is called an undescended testicle. It might raise the risk of some scrotal masses later in life.

Causes

Spermatocele Enlarge image

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Spermatocele

Spermatocele

A spermatocele is a typically painless, noncancerous (benign), fluid-filled sac that grows near the top of a testicle.

Hydrocele Enlarge image

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Hydrocele

Hydrocele

Hydrocele is the type of scrotal swelling that occurs when fluid collects in the thin sheath that surrounds the testicle.

Varicocele Enlarge image

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Varicocele

Varicocele

A varicocele is enlargement of the veins that transport oxygen-depleted blood away from the testicle.

Inguinal hernia Enlarge image

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Inguinal hernia

Inguinal hernia

Inguinal hernias occur when part of the membrane lining the abdominal cavity (omentum) or intestine protrudes through a weak spot in the abdomen — often along the inguinal canal, which carries the spermatic cord in men.

Many health conditions can cause a scrotal mass or an unusual change in the scrotum. These include:

• Testicular cancer. This is cancer that starts in the testicles. It often causes a painless lump or swelling in the scrotum. But some people with testicular cancer don't have any symptoms. See your doctor or other health care professional if you notice a new lump in your scrotum.
• Spermatocele. This fluid-filled sac in the scrotum is often above the testicle. It tends to be painless. And usually, it's not cancer. A spermatocele also is known as a spermatic cyst or epididymal cyst.

• Epididymitis. This is when the coiled tube at the back of the testicle, called the epididymis, becomes inflamed.

  Often, epididymitis is caused by an infection with bacteria. For instance, bacterial infections that spread through sex, such as chlamydia, can cause it. Less often, a virus can lead to epididymitis.

• Orchitis. This is when inflammation, which can include pain and swelling, affects the testicle. Usually, it's due to an illness caused by a virus, most often mumps.

• Hydrocele. This is when extra fluid collects between the layers of a sac that surrounds each testicle. Most often, there's a small amount of fluid in this space. But the excess fluid of a hydrocele can lead to a painless swelling of the scrotum.

  In adults, a hydrocele can happen because of an imbalance in the amounts of fluid made or absorbed. Often, this is due to an injury or infection in the scrotum.

  In babies, a hydrocele tends to happen because an opening between the stomach area and the scrotum hasn't properly closed during development.

• Hematocele. This is a buildup of blood between the layers of a sac that surrounds each testicle. An injury, such as a direct hit to the testicles, is the most likely cause.
• Varicocele. This happens when the veins inside the scrotum get bigger. Varicocele is more common on the left side of the scrotum due to differences in how blood flows from each side. A varicocele might cause infertility, which is when you can't get your partner pregnant after a year of unprotected sex.

• Inguinal hernia. This is when part of the small intestine pushes through an opening or weak spot in the tissue that separates the stomach area and groin. It might appear as a mass in the scrotum or higher in the groin.

  In infants, an inguinal hernia often happens before birth when the passageway from the stomach area to the scrotum doesn't close.

• Testicular torsion. This is a painful problem that cuts off blood to the testicle. It happens due to a twisting of the spermatic cord. That's a bundle of blood vessels, nerves and the tube that carries semen from the testicle to the penis. Without prompt treatment, testicular torsion can lead to the loss of the testicle.

Risk factors

Things that can raise the risk of a scrotal mass include:

• Undescended testicle. An undescended testicle doesn't leave the stomach area and move down into the scrotum before birth or in the months afterward.
• Conditions present at birth. Some people are born with irregular changes in the testicles, penis or kidneys. These might raise the risk of a scrotal mass and testicular cancer later in life.
• History of testicular cancer. If you've had cancer in one testicle, your risk of getting cancer in the other testicle is higher. Having a parent or a sibling who's had testicular cancer also raises your risk.

Complications

Not all scrotal masses lead to long-term medical conditions. But any mass that affects the health or function of the testicle can result in:

• Delayed or poor development during puberty.
• Infertility.