What to Know About Scrotal Masses

Medically Reviewed by Nazia Q Bandukwala, DO on February 24, 2024
4 min read

The scrotum is a bag of skin behind the penis, containing testicles and other structures responsible for storing, producing, and transporting male sex hormones and sperm. A scrotal mass may contain fluids, abnormal tissue, or regular scrotal contents that have become hardened or inflamed. 

When they are non-cancerous, scrotal masses are also called epididymal cysts or epididymal masses. these forms are usually painless and filled with fluid. 

Still, some scrotal masses can be cancerous. These are more likely to be caused by less serious conditions affecting the testicles and male sexual health. 

Regular self-examination is important to recognize cysts quickly and get treatment. While these masses are usually harmless, they could cause damage to your testicles.

If you are young, a scrotal cyst could cause delayed development during puberty and infertility later in life. 

Scrotal or epididymal masses are caused by:

Testicular Cancer. A non-tender mass could be due to a tumor in the testicles that contains abnormal tissue. Some people may have swelling and pain in the scrotal mass. Otherwise, testicular tumors are generally painless. 

Epididymitis. Any illness with the suffix "itis" indicates inflammation. In this case, the title refers to the inflammation of the epididymis, the structure behind the testicle containing and transporting sperm. 

Spermatocele. This is commonly called an epididymal mass or cyst. These masses are typically filled with fluid and are noncancerous and painless. You will find them above your testicles. 

Hydrocele. The sacs surrounding each of your testicles have many layers. Sometimes, fluid may fill between these layers, creating a lump on the testicle. Additionally, hydrocele can form in infants because of the improper sealing of an opening between the scrotum and the abdomen during development in the womb. A hydrocele forms in adults due to infection, injury, or irregular absorption and production of scrotal fluid. 

Varicocele. Varicoceles usually form on the left side of the scrotum. This condition occurs when the scrotal veins carrying blood from the testicles to the scrotum are enlarged. Varicocele can lead to infertility. 

Testicular Torsion. This happens when there is a twisting of the testes or the spermatic cord, a tube carrying semen to the penis. Testicular torsion is quite painful, as it cuts off the testicle's blood supply. If you do not get quick attention from your doctor, the testicle could lose its function. 

Scrotal mass symptoms differ among people. They include: 

  • An unusual lump near the testicles
  • Pain in the lower back, abdomen, and groin 
  • Heaviness or dull aching pain in the scrotum 
  • Sudden pain 
  • Swelling in the area
  • Vomiting or nausea
  • Redness in the scrotum 
  • Swollen, tender, or hard testicles 

If the scrotal mass is due to an infection, symptoms may include blood or pus in the urine and fever. You may also urinate more often. 

If you are young, a scrotal cyst that affects your testicular health seriously could cause delayed development during puberty and infertility. 

When you go to a doctor with a lump on your testicle, they will first ask you about your medical history. Then, they will use the following tests to identify the cause of the epididymal mass: 

Blood or urine test: These tests show if you have an infection. They may also show signs of severe conditions like cancer. 

Physical exam: The doctor will touch the mass and feel its contents and hardness to identify what it may contain. 

Transillumination. This is a procedure in which a bright light is shone on your testicle. The doctor uses this to see the size and location of the mass. 

Imaging: A doctor can use ultrasound to check the lump's location and rule out certain conditions, like cancer or a hernia. 

Treatment depends on the cause of the scrotal mass. In some cases, you may not need much treatment. Here are some common treatments for scrotal masses: 

  • Antibiotics and other medications to treat infections 
  • Surgery to drain or remove a scrotal mass
  • Testicle removal through surgery, in the case of testicular cancer 

If the mass is due to a hernia, the doctor will push the protruding section back into its place. 

If the lump has suddenly appeared on your testicle, or a lump that has been there becomes painful, you should see your doctor immediately. Treatment may prevent permanent testicular damage. 

To be on the safe side, though, it is best to get every scrotal mass checked by your doctor, even if there is no pain or swelling.