Scrotal masses

Scrotal masses are abnormalities in the bag of skin hanging behind the penis (scrotum). The scrotum contains the testicles and related structures that produce, store and transport sperm and male sex hormones.

Scrotal masses might be an 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 in pain or having other symptoms. Scrotal masses could be cancerous or caused by another condition that affects testicular function and health.

Self-examination and regular doctor exams of the scrotum are important for prompt recognition, diagnosis and treatment of scrotal masses.

Symptoms

Signs and symptoms of scrotal masses vary depending on the abnormality. Signs and symptoms might include:

• An unusual lump
• 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-miss), 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, signs and symptoms also might include:

• Fever
• 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, even if it's not painful or tender, or if you experience other symptoms of a scrotal mass.

Some scrotal masses are more common in children. See your doctor if your child experiences symptoms of a scrotal mass, if you have any concerns about the development of the genitals or if a testicle is “missing” — an undescended or retractile testicle, which might increase the risk of some scrotal masses later in life.

Causes

A number of disorders can result in a scrotal mass or an abnormality in the scrotum, including:

• Testicular cancer. Testicular cancer is a tumor containing abnormal testicular tissue, which can usually be felt as a nontender lump in the scrotum.

  Some men experience pain and swelling, but most tumors don't cause symptoms. See your doctor if you notice any new lump in your scrotum.

• Spermatocele. Also known as a spermatic cyst or epididymal cyst, spermatocele is a typically painless, noncancerous (benign), fluid-filled sac in the scrotum, usually above the testicle.

• Epididymitis. This is inflammation of the epididymis, the comma-shaped structure 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. Less commonly, epididymitis is caused by a viral infection or an abnormal flow of urine into the epididymis.

• Orchitis. This is inflammation of the testicle usually due to a viral infection — most commonly mumps. When orchitis is caused by a bacterial infection, the epididymis also might be infected.

• Hydrocele. Hydrocele occurs when there is excess fluid between the layers of a sac that surrounds each testicle. A small amount of fluid in this space is normal, but 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. Hematocele occurs where there is 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.

• Varicocele. This is the enlargement of the veins within the scrotum that carry oxygen-depleted blood from each testicle and the epididymis. Varicocele is more common on the left side of the scrotum because of differences in how blood circulates from each side.

  A varicocele might cause infertility.

• Inguinal hernia. This 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 might appear as a mass in the scrotum or higher in the groin.

• Testicular torsion. This 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 might be sideways, enlarged and higher than normal.

Risk factors

Factors that increase the risk of a scrotal mass vary because of the various causes of scrotal abnormalities. Significant risk factors include:

Undescended or retractile testicle

An undescended testicle doesn't leave the abdomen and enter the scrotum during fetal development or early infancy. A retractile testicle descends into the scrotum, but retreats to the abdomen. Either might increase the risk of:

• Inguinal hernia
• Testicular torsion
• Testicular cancer

Abnormalities present at birth

Abnormalities of the testicles, penis or kidneys present at birth (congenital) might 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. Having a father or brother who has had testicular cancer also increases your risk.

Complications

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
• Infertility

Diagnosis

Your doctor will rely on a number of factors to diagnose a scrotal mass. These may include:

• A physical exam. Your doctor will feel your scrotum, its contents and nearby areas of the groin while you're standing and lying down.
• Transillumination. Shining a bright light through the scrotum might provide information about the size, location and makeup of a scrotal mass.
• Ultrasound. Using 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. An ultrasound usually is necessary to diagnose a scrotal mass.
• Urine test. Laboratory tests of a sample of urine might detect a bacterial or viral infection or the presence of blood or pus in the urine.
• Blood test. Laboratory tests of a blood sample might 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 indicate 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.

Treatment

Most scrotal masses require minimally invasive or no treatment, but some require medicine or more-serious procedures.

Infections

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 might be left untreated or surgically removed, repaired, or drained. These treatment decisions depend on factors such as whether the scrotal mass:

• Causes discomfort or pain
• Contributes to or increases the risk of infertility
• Becomes infected

Testicular cancer

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. This is the primary treatment for testicular cancer. It's a surgical procedure to remove the affected testicle and spermatic cord through an incision in the groin. Lymph nodes in your abdomen also might be removed if the cancer has spread to them.
• Chemotherapy. This is a drug treatment that uses powerful chemicals to kill cancer cells.

In some cases radiation therapy also may be used. This type of therapy uses high-dose X-rays or other high-energy radiation to kill cancer cells that may remain after removal of the affected testicle.

Most cases of testicular cancer can be cured, but follow-up care is necessary to watch for possible recurrences.

Lifestyle and home remedies

Testicular self-exams might 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 abnormality. To do a testicular self-exam, follow these steps:

1. Examine your testicles once a month, especially if you've had testicular cancer or you have a family history of testicular cancer.
2. Perform the exam after a warm bath or shower. The heat from the water relaxes your scrotum, making it easier for you to check.
3. Stand in front of a mirror. Look for swelling on the skin of the scrotum.
4. Cup your scrotum with one hand to see if it feels different from normal.
5. Examine one testicle at a time using both hands. Place the index and middle fingers under the testicle; place your thumbs on top.
6. Gently roll the testicle between the thumbs and fingers to feel for lumps. The testicles are usually smooth, oval shaped and somewhat firm. It's normal for one testicle to be slightly larger than the other.
7. Feel along the soft, comma-shaped structure that runs above and behind the testicle (epididymis) to check for swelling.

If you find a lump or other abnormality, call your doctor as soon as possible.

Preparing for an appointment

If you're having pain, seek emergency care. If you detect a scrotal mass, you'll probably start by seeing your family doctor. You might be referred to a specialist in urinary tract and male genital disorders (urologist).

Preparing for your or your child's appointment with your doctor or a urologist will help you make the most of your time with the doctor.

What you can do

Write down information to share with your doctor, including:

• Symptoms you're experiencing, including any that may seem unrelated to a scrotal mass
• Key personal information, including major stresses or recent life changes
• Medications, vitamins and supplements you're taking
• Family history of testicular cancer or other disorders of the scrotum
• Personal medical history, including previous scrotal masses, undescended testicle or congenital defects related to the genitals
• Questions to ask your doctor

Questions about scrotal masses might include:

• What tests will I need?
• How long will it take to get the test results?
• If the scrotal mass is cancerous (malignant), what are the next steps?
• If the scrotal mass isn't cancerous, will I need treatment?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did you discover a lump or experience other symptoms associated with a scrotal mass?
• Are you having or have you had pain in or near your scrotum?
• Have you had 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 had a sexually transmitted infection?
• Do you have multiple sex partners or a new sex partner?

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