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Testicular lumps, and swellings

Introduction

The testicles

The testicles are part of the male reproductive system. They produce sperm and testosterone (the male sex hormone). The testicles sit inside the scrotum (a loose sac of skin) that hangs down behind the penis.

Testicular lumps and swellings can have many different causes. In rare cases, they can be a sign of testicular cancer. However, most lumps are benign (non-cancerous). Cancer Research UK estimates that less than four in every 100 testicular lumps are testicular cancer. 

Types of testicular lumps and swellings

There are four main types of  testicular lumps and swellings, which are outlined below.

  • Varicoceles - a swelling that is caused by dilated (enlarged) veins within the testicles.
  • Hydroceles - a swelling that is caused by fluid around the testicle.
  • Epididymal cyst - a lump that is caused by a collection of fluid in the epididymis (a long, coiled tube behind the testicles).
  • Testicular torsion - a sudden, painful type of swelling that occurs when a testicle becomes twisted, interrupting the blood supply to the testicles; it is a medical emergency (see below).

See Testicular lumps and swellings - causes for other types of testicular swellings. 

How common are testicular lumps and swellings?

Varicoceles are relatively common, affecting one in seven men. They usually become noticeable after puberty (when the body matures sexually) because by this time the testicles are fully grown and the blood flow to the affected veins increases.

Hydroceles affect 1 or 2 in every 100 newborn male babies. They can also occur in older boys or men after an injury or illness.

Epididymal cysts can develop at any age, but they are most common in middle-aged men and affect up to a third of men

Testicular torsions usually develops in boys aged 13-17, but they can also occur in men who are in their 20s. It is a rare condition, figures from the US suggest that it affects1 in every 4,000 males each year. 

Outlook

Any lumps, swellings or changes to the testicles should always be checked by a healthcare professional.

Testicular torsion is a medical emergency and will require urgent surgery within hours of it starting. 

Other types of lumps may not require any treatment because they often do not cause any symptoms. Hydroceles in newborn babies often disappear on their own during the first year or two.

If a lump causes pain or discomfort, it may be possible to have it surgically removed. See Testicular lumps and swellings - treatment for more information.  

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Symptoms

Always see your GP if you find a lump or swelling on one or both of your testicles.

In most cases, a lump or swelling is not cancerous, but you should always have it checked by a health professional.

Varicoceles

In most cases, varicoceles cause no symptoms. However, up to 1 in 10 men may experience a heavy feeling or aching pain in either their:

  • scrotum (the loose sac of skin that contains the testicles)
  • groin

Varicoceles usually develop on the left side. This is due to the way that the veins in the testicles are arranged.

Varicoceles develop as a soft lump in the scrotum and can feel like a 'bag of worms'. The size of varicoceles can vary. Some may only be noticeable when you touch them, while others can be larger and more easily seen. The side of the scrotum that contains the varicoceles may hang slightly lower than the other side.

Varicoceles may be linked to infertility. However, about two out of three men with varicoceles can have children. There is no evidence to suggest that surgically removing varicoceles improves fertility.

Hydroceles

Hydroceles usually affect newborn babies.  In almost all cases, the only symptom is a painless swelling of one or both testicles. Hydroceles can sometimes affect older boys or men, who may feel pressure in their abdomen (tummy).

Epididymal cysts

Epididymal cysts develop as a small, smooth fluid-filled lump.  Removing fluid from inside the cyst by squeezing it is not recommended as it can lead to scarring, or infection.

Epididymal cysts do not usually cause symptoms unless they become infected. Symptoms of infection can include:

  • a red, swollen and painful cyst
  • a foul-smelling yellow fluid which drains from the cyst

Testicular torsion

Unlike the other types of benign (non-cancerous) testicular lumps, testicular torsion is a medical emergency.

Dial 999 to request an ambulance if you suspect that you, or someone you know, is experiencing testicular torsion.

In cases of testicular torsion, if surgery needs to be carried out as soon as possible to avoid the loss of the testicle.

The symptoms of testicular torsion usually begin with a severe pain in one of your testicles. Other possible symptoms include:

  • swelling of the scrotum (the sac of skin that houses your testicles)
  • nausea (feeling sick)
  • vomiting
  • abdominal (tummy) pain
  • a high temperature (fever) of 38ºC (100.4ºF) or more
  • a frequent need to urinate

Some people with testicular torsion may have a history of testicular pain and swelling in the past.

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Causes

There are many different causes of testicular lumps and swellings. Testicular cancer is a possible cause. About 2,000 cases of testicular cancer are diagnosed in the UK every year. However, less than 4 in 100 lumps are testicular cancer.

The main types of lumps and their causes are explained below.

Varicoceles

The exact cause of varicoceles is unknown. However, most experts believe that they are caused by abnormalities that affect the veins in the testicles. There may be a blockage in the veins, or a problem with the valves in the veins. The valves are flaps that prevent blood flowing in the wrong direction.

The abnormal veins do not circulate blood as efficiently as normal veins, leading to an accumulation of excess blood in the veins which causes them to swell.

During puberty (when the body matures sexually), blood flow increases to the testicles and they grow larger. This can make varicoceles more noticeable.

Hydroceles

During pregnancy, a male baby's testicles develop inside his abdomen (tummy). Once they have formed, the testicles pass down through a passage into the scrotum(the loose sac of skin that contains the testicles).

The passage usually closes before birth but, in some cases, this fails to happen. If the passage does not close, fluid can pass from the abdomen into the scrotum, which causes the swelling associated with a hydrocele.

In most cases, during the child's first or second year of life, fluid is absorbed into the surrounding tissue, and the hydrocele will disappear.

Hydroceles that develop in men or older boys may be indicated by inflammation (redness and swelling) of the scrotum, caused by:

  • injury
  • infection
  • a tumour (growth)

Epididymal cysts

The epididymis is a coil-like structure behind the testicles that helps to store and transport sperm. Sometimes, a fluid-filled swelling can appear on the epididymis, although the cause is usually unknown.

People who have certain conditions that affect their kidneys may be at increased risk of developing epididymal cysts. For example, autosomal dominant polycystic kidney disease (ADPKD) is a genetic condition that causes multiple cysts to develop on the kidneys.

Testicular torsion

The testicles hang from a cord that is known as the spermatic cord. The spermatic cord should be loose enough to allow the testicles some movement within the scrotum, but not so loose that they can move too freely.

Some boys are born with a spermatic cord that is too loose. This means that there is an increased risk that a testicle could move too much, leading to the spermatic cord becoming twisted.

If a spermatic cord becomes severely twisted, the main blood supply for the affected testicle can become interrupted. This is a dangerous situation which, if not immediately treated, can lead to the testicle dying.  Immediate surgery is required to untwist the cord, restore the blood supply, and save the testicle.

Testicular torsion is most common among boys aged 13-17, although it can also occur in:

  • men in their 20s
  • unborn babies in the womb
  • newborn babies

Testicular torsion can sometimes occur if there is trauma to the testicle, such as in an accident. However, most cases happen for no apparent reason. Testicular torsion may be more likely if you have:

  • a tumour (growth) in your testicles
  • a history of undescended testicles (where a boy is born without one or both testicles in their scrotum)

Other causes

Other causes of testicular lumps or swellings include: 

  • epididymitis – inflammation of the epididymis, which may be caused by a sexually transmitted infection or a urinary tract infection
  • epididymo-orchitis – epididymitis (see above) combined with orchitis (inflammation of the testicle), which is usually due to an infection 
  • an inguinal hernia – a piece of your bowel pokes through a weakness in the muscle or surrounding tissue wall into your groin; more than a quarter of men will have an inguinal hernia during their lifetime 
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Diagnosis

Always visit your GP if you notice any lumps or swellings in your testicles. In very rare cases, a lump can be a sign of testicular cancer (less than 4 in 100 lumps).

Your GP will ask you whether you have:

  • felt any pain – and if so, where it was, how severe it was and how long it lasted for 
  • any other symptoms, such as pain when you urinate (which is a sign of a urinary tract infection) or any discharge from your urethra (the tube that carries urine from the bladder to outside of the body)
  • a history of trauma, such as a sports injury to your groin 

Your GP will also physically examine your testicles to check:

  • the size of your testicles 
  • the position of the lump or swelling 
  • whether the lump causes any pain when it is touched 
  • whether the lump is firm or soft

If your GP cannot confirm a diagnosis from the examination alone, you may need to have an ultrasound scan. This uses high-frequency sound waves to create an image of the inside of your body.

Varicoceles

Varicocele can usually be confidentially diagnosed by your GP asking about your symptoms and carrying out a physical examination. Further testing is not usually necessary.

Referral

In some cases, you may be referred to a urologist (a doctor who specialises in treating conditions that affect the urinary system). For example, if:

  • if a varicocele suddenly develops
  • you have a single varicocele on the right side 
  • there is uncertainty about the cause of your lump
  • you are in pain
  • it is causing you embarrassment

In these circumstances, you may be referred for an ultrasound to confirm the diagnosis and check for any problems.

Hydroceles

As with varicoceles, a hydrocele can usually be diagnosed by having a physical examination.

If a hydrocele develops in your child, your GP will feel your child's scrotum (the loose sac of skin that contains the testicles) to check that the swelling is caused by fluid and not something solid. The fluid is usually clear, so your GP may shine a torch through the scrotum. If a hydrocele is present, the outlines of the testicles should appear against the background of the fluid.

If you have a hydrocele, your GP will examine your scrotum as described above. If you are 20 to 40 years old, your GP may refer you for an ultrasound scan to rule out testicular cancer.

If your GP suspects that your hydrocele may be caused by an infection, they may ask for a urine sample and test it. Alternatively, your GP may use a swab (small piece of absorbent material, such as gauze, attached to the end of a stick) to collect a sample of cells and fluid from your urethra. This sample can then be tested to see if you have an infection.

Epididymal cysts

The diagnosis of an epididymal cyst can usually be made by physical examination alone. Further tests are not usually required.

Testicular torsion

Testicular torsion is usually diagnosed by the distinctive symptoms of severe testicular pain and swelling.

The diagnosis can be confirmed by using an ultrasound scanner, or magnetic resonance imaging (MRI) that uses a strong magnetic field and radio waves to produce detailed pictures of the inside of your body. However, these tests may delay the urgent need for surgical treatment, and so it is unlikely that these tests will be carried out.

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Treatment

Treatment for your testicular lump will depend on the underlying cause of the lump. 

Varicoceles

In most cases, varicoceles do not require treatment. If you have a varicocele, and you are experiencing pain or discomfort, you can:

  • taking painkillers, such as paracetamol
  • wear tight-fitting, supportive underwear

Surgery may be recommended if your varicocele is causing you pain or discomfort.

Surgery

A surgical technique called varicocele embolisation can be used to treat varicocele.  You will usually be referred to a urologist (a doctor who specialises in treating conditions that affect the urinary system) to discuss the benefits and risks of surgery.

A varicocele embolisation is usually carried out on an out-patient basis, which means that you will not have to stay in hospital overnight. You will usually be given a local anaesthetic (painkilling medication to numb the affected area).

The surgeon will use X-ray equipment to guide a tiny tube into the affected veins in your testicles.  They will then use metal coils or a special liquid to block the veins. Blood will then bypass the blocked veins, reducing the swelling and removing the varicocele.

Varicocele embolisation is a very safe procedure, although there is a small risk of infection. If infection occurs, it can be treated using antibiotics (medication to treat bacterial infections). Other possible risks include:

  • the varicocele returning 
  • numbness or pain in the scrotum (loose sac of skin that contains the testicles)

Some varicoceles require a different treatment in the form of surgery to directly divide the dilated (widened) veins. This is usually performed under general anaesthetic so you will be unconscious. Your surgeon will make an incision in your groin, then find and remove the dilated veins.

More than 9 out of 10 varicoceles are successfully removed through surgery.

Hydroceles

Hydroceles in newborn babies usually disappear on their own within the first year or two of life.  Treatment for hydroceles is usually only required if they persist for longer than this or if they begin to cause troublesome symptoms. Hydroceles in older boys and men may be treated if they are causing pain or discomfort.

Surgery

If you require treatment for hydroceles, a surgical procedure, known as a hydrocelectomy, may be recommended.

A hydrocelectomy is carried out under general anaesthetic. The surgeon will make an incision in the scrotum in order to drain away the fluid, before sealing the passageway between the abdomen (tummy) and the scrotum. The incision is sealed using dissolvable stitches. Most people will be able to return home soon after the operation.

As with a varicocele embolisation, with hydrocelectomy there is a small risk of infection. Children may be given antibiotics before or during the operation in order to prevent infection.

Epididymal cysts

Epididymal cysts do not usually require treatment.  However, if they are causing troublesome symptoms, you may be referred to a urologist.

Your urologist may recommend further treatment, or may suggest surgically removing the entire cyst under a local anaesthetic. This may leave some scarring.

Testicular torsion

If you have testicular torsion, you will need to have surgery as soon as possible to release the trapped testicle. Permanent injury to the testicle can occur within four hours of having testicular torsion, which may affect your fertility or result in the loss of your testicle.

Surgery for testicular torsion is carried out under general anaesthetic. The surgeon will make a cut in your scrotum and then untwist the spermatic cord (the cord that the testicles hang from inside the scrotum). The testicle (or testicles) will then be stitched to the inside of your scrotum to prevent the spermatic cord twisting again.

The longer you wait before having surgery, the higher the risk that your surgeon will not be able to save the trapped testicle. Figures show that when people have surgery within six hours of testicular torsion occurring, 9 out of 10 trapped testicles will be saved. However, if the surgery is delayed for 24 hours, only 1 out of 10 trapped testicles will be saved. 

Following surgery for testicular torsion, you should avoid strenuous activity for about a week. Your surgeon will be able to advise you about this. 

Other types of lumps

Other types of lumps are treated differently depending on their cause. For example, if your lump is caused by an underlying infection, the infection may be treated with antibiotics. See the Health topic about Sexually transmitted infections and Urinary tract infections if one of these has caused your lump.

If you have been diagnosed with testicular cancer, it may be treated with surgery and radiotherapy. See the Health topic about Testicular cancer - treatment for more information.

If you have been diagnosed with an inguinal hernia, you will usually need to have an operation. See the Health topic about Inguinal hernia repair for more information.  

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Q&A

What should my testicles look and feel like?

Most men’s testicles are about the same size, though it’s common for one to be slightly bigger than the other. It’s also common for one testicle to hang lower than the other one.

The testicles should feel smooth without any lumps or bumps and firm but not hard. You may feel a soft tube at the back of each testicle, which is called the epididymis.

What are testicles?

The testicles are two small oval-shaped organs. They are contained in a man’s scrotum, a sac of skin that hangs below the penis.

The testicles are part of the male reproductive system. They produce sperm and the male sex hormone testosterone.

Examining your testicles

It’s important for men to examine their testicles regularly, about once a month, for any lumps or swellings. Knowing what’s normal for you will help you to notice any changes.

Most lumps in the testicles are harmless. However, in rare cases, a lump can be a sign of testicular cancer. Testicular cancer is most common in younger men and can be successfully treated if diagnosed early.

The best time to examine your testicles is after a warm bath or shower, when the scrotum is relaxed. Hold your scrotum in the palm of your hand and use your fingers and thumb to gently feel each testicle.

If you feel any lumps or swellings in either testicle, or notice any changes in the shape or size of your testicles, see your GP as soon as possible.

What causes lumps and swelling in the testicles?

There are several causes of testicular lumps and swellings:

  • varicocele: caused by enlarged veins in the testicles
  • hydrocele: a swelling caused by fluid around the testicle
  • epididymal cyst: a lump caused by a collection of fluid in the epididymis
  • testicular torsion: a sudden painful swelling that occurs when a testicle becomes twisted (this is a medical emergency and requires surgery as soon as possible)
  • testicular cancer: an estimated 4 in 100 lumps are cancer, so this is an uncommon cause of lumps
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