What to do about Testicular Pain and Lumps?

Hydroceles

A hydrocele is a small cyst (collection of fluid) that can form on the testicle.  They occur in about 1% of men, and while always benign and usually painless, they can be painful if they get large enough.  Hydroceles feel like a soft round ball on your testicle.  They can be identified with a testicular ultrasound and no treatment is needed.  However, if they are causing pain, we can refer you to a urologist for further treatment (typically drainage of cyst or surgical removal)

Varicoceles

A varicocele is a collection of swollen blood vessels that develop above your testicle.  They usually occur on the left side and can feel like a “bag of worms.”  They are fairly common, occurring in about 15% of men, and are always benign and usually painless.  Varicoceles can be identified with a testicular ultrasound and no treatment is needed.  However, if they get large enough, they can cause pain and lead to infertility.   A urologist can treat varicoceles that are causing these symptoms.

Epididymal cysts/Spermatoceles

An epididymal cyst is a collection of fluid that develops above the testicle. They occur in about 30% of men and are also always benign and usually painless.  These cysts can feel like a soft round ball above your testicle.  They can be identified with a testicular ultrasound and no treatment is needed.  However, if they are causing pain, we can refer you to a urologist for further treatment.

A spermatocele is a type of epididymal cyst that contains sperm cells and occur more commonly in men who have had a vasectomy

Hernia

A hernia is a bulge that can occur in your groin region, specifically into your scrotum where your testicles are.  Hernias generally are painful and need to be evaluated with an in person physical exam and ultrasound.  You may ultimately need to be referred to a surgeon for treatment.

Testicular Torsion

Testicular Torsion occurs when the cord that is holding the testicle becomes twisted, leading to severe and acute/sudden testicular pain along with nausea, vomiting, and swelling in your scrotum.  This condition is rare, occurring in about 1 in 4000 adult men, but can be very serious.  Sometimes urgent care with a urologist is needed to perform surgery to untwist the cord.  If we diagnose this condition with an in person physical exam during your visit with City Care Family Practice, we will have to refer you to the emergency room for further care and treatment.

Epididymitis/Orchitis

Epididymitis is inflammation of the epididymis (the passageway for sperm located behind the testicle) which is usually caused by a bacterial infection such as gonorrhea, chlamydia, or a urinary tract infection.  It occurs in about 1 in 1000 adult men and causes gradually increasing scrotal pain and swelling.  This condition can be diagnosed with an in person physical exam, urine tests, and ultrasound; and ultimately treated with antibiotics.

Orchitis is inflammation of the testicle and tends to cause similar symptoms. It is usually caused by a viral infection such as mumps.

Testicular Cancer

Testicular Cancer is the most common solid malignant tumor diagnosed in men ages 15-34.  Overall, it is rare.  The rate of new cases of testicular cancer is 6 per 100,000 men per year, and the death rate is 0.3 per 100,000 men per year in the United States.  About 9000 cases are diagnosed every year.  You would generally feel a hard, fixed lump on your testicle that is usually painless.  This condition can be diagnosed with an in person physical exam and ultrasound, followed by a referral to a urologist and/or oncologist for treatment. 

What can you do?

The best way to prevent problems in this area is to simply be aware of your body.   While taking a shower or bath, if you notice any of the symptoms mentioned above, make an appointment at City Care Family Practice so one our providers can perform a thorough examination and, if needed, arrange for treatment.

Langan RC, Puente ME. Scrotal Masses.  Am Fam Physician.  2022; 106(2): 184-189