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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
If you’re reading this, you may have found a lump on your testicle. Understandably, you may be feeling a bit anxious. Take a deep breath. Testicular or scrotal lumps are much more common than a lot of men realize.
While they can be a sign of testicular cancer, in most cases, they’re not. Whether the lump is painful or painless, large or small, hard or soft, on the bottom of the testicle or somewhere else, it’s probably not cancer.
In fact, a large assortment of medical conditions could explain that worrying lump. Here’s a rundown of the types of lumps you may discover. Keep in mind that even if a lump feels like it’s on your testicle, it may actually be located on a different structure inside your scrotum, not on the testicle itself (Valentino, 2011).
Here are a few possible causes for that lump on your testicle—starting with some of the most likely.
The epididymis is a coiled tube located above and behind each of your testicles that stores and transports sperm. It’s prone to cysts, which are pockets of fluid, dead cells, or other material.
Researchers have found that anywhere between 20% to 75% of men have one or more epididymal cysts. Often, they never even notice these abnormalities (Valentino, 2011). But these cysts can become quite large—so large that men often describe them to doctors as like “a third testicle.” They can also become infected and painful (Arora, 2019).
If an epididymal cyst is small or painless—which is typical—it doesn’t require any treatment. But if an epididymal cyst is large and/or painful, or if there’s enlargement or inflammation of the epididymis, your healthcare provider (typically a urologist) may choose to drain the cyst or remove it entirely (Arora, 2019).
Medical providers sometimes break down epididymal cysts into several different categories (Valentino, 2011). For example, spermatoceles are large epididymal cysts that push out into the space inside your scrotum and around your testicles (Valentino, 2011). These cysts are benign and often painless. But in some cases, they can cause pain, a dull ache, or discomfort (Lundström, 2019).
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A hydrocele is a collection of fluid that forms in your sac and around your testicle (Huzaifa, 2021). A hydrocele, though usually painless, can feel like a swollen or enlarged testicle. It can also cause a feeling of one-sided weight or bulk. It tends to get more swollen throughout the day (Lundström, 2019). Treatment may involve removal or drainage (Huzaifa, 2021).
The contents of your abdomen can push through the abdominal lower wall and into two canals that run alongside your groin. This is called an inguinal hernia, and it’s common. Roughly one in four men will develop an inguinal hernia at some point in their lifetimes (NIDDK, 2019).
In some cases, this inguinal hernia can cause a mass to form in your scrotum. Other symptoms include pain, heaviness, or burning in or around your groin (NIDDK, 2019). Surgery is often the recommended treatment (Köckerling, 2018).
Testicular tumor (cancer)
Your testicles, if healthy, should be smooth, soft, and moveable. Hard or firm areas, or differences in texture between one testicle and the other, are not typical. These abnormalities may be signs of testicular cancer. Lumps can also be symptoms of testicular cancer (Baird, 2019).
While rates of testicular cancer have gone up in recent decades, it’s still a rare and very treatable disease. Only about 9,000 new cases are diagnosed in the U.S. each year, and almost all men who undergo treatment for testicular cancer survive. If it turns out that you do have testicular cancer, the usual treatment is removal of the testicles. But only a doctor will be able to determine if that lump on your testicle is cancer or if it’s something else (Baird, 2019).
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Other causes of testicular lumps
Believe it or not, there are still more medical issues that could cause a lump or mass to develop in your scrotum:
- Varicocele: Varicoceles are enlarged or inflamed veins inside the scrotal sac that healthcare providers describe as feeling like a “bag of worms” inside of the scrotum. Estimates show that about 15% of all men have varicoceles, although, for most (90% or more), they’re not painful (Gordhan, 2015; Paick, 2019). People with varicoceles often feel a “heaviness” in their sac that gets worse with exercise, physical activity, or after standing (Paick, 2019).
- Spermatic cord cysts: The spermatic cord—a structure that runs from the groin into the back of the testes—can also develop cysts that could feel to you like a testicular lump (Valentino, 2011).
- Scrotal injury: An injury to your genitals could also cause swelling that could seem lump-like (Gordhan, 2015).
How to find testicle lumps
Right now, the U.S. Preventive Services Task Force (USPSTF), the American Academy of Family Physicians, and other groups do not recommend self-exams to check for lumps or testicular cancer. The American Cancer Society recommends men with certain risk factors (previous testicular cancer or family history of testicular cancer) consider monthly self-examination (ACS, 2018).
To perform this kind of self-examination, you should (ACS, 2018):
- Do so in a hot shower, which will relax your scrotum and make the exam easier
- Hold your penis out of the way
- Soap your hands and testicles
- Roll each testicle around in your fingers, feeling for any lumps, bumps, or painful areas
- Take note of any changes in size, shape, or feel.
That said, if you notice a painful lump on your testicle or around your testicles, you should see a medical professional who can provide you with sound medical advice based on your symptoms (Stonier, 2017).
- American Cancer Society. (ACS). (2018). Can Testicular Cancer Be Found Early? Retrieved September 30, 2021 from https://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/detection.html
- Arora, B., Arora, R., & Arora, A. (2019). A randomised study of management modalities in epididymal cyst. International Surgery Journal, 6(2), 340-344. doi: 10.18203/2349-2902.isj20190379. Retrieved from https://www.ijsurgery.com/index.php/isj/article/view/3710
- Baird, D. C., Meyers, G. J., & Hu, J. S. (2018). Testicular Cancer: Diagnosis and Treatment. American Family Physician, 97(4), 261–268. Retrieved from https://www.aafp.org/afp/2018/0215/p261.html
- Gordhan, C. G., & Sadeghi-Nejad, H. (2015). Scrotal pain: evaluation and management. Korean Journal of Urology, 56(1), 3–11. doi: 10.4111/kju.2015.56.1.3. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25598931/
- Huzaifa, M., & Moreno, M. A. (2021). Hydrocele. [Updated Jul 12, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559125/
- Karavas, E., & Taydas, O. (2019). Tunica albuginea cyst presenting with milk of calcium. Urology Annals, 11(4), 447–448. doi: 10.4103/UA.UA_163_18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6798307/
- Köckerling, F., & Simons, M. P. (2018). Current Concepts of Inguinal Hernia Repair. Visceral Medicine, 34(2), 145–150. doi: 10.1159/000487278. Retrieved from https://www.karger.com/Article/FullText/487278
- Lundström, K. J., Söderström, L., Jernow, H., Stattin, P., & Nordin, P. (2019). Epidemiology of hydrocele and spermatocele; incidence, treatment and complications. Scandinavian Journal of Urology, 53(2-3), 134–138. doi: 10.1080/21681805.2019.1600582. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30990342/
- McCammack, K. C., Aganovic, L., Hsieh, T. C., Guo, Y., Welch, C. S., Gamst, A. C., & Cassidy, F. (2014). MRI of the epididymis: can the outcome of vasectomy reversal be predicted preoperatively?. AJR. American Journal of Roentgenology, 203(1), 91–98. doi: 10.2214/AJR.13.11619. Retrieved from https://www.ajronline.org/doi/pdfplus/10.2214/AJR.13.11619
- Paick, S., & Choi, W. S. (2019). Varicocele and Testicular Pain: A Review. The World Journal of Men’s Health, 37(1), 4–11. doi: 10.5534/wjmh.170010. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305863/
- Pomajzl, A. J., & Leslie, S. W. (2021). Appendix Testes Torsion. [Updated Aug 12, 2021]. In: StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31550101/
- Stonier, T., Simson, N., & Challacombe, B. (2017). Diagnosing testicular lumps in primary care. The Practitioner, 261(1803), 13–17. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29020728/.
- U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2019). Inguinal Hernia. Retrieved on September 24, 2021, from https://www.niddk.nih.gov/health-information/digestive-diseases/inguinal-hernia
- Valentino, M., Bertolotto, M., Ruggirello, M., Pavlica, P., Barozzi, L., & Rossi, C. (2011). Cystic lesions and scrotal fluid collections in adults: Ultrasound findings. Journal of Ultrasound, 14(4), 208–215. doi: 10.1016/j.jus.2011.10.008. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558078/?report=classic
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.