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Scrotal massesBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/scrotal-masses/DS00410
Scrotal masses are abnormalities in the contents of the scrotum, the bag of skin hanging behind the penis. The scrotum contains the two testicles and related structures that produce, store and transport sperm and male sex hormones. Scrotal masses may be the accumulation of fluids, the growth of abnormal tissue, or normal contents of the scrotum that have become swollen, inflamed or hardened.
Scrotal masses need to be examined by a doctor, even if you're not experiencing pain or other symptoms. Scrotal masses could be cancerous or caused by another condition that affects the function and health of the testicles.
Self-examination and regular doctor exams of the scrotum are important for prompt recognition, diagnosis and treatment of scrotal masses.
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|Male reproductive system|
Signs and symptoms of scrotal masses vary depending on the nature of the abnormality. In some cases, the only sign may be the presence of a lump in the scrotum that you can feel with your fingers.
Scrotal mass symptoms may include:
- An unusual lump in the scrotum
- Sudden pain
- A dull aching pain or feeling of heaviness in the scrotum
- Pain that radiates throughout the groin, abdomen or lower back
- Tender, swollen or hardened testicle
- Tender, swollen or hardened epididymis (ep-ih-DID-uh-mis), the soft, comma-shaped tube above and behind the testicle that stores and transports sperm
- Swelling in the scrotum
- Redness of the skin of the scrotum
- Nausea or vomiting
If the cause of a scrotal mass is an infection, symptoms may also include:
- Urinary frequency
- Pus or blood in the urine
When to see a doctor
Seek emergency medical care if you develop sudden pain in your scrotum. Some conditions require prompt treatment to avoid permanent damage to a testicle. See your doctor if you detect a lump in your scrotum or experience other symptoms of a scrotal mass.
Some scrotal masses are more common in children. See your doctor if your son experiences symptoms of a scrotal mass, if you have any concerns about the development of his genitals, or if he is "missing" a testicle — an undescended or retractile testicle, which may increase the risk of some scrotal masses later in life.
A number of different disorders can result in a scrotal mass or the development of an abnormality in the scrotum:
- Testicular cancer is a tumor containing abnormal testicular tissue. A cancerous tumor can usually be felt as a lump in the scrotum. Although such tumors often don't cause other symptoms, some men experience pain or a dull ache in the scrotum, a dull ache, pain that radiates throughout the groin, or swelling of the scrotum. Testicular cancer is more common in adolescent boys and young adult men.
- Spermatocele, also known as a spermatic cyst or epididymal cyst, is a typically painless, noncancerous (benign), fluid-filled sac located in the scrotum, usually above the testicle.
- Epididymitis (ep-ih-did-uh-MY-tis) is inflammation of the epididymis, the comma-shaped structure located above and behind the testicle that stores and transports sperm. Epididymitis is often caused by a bacterial infection, including sexually transmitted bacterial infections, such as chlamydia and gonorrhea. Less commonly, epididymitis is caused by a viral infection or abnormal flow of urine into the epididymis.
- Orchitis (or-KY-tis) is inflammation of the testicle usually due to a viral infection — most commonly mumps. When orchitis is caused by a bacterial infection, the epididymis may also be infected.
- Hydrocele (HY-droe-seel) is a collection of excess fluid between the layers of a sac that surrounds each testicle. A very small amount of fluid in this space is normal. The excess fluid of a hydrocele usually results in a painless swelling of the scrotum. In infants, a hydrocele occurs usually because an opening between the abdomen and the scrotum hasn't properly sealed during development. In adults, a hydrocele occurs usually because of an imbalance in the production or absorption of fluid, often as a result of injury or infection in the scrotum.
- Hematocele (HE-muh-toe-seel) is a collection of blood between the layers of a sac that surrounds each testicle. Traumatic injury, such as a direct blow to the testicles, is the most likely cause of a hematocele.
- Varicocele (VAR-ih-koh-seel) is enlargement of the veins within the scrotum that carry oxygen-depleted blood from each testicle and epididymis. Varicocele is more common on the left side of the scrotum than on the right side because of differences in how blood circulates from each side. Although varicocele is fairly common, the exact cause isn't known. A varicocele may cause infertility.
- Inguinal (ING-gwih-nul) hernia is a condition in which a portion of the small intestine pushes through an opening or weak spot in the tissue separating the abdomen and groin. In infants, an inguinal hernia usually occurs because the passageway from the abdomen to the scrotum has failed to close during development. An inguinal hernia may appear as a mass in the scrotum or higher in the groin.
- Testicular torsion is a twisting of the spermatic cord, the bundle of blood vessels, nerves and the tube that carries semen from the testicle to the penis. This painful condition cuts off blood to the testicle and can result in the loss of the testicle if not promptly treated. The affected testicle may be sideways in the scrotum. It may be enlarged and positioned higher than normal.
Factors that increase the risk of a scrotal mass vary because of the variety of causes of abnormalities in the scrotum. Significant risk factors include the following:
Undescended or retractile testicle
An undescended testicle is a testicle that never leaves the abdomen and, therefore, never enters the scrotum during fetal development or early infancy. A retractile testicle is one that has descended into the scrotum at some point but retreats to the abdomen. An undescended or retractile testicle may be linked to an increased risk of:
- Inguinal hernia
- Testicular torsion
- Testicular cancer
Abnormalities present at birth
Abnormalities of the testicles, penis or kidneys present at birth (congenital) may increase the risk of a scrotal mass and testicular cancer later in life.
History of testicular cancer
If you have had cancer in one testicle, you're at increased risk of cancer affecting the other testicle. If your father or brother has had testicular cancer, you also have an increased risk of the cancer.
Not all scrotal masses result in long-term complications. However, any mass that affects the health or function of the testicle can lead to:
- Delayed or poor development during puberty
Preparing for your appointment
If you're experiencing pain, you should get emergency care. If you detect a scrotal mass, you'll probably start by seeing your family doctor. For some diagnostic tests, you may be referred to a specialist in urinary tract and male sexual disorders (urologist). Preparing for your appointment with your doctor or a urologist will help you make the best use of your time. Preparations that you would make for your child's appointment are, for the most part, the same as you would make for yourself.
What you can do
Make a list ahead of time that you can share with your doctor. Your list should include:
- Symptoms you're experiencing, including any that may seem unrelated to a scrotal mass
- Key personal information, including any major stresses or recent life changes
- Medications that you're taking, including any vitamins or supplements
- Family history of testicular cancer or other disorders of the scrotum
- Personal medical history, such as previous scrotal masses, undescended testicle or congenital defects related to the genitals
- Questions to ask your doctor
If you think you have signs or symptoms of a scrotal mass, you may want to ask some of the following questions.
- What tests will I need to diagnose the condition?
- How long will it take to find out the results of tests?
- If the scrotal mass is cancerous (malignant), what are the next steps?
- If the scrotal mass isn't cancerous, will we need to treat the condition?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first discover a lump or experience other symptoms associated with a scrotal mass?
- Are you experiencing pain now, or have you experienced pain?
- Have you had symptoms that may suggest a bacterial or viral infection, such as fever or blood or pus in your urine?
- Have you had a recent injury to the groin?
- Does anything, such as pain medication, improve your symptoms?
- Does anything worsen symptoms, such as exercise or exertion that puts a strain on the groin?
- Did you have an undescended or retractile testicle that was corrected with surgery?
- Have you ever been diagnosed with a sexually transmitted disease?
- Do you have multiple sex partners or a new sex partner?
Tests and diagnosis
Your doctor will rely on a number of factors to diagnose a scrotal mass. These may include:
- A physical exam. Your doctor will examine the scrotum by carefully feeling (palpating) the scrotum, its contents and nearby areas of the groin.
- Transillumination. Shining a bright light through the scrotum may provide preliminary information about the size, location and makeup of a scrotal mass.
- Ultrasound. An ultrasound test uses sound waves to create an image of internal organs. This test can provide detailed information about the size, location and makeup of a scrotal mass, as well as the condition of the testicles. In most cases, an ultrasound is a necessary tool to diagnose a scrotal mass.
- Urine test. Laboratory tests of a sample of urine may detect a bacterial or viral infection or the presence of blood or pus in the urine.
- Blood test. Laboratory tests of a blood sample may detect a bacterial or viral infection or elevated levels of certain proteins that are associated with testicular cancer.
- Computerized tomography (CT) scan. If other tests have indicated testicular cancer, you'll likely undergo a specialized X-ray exam (CT scan) of your chest, abdomen and groin to see if cancer has spread to other tissues or organs (metastasized).
Treatments and drugs
Most scrotal masses require minimally invasive treatment or no treatment at all, but some require more-serious procedures.
Scrotal masses caused by a bacterial infection, as is usually the case with epididymitis, are treated with antibiotics. Viral infections causing epididymitis or orchitis are usually treated with rest, ice and pain relief medication.
Noncancerous (benign) scrotal masses
Benign scrotal masses may be left untreated or surgically removed, repaired or drained. These treatment decisions depend on such factors as whether the scrotal mass:
- Causes discomfort or pain
- Contributes to infertility
- Increases the risk of infertility
- Becomes infected
A specialist in cancer treatment (oncologist) will recommend treatments based on whether the cancer is isolated to a testicle or has spread to other tissues in the body. Your age and overall health also are factors in choosing treatment options for testicular cancer.
- Radical inguinal orchiectomy is a surgical procedure to remove the affected testicle and spermatic cord through an incision in the groin. This procedure is the primary treatment for testicular cancer. If the cancer has spread to lymph nodes in your abdomen, they also may be removed (lymph node dissection).
- Radiation therapy uses high-dose X-rays or other high-energy radiation to kill cancer cells that may remain after removal of the affected testicle.
- Chemotherapy is a drug treatment that uses powerful chemicals to kill cancer cells.
Most cases of testicular cancer can be cured, but close follow-up care is necessary to watch for possible recurring cancer.
Lifestyle and home remedies
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Testicular self-exams may help you find a scrotal mass early, allowing you to get prompt medical care. If you perform this exam regularly, you'll understand what "normal" feels like and be better prepared to detect any abnormality. To do a testicular self-exam, follow these steps:
- Examine your testicles once a month, especially if you've already had testicular cancer or you have a family history of testicular cancer.
- Perform the exam after a warm bath or shower. The heat from the water relaxes your scrotum, making it easier for you to check for anything unusual.
- Stand in front of a mirror. Look for any swelling on the skin of the scrotum.
- Cup your scrotum with one hand to see if it feels different from normal.
- Examine one testicle at a time using both hands. Place the index and middle fingers under the testicle while placing your thumbs on the top.
- Gently roll the testicle between the thumbs and fingers. Feel for lumps and bumps. The testicles are usually smooth, oval shaped and somewhat firm. It's normal for one testicle to be slightly larger than the other.
- Feel along the soft, comma-shaped structure that runs above and behind the testicle (epididymis) to check for any swelling.
If you find a lump or other abnormality, call your doctor as soon as possible.
- Montgomery JS, et al. The diagnosis and management of scrotal masses. Medical Clinics of North America. 2011;95:235.
- Wampler SM, et al. Common scrotal and testicular problems. Primary Care: Clinics in Office Practice. 2010;37:613.
- Tiemstra JD, et al. Evaluation of scrotal masses. American Family Physician. 2008;78:1165.
- Trojian TH, et al. Epididymitis and orchitis: An overview. American Family Physician. 2009;79:583.
- Hagerty JA, et al. Pediatric scrotal masses. Clinical Pediatric Emergency Medicine. 2009;10:50.
- Testicular self-exam. American Cancer Society. http://www.cancer.org/cancer/testicularcancer/moreinformation/doihavetesticularcancer/do-i-have-testicular-cancer-self-exam. Accessed May 10, 2011.