Scrotal Masses: What to Do When You Feel a Lump Near Your Testicles

What Are the Testicles?

The testicles are a pair of oval-shaped glands that form part of the male reproductive system. They serve two primary and vital functions:

• Sperm production (spermatogenesis): The testicles continuously produce millions of sperm cells, which are essential for male fertility and reproduction.
• Hormone production: The testicles are the primary source of testosterone, the main male sex hormone responsible for the development of secondary sexual characteristics, muscle mass, bone density, and libido.

The testicles are housed within a pouch of skin called the scrotum, which is located behind and below the penis. The scrotal skin is thin and sensitive. Its primary function is to regulate the temperature of the testicles, maintaining them slightly cooler than the rest of the body. This cooling is essential for optimal sperm production.

Between the testicles and closely connected to them is the epididymis, a coiled tube that stores sperm as it matures and transports it during ejaculation. Many scrotal lumps actually originate in the epididymis rather than in the testicle itself. Understanding this anatomy is helpful when interpreting what a lump might mean.

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Symptoms of Scrotal Masses

Lumps, bumps, and swellings in and around the testicles are relatively common in boys and men across all age groups. They can arise from a wide variety of underlying causes, ranging from completely harmless cysts to urgent medical emergencies.

Broadly speaking, scrotal masses may indicate:

• Fluid accumulation around or within the testicular sac
• Abnormal tissue growth, benign or malignant
• Localized swelling or inflammation
• Hardening of normal scrotal contents
• Vascular abnormalities, such as dilated veins

The vast majority of scrotal masses are benign, meaning they are not cancerous, and many do not require any treatment. However, it is always important to have any new testicular lump or change evaluated by a doctor. You should never assume a mass is harmless without a proper medical assessment.

The most common causes include:

• Varicocele: Swelling caused by enlarged veins within the scrotum, sometimes described as a “bag of worms”
• Hydrocele: A fluid-filled swelling around the testicle
• Epididymal cyst or spermatocele: A fluid-filled sac in or near the epididymis
• Epididymo-orchitis: Inflammation of the epididymis and/or testicle, usually due to infection
• Inguinal hernia: Fatty tissue or a section of intestine pushing through the groin into the scrotal area

A sudden and painful swelling of one testicle should always be treated as a medical emergency. This symptom may indicate testicular torsion, a condition where blood supply to the testicle is cut off.

Although it is a less common cause, scrotal lumps can occasionally represent testicular cancer. Data from the UK’s National Health Service suggests that fewer than 4 in every 100 testicular lumps are cancerous. However, this still makes prompt evaluation critically important.

General Signs and Symptoms

The signs and symptoms associated with scrotal masses vary widely depending on the underlying cause, but they may include one or more of the following:

• Development of an unusual small lump or swelling in the scrotal area
• Testicular pain, which can be sudden, dull, sharp, persistent, or intermittent
• A feeling of heaviness or dragging sensation in the scrotum
• Pelvic pain or discomfort
• Pain radiating to the groin, abdomen, or lower back
• A swollen or hardened testicle
• A tender, swollen, or hardened epididymis
• General scrotal swelling
• Redness or skin changes on the scrotal surface
• Nausea and/or vomiting

Symptoms Specific to Infection-Related Masses

If the scrotal mass is caused by an infection, additional systemic signs and symptoms may also be present:

• Fever
• Altered urination frequency (more or less frequent than usual)
• Discharge of pus or blood in the urine
• Dysuria (pain or burning during urination)
• Urethral discharge

Early recognition of these symptoms and prompt medical consultation are essential to avoid complications.

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When to Call a Doctor

Any new lump, swelling, or change in the testicles or scrotum should be evaluated by a doctor. This is not an area of health where a “wait and see” approach is advisable, even if you feel no pain.

Initial assessment will typically involve a physical examination of the scrotum and genital area to identify possible causes. In some cases, further investigations like a scrotal ultrasound will be necessary to establish a clear diagnosis. Your primary care physician may refer you to a urologist (a specialist in urinary tract and male genital health) for expert evaluation.

Emergency Situations

If you experience sudden, severe pain in one testicle, go to the nearest emergency department immediately. This may indicate testicular torsion, which is a urological emergency requiring surgery within hours to save the testicle.

Scrotal Masses in Children

Some types of scrotal masses are more common in infants and children. Parents should consult a doctor promptly if:

• Their child shows signs of a scrotal lump or swelling
• There are concerns about the development of their child’s genitals
• A testicle appears to be absent from the scrotum. This may indicate cryptorchidism (undescended testicle) or a retractile testicle, both of which can increase the long-term risk of certain scrotal conditions and testicular cancer if left unmanaged.

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Causes of Scrotal Masses

The great majority of scrotal masses have a benign (non-cancerous) cause. However, because some causes require urgent or specialist treatment, and because testicular cancer is most curable when detected early, it is essential to understand and recognize the full spectrum of causes.

Below is a comprehensive overview of the most common causes of scrotal masses.

Testicular Cancer

Although rare, testicular cancer is one of the most important causes to rule out when a scrotal mass is detected. It is the most common cancer in young men aged 15 to 49 years. Unlike many other cancers, the risk of testicular cancer does not increase significantly with age. Instead, it predominantly affects young and middle-aged men.

Characteristics of lumps associated with testicular cancer:

• Develop slowly and directly on the testicle itself (rather than in surrounding tissue)
• Are usually painless (though some men report mild discomfort or a dull ache)
• Feel firm, solid, and hard to the touch
• Are not tender when pressed
• May be accompanied by a dragging or heavy sensation in the scrotum
• May be accompanied by a dull ache in the lower abdomen or back

It is important to note that not all painless lumps are cancer, and not all testicular cancers are painless. This is why any persistent lump must be medically assessed, regardless of whether it hurts.

Testicular cancer is highly treatable, especially when caught early. Survival rates for early-stage testicular cancer exceed 95% in most developed countries, according to Cancer Research UK.

Spermatocele

A spermatocele, also known as a spermatic cyst or epididymal cyst, is a benign, fluid-filled sac. It develops in the epididymis, which is the coiled tube located above and behind each testicle.

Key characteristics

• Usually located above or behind the testicle
• Typically painless and soft
• The fluid may contain dead sperm cells
• Almost always non-cancerous
• May remain stable in size or gradually enlarge over time
• Usually discovered incidentally during a self-examination or routine medical check

Most spermatoceles do not require treatment unless they cause significant discomfort or cosmetic concern. In such cases, a minor surgical procedure (spermatocelectomy) can be performed to remove the cyst.

Epididymal Cyst

An epididymal cyst is a small, slowly developing fluid-filled sac within the epididymis. It differs slightly from a spermatocele because it does not contain sperm. Instead, it is filled with clear fluid rather than milky fluid.

Key characteristics

• Usually smooth, round, and soft to the touch
• Typically painless, though a sense of heaviness or tenderness may be felt on the affected side
• May cause discomfort if it presses on surrounding structures
• More common in middle-aged men, though the exact cause is unclear
• Benign in nature, with no malignant potential

Small, asymptomatic epididymal cysts require no treatment. Larger cysts that cause pain or discomfort may be surgically removed.

Epididymitis and Orchitis

Epididymitis refers to inflammation of the epididymis. When the inflammation also involves the testicle itself, the condition is called epididymo-orchitis. Orchitis alone refers to isolated inflammation of the testicle, most commonly due to viral infection.

Symptoms typically include

• Swelling and pain on the affected side, developing over hours to days
• Redness and warmth of the scrotal skin
• Fever and chills (especially in bacterial infections)
• Urethral discharge or pain during urination (in sexually transmitted infections)

Common causes

• Sexually transmitted infections (STIs): Chlamydia and gonorrhea are the most frequent causes in sexually active young men
• Urinary tract infections (UTIs): More common in older men, often caused by enteric bacteria such as Escherichia coli
• Mumps virus: Mumps is a classic cause of viral orchitis; it can affect one or both testicles and, in severe cases, may impact fertility

Complications

Epididymo-orchitis is usually treatable and does not lead to permanent damage when addressed promptly. However, it can occasionally reduce sperm production. Rarely, if left untreated, it may contribute to male infertility.

Hydrocele

A hydrocele is a collection of clear fluid in the thin sheath surrounding the testicle, causing painless scrotal swelling. It is the most common cause of scrotal swelling in newborns.

In newborns and infants

During fetal development, the testicles form in the abdomen and descend into the scrotum through the inguinal canal. A small channel (the processus vaginalis) normally closes before or shortly after birth. If it remains open, abdominal fluid can flow into the scrotum, creating a hydrocele. In the vast majority of cases in infants, this fluid is naturally reabsorbed within the first one to two years of life, and the hydrocele resolves spontaneously without treatment.

In older boys and adult men

Hydroceles can develop secondary to:

• Scrotal trauma
• Infection (such as epididymo-orchitis)
• Inflammation
• Occasionally, testicular tumors (which can trigger fluid production)

A large or symptomatic hydrocele in adults may require aspiration (draining the fluid with a needle) or surgical repair.

Hematocele

A hematocele is a collection of blood between the layers of the tunica vaginalis, the thin sheath surrounding each testicle.

Primary cause:

• Traumatic injury to the scrotum or testicle, such as a direct blow during sports or an accident

Symptoms:

• Painful swelling of the scrotum
• Skin bruising or discoloration
• Firmness of the scrotum on palpation

A hematocele can be associated with underlying testicular injury and should be evaluated with a scrotal ultrasound to rule out testicular rupture. Larger or symptomatic hematoceles may require surgical drainage.

Varicocele

A varicocele is an abnormal dilation and tortuosity of the pampiniform plexus, the network of veins that drains the testicles. It is essentially varicose veins within the scrotum and is found in approximately 15% of the general male population and in up to 40% of men investigated for infertility.

Key characteristics

• Almost always occurs on the left side (due to the different angle at which the left testicular vein drains into the left renal vein)
• Often described as a “bag of worms” due to the feel and appearance of the enlarged, tortuous veins
• Usually develops gradually
• Variable in size: some are detectable only on examination (clinical varicocele), while others are visible to the naked eye
• The scrotum may appear to hang lower on the affected side

Symptoms

Most varicoceles are asymptomatic. Some men describe:

• A dull ache or dragging sensation in the scrotum or groin
• Discomfort that worsens after prolonged standing or physical activity
• A feeling of heaviness

Varicocele and fertility

Varicoceles are the most commonly identified correctable cause of male infertility. They are thought to impair fertility by increasing testicular temperature, reducing blood flow, and creating oxidative stress that damages sperm. However, it is important to note that surgical correction (varicocelectomy or embolization) does not guarantee improvement in fertility, and the decision to treat should be individualized.

Inguinal Hernia

An inguinal hernia occurs when fatty tissue or a portion of the intestine protrudes through a weak point in the muscles of the lower abdominal wall, into the inguinal canal and sometimes extending into the scrotum.

Key characteristics

• More common in men than women, due to anatomical differences
• May present as a visible or palpable bulge in the groin or scrotum
• Often reducible (the bulge may disappear when lying down and reappear when standing or straining)
• Usually painless, but can cause discomfort, particularly after prolonged standing, heavy lifting, or coughing

When to seek emergency care:

If the hernia becomes incarcerated (trapped) or strangulated (blood supply cut off), it causes sudden, severe pain and requires emergency surgery. Signs of a strangulated hernia include:

• Sudden worsening pain
• Nausea and vomiting
• Inability to reduce the bulge
• Redness or discoloration of the overlying skin
• Fever

Causes:

Inguinal hernias often result from a combination of:

• Age-related weakening of the abdominal wall muscles
• Increased intra-abdominal pressure from chronic constipation, heavy lifting, or persistent coughing
• Congenital weakness in the inguinal canal (present from birth)

The only definitive treatment is surgical repair, which can be performed as an open operation or laparoscopically.

Testicular Torsion

Testicular torsion is a urological emergency that occurs when the spermatic cord, which carries blood to and from the testicle, twists around itself and cuts off the blood supply to the affected testicle.

This is not simply a painful scrotal mass: it is a time-critical medical emergency.

Symptoms

• Sudden onset of severe, sharp pain in one testicle
• Rapid swelling of the scrotum
• Nausea and vomiting
• Abdominal pain
• The affected testicle may appear to be positioned higher than usual (high-riding testicle) or at an abnormal angle

Age distribution

Testicular torsion can occur at any age, including in fetuses in the womb, but it is most common in boys aged 13 to 17 years. It becomes increasingly rare after age 30.

Why timing matters

The testicle can only survive without blood flow for a limited period:

• Within 6 hours: Testicle salvage rate approximately 90%
• After 12 hours: Salvage rate drops to around 50%
• After 24 hours or more: Salvage rate falls to approximately 10% or less

If you suspect testicular torsion, call emergency services or go to the nearest emergency department immediately. Do not wait to see if the pain resolves on its own.

Causes and predisposing factors:

Most cases occur without a clear precipitating cause. However, risk is higher in men with:

• A “bell-clapper” deformity (a congenital anomaly in which the testicle is not firmly attached to the tunica vaginalis) allows it to rotate freely
• History of undescended or retractile testicles
• Family history of testicular torsion
• Prior trauma to the scrotum

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Risk Factors

Different types of scrotal masses have different risk factors. The following are considered the most clinically significant:

Undescended or Retractile Testicle (Cryptorchidism)

A testicle is said to be undescended (cryptorchid) when it fails to descend from the abdomen into the scrotum during fetal or early postnatal development. A retractile testicle is one that has descended but can be drawn back up into the groin.

Both conditions are associated with an increased risk of:

• Inguinal hernia
• Testicular torsion
• Testicular cancer (the risk remains elevated even after surgical correction)

Early surgical correction (orchiopexy) is recommended to minimize these risks.

Congenital Anomalies

Certain abnormalities present at birth, including anatomical variants in the shape, position, or attachment of the testicles, can increase the risk of scrotal masses and testicular cancer later in life.

Personal or Family History of Testicular Cancer

Men who have previously had cancer in one testicle face a significantly higher risk of developing cancer in the other testicle. A family history of testicular cancer (father, brother) also increases risk substantially. Regular self-examination is especially important in these individuals.

Age

While testicular cancer most commonly affects men between 15 and 49 years, various other types of scrotal masses (such as varicocele, epididymal cysts, and inguinal hernias) become more prevalent with age.

Sexual Activity and STI History

A history of sexually transmitted infections, multiple sexual partners, or unprotected sex increases the risk of epididymo-orchitis caused by chlamydia or gonorrhea.

Potential Complications of Untreated Scrotal Masses

Not all scrotal masses lead to long-term complications: many are entirely harmless. However, certain conditions, if left untreated, can result in:

• Delayed or impaired puberty (particularly in boys with untreated cryptorchidism or hormonal disruption)
• Male infertility, either through direct damage to the testicle or through impaired sperm production or transport
• Testicular atrophy (shrinkage), especially after torsion or severe infection
• Spread of cancer (in the case of undetected or untreated testicular malignancy)

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Diagnosis

Medical History and Physical Examination

When you present to your doctor with a scrotal lump or swelling, they will begin by taking a detailed medical history, asking about:

• When you first noticed the lump
• Whether it has changed in size, shape, or texture
• Associated pain, its character, onset, and radiation
• Any recent trauma, infections, or urinary symptoms
• Personal and family history of testicular cancer or cryptorchidism

The doctor will then perform a physical examination of the scrotum, testicles, and groin, carefully palpating each structure to identify the location, size, consistency, and tenderness of the mass.

Transillumination

A simple bedside test called transillumination involves shining a light source (such as a pen torch) through the scrotal lump in a darkened room. Fluid-filled structures (such as hydroceles or cysts) will allow light to pass through them, while solid masses (such as tumors or hematomas) will block the light. This quick test provides useful initial information about the nature of the mass.

Scrotal Ultrasound

A scrotal ultrasound is the gold standard imaging investigation for evaluating testicular lumps. It is a painless, non-invasive procedure that uses high-frequency sound waves to produce detailed images of the internal structures of the scrotum. It can:

• Differentiate between solid and cystic masses
• Identify the precise location and size of the mass
• Detect features suggestive of malignancy (e.g., irregular borders, internal vascularity)
• Evaluate blood flow to the testicle (Doppler ultrasound is particularly useful in suspected torsion)

Blood and Urine Tests

Depending on the suspected diagnosis, the doctor may request:

• Urine tests to look for signs of urinary tract infection or STI
• Urethral swabs: to detect chlamydia, gonorrhea, or other pathogens
• Blood tests, including a full blood count (to look for signs of infection or inflammation) and tumor markers, such as:
  • Alpha-fetoprotein (AFP)
  • Beta-human chorionic gonadotropin (β-hCG)
  • Lactate dehydrogenase (LDH)

These markers are elevated in certain types of testicular cancer and are also used to monitor treatment response and detect recurrence.

Additional Imaging

If testicular cancer is confirmed or strongly suspected, further staging investigations may include:

• CT scan of the chest, abdomen, and pelvis: to detect lymph node involvement or distant metastases
• MRI: occasionally used for further characterization of equivocal lesions

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Treatment Options

The treatment of scrotal masses depends entirely on the underlying cause, the severity of symptoms, and individual patient factors. Here is a detailed overview of treatment approaches for each major condition.

Treating Varicocele

Many varicoceles require no treatment, particularly if they are asymptomatic and not associated with infertility.

When treatment is indicated, typically for pain, infertility concerns, or progressive testicular atrophy, options include:

• Surgical varicocelectomy: The dilated veins are tied off through a small incision, typically performed under general or spinal anesthesia. This can be performed as an open procedure or laparoscopically.
• Percutaneous embolization: A minimally invasive, radiologically guided procedure in which the abnormal veins are blocked using a catheter inserted through the groin or neck. It carries a lower risk of complications and allows faster recovery.
• Microsurgical varicocelectomy: Considered the gold standard by many specialists, this technique uses a surgical microscope to allow precise ligation of abnormal veins while preserving arteries and lymphatics, minimizing the risk of recurrence and complications.

Treating Hydrocele

In infants and young children, hydroceles are typically observed conservatively, as the majority resolve spontaneously within the first one to two years of life.

In older boys and adult men, treatment may be considered if the hydrocele:

• Is large and causing discomfort
• Is associated with an underlying condition (e.g., infection, tumor)
• Shows no signs of spontaneous resolution

Treatment options include:

• Aspiration: Draining the fluid with a fine needle. Simple and quick, but with a high recurrence rate.
• Hydrocelectomy: Surgical removal or marsupialisation of the hydrocele sac. This is definitive and has lower recurrence rates than aspiration.

Treating Infections

The treatment of infection-related scrotal masses depends on whether the cause is bacterial or viral.

Bacterial epididymo-orchitis:

• Treated with a 10 to 14-day course of antibiotics
• The choice of antibiotic depends on the likely causative organism:
  • In sexually active men under 35: doxycycline (covering chlamydia) ± ceftriaxone (covering gonorrhea)
  • In older men or those with urinary tract risk factors: quinolone antibiotics (e.g., ofloxacin or levofloxacin)
• Supportive measures: scrotal support, pain relief (NSAIDs or paracetamol), rest, and ice packs

Viral orchitis (e.g., mumps):

• No specific antiviral treatment is available
• Management is supportive: rest, scrotal elevation, ice packs, and analgesics
• Vaccination against mumps (as part of the MMR vaccine) is the most effective prevention

Treating Benign Scrotal Masses

Benign scrotal masses, such as epididymal cysts, spermatoceles, and small lipomas, may be:

• Observed without treatment if asymptomatic and stable
• Surgically removed if they cause significant pain, discomfort, or cosmetic concerns
• Aspirated (drained) in some cases, though fluid may reaccumulate

The decision to intervene depends on:

• Whether the mass causes pain or discomfort
• Whether it is contributing to infertility or increasing its risk
• Whether it has become infected or is enlarging

Treating Inguinal Hernia

Surgical repair is the only definitive treatment for an inguinal hernia. Observation may be appropriate for very small, asymptomatic hernias in elderly patients with significant surgical risk, but most inguinal hernias should be repaired to prevent complications.

Surgical options include:

• Open hernia repair (herniorrhaphy or hernioplasty): A single incision in the groin through which the hernia is repaired. A mesh is usually used to reinforce the weakened abdominal wall.
• Laparoscopic repair: A minimally invasive approach using small incisions and a camera. Associated with faster recovery and less post-operative pain.

In the case of a strangulated hernia, emergency surgical intervention is required immediately.

Treating Testicular Torsion

Testicular torsion is a surgical emergency. Time from symptom onset to surgical intervention is the most critical factor in determining outcome.

• Manual detorsion: A doctor may attempt to manually untwist the spermatic cord (manual detorsion) as a temporary measure while the patient is prepared for surgery. This is not always successful and should not delay surgical intervention.
• Emergency surgical exploration: Under general anesthesia, the scrotum is opened, the spermatic cord is untwisted, and the testicle is assessed for viability.
  • If the testicle is viable: orchiopexy (fixing the testicle to the scrotal wall to prevent future torsion) is performed on both sides (bilateral fixation).
  • If the testicle is non-viable: orchiectomy (surgical removal of the testicle) is performed, followed by orchiopexy of the remaining testicle.

Outcomes based on timing:

The message is clear: if testicular torsion is suspected, do not wait. Seek emergency medical care immediately!

Treating Testicular Cancer

The treatment of testicular cancer is determined by several factors, including the type and stage of the cancer, the patient’s age, and overall health status. An oncologist (cancer specialist) will develop an individualized treatment plan.

Radical inguinal orchiectomy:

This is the primary and essential treatment for testicular cancer. It involves the surgical removal of the affected testicle and the spermatic cord through an incision in the groin (not the scrotum, to avoid disrupting lymphatic drainage). This procedure serves both as a therapeutic intervention and as a histological diagnosis. A testicular prosthesis (implant) can be offered to men who are concerned about cosmetic appearance after orchiectomy.

Lymph node surgery (retroperitoneal lymph node dissection, RPLND):

If there is evidence of cancer spread to the retroperitoneal lymph nodes, surgical removal of these nodes may be recommended, particularly for non-seminomatous germ cell tumors.

Radiotherapy:

High-energy X-rays or other radiation are used to destroy residual cancer cells after the testicle is removed. Radiotherapy is used primarily in seminoma, one of the two main types of testicular germ cell tumor, to treat lymph nodes in the abdomen and pelvis.

Chemotherapy:

Chemotherapy uses powerful cytotoxic drugs to kill cancer cells throughout the body. The most commonly used regimen for testicular cancer is BEP (bleomycin, etoposide, and cisplatin). Chemotherapy may be used:

• As adjuvant treatment after orchiectomy
• For metastatic disease
• For non-seminomatous germ cell tumors

Prognosis:

Testicular cancer has one of the highest cure rates of any solid tumor. Five-year survival rates exceed:

• 95% for localized disease (confined to the testicle)
• 80–90% for regional spread (to lymph nodes)
• 70–80% for metastatic disease (depending on risk classification)

Regular follow-up with tumor markers, imaging, and clinical assessment is essential after treatment to detect any recurrence early.

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Prevention: Testicular Self-Examination

Testicular self-examination (TSE) is a simple, painless procedure that every man should perform regularly, ideally once a month. It allows you to become familiar with the normal size, shape, and feel of your testicles, making it easier to detect any unusual changes early.

While TSE has not been formally recommended as a universal population screening tool by all health authorities (due to limited evidence of reduction in mortality), it remains a widely endorsed practice for raising awareness and detecting abnormalities early. It is particularly recommended for men with risk factors for testicular cancer.

How to Perform a Testicular Self-Examination

Follow these step-by-step instructions for an effective examination:

1. Examine your testicles once a month, especially if you have a personal or family history of testicular cancer.

2. Perform the examination after a warm bath or shower. The heat causes the scrotal skin to relax and the testicles to descend lower, making the examination easier and more comfortable.

3. Stand in front of a mirror. Look at the surface of the scrotal skin for any visible swelling, redness, or changes in appearance.

4. Support the scrotum in the palm of one hand and feel whether it seems heavier or different than usual.

5. Examine each testicle separately using both hands:

   • Place your index and middle fingers beneath the testicle
   • Place your thumbs on top
   • Gently roll the testicle between your thumbs and fingers

6. Feel for any lumps, bumps, or areas of hardness. Testicles should feel smooth, firm, and oval-shaped. It is normal for one testicle to be slightly larger or hang lower than the other, which is not a cause for concern.

7. Locate the epididymis, the soft, rope-like structure that runs behind and on top of each testicle. This is a normal anatomical structure and should not be confused with a lump. Check it for tenderness, swelling, or hardness.

8. See your doctor promptly if you notice:

   • A hard, painless lump on the testicle itself
   • A significant change in size or shape
   • A dragging sensation or dull ache in the scrotum
   • Any other change that concerns you

Additional Preventive Measures

• Wear appropriate protective gear during contact sports to prevent scrotal trauma and reduce the risk of hematocele and testicular injury.
• Practice safe sex to reduce the risk of sexually transmitted infections that can cause epididymo-orchitis.
• Ensure timely treatment of undescended testicles in boys to reduce the long-term risk of testicular cancer and other scrotal conditions.
• Maintain a healthy lifestyle: regular physical activity, a balanced diet, and avoiding tobacco use support overall reproductive health.
• Attend routine medical check-ups: a physician can perform a professional genital examination as part of a standard health assessment.

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A Note on Anxiety and Men’s Health

It is well recognized that many men delay seeking medical attention for symptoms related to their genitalia, often due to embarrassment, anxiety, or a tendency to minimize symptoms. This delay can have serious consequences, particularly in conditions like testicular torsion (where hours matter) or testicular cancer (where early detection dramatically improves outcomes).

There is no reason to be embarrassed. Urologists and primary care physicians routinely evaluate scrotal symptoms and are trained to do so in a professional and sensitive manner. Any new or unusual change in the testicles or scrotum deserves prompt evaluation, not because it is necessarily serious, but because knowing is always better than not knowing.

If you are anxious about a testicular lump, the single best thing you can do is make an appointment with your doctor today.

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Key Takeaways

• Scrotal masses are common and usually benign, but always require medical evaluation.
• The most common causes include varicocele, hydrocele, epididymal cysts, epididymo-orchitis, and inguinal hernia.
• Sudden, severe testicular pain may indicate testicular torsion, a medical emergency requiring immediate surgery.
• Testicular cancer is the most common cancer in men aged 15–49 but is highly treatable when detected early.
• Regular testicular self-examination is a simple and effective way to detect changes early.
• Never delay seeking medical care for a scrotal lump or change in testicular appearance or sensation.

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References and Bibliography

• NHS: Testicle Lumps and Swellings (Licensed under the Open Government Licence)
• Cancer Research UK: Testicular Cancer Statistics. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/testicular-cancer
• Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. American Family Physician. 2009;79(7):583-587.
• Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology. 2003;227(1):18-36.
• Favorito LA, Sampaio FJB. Testicular torsion: epidemiology and pathophysiology. International braz j urol. 2020.
• Tan WP, Levine LA. An overview of the management of inguinal hernias in men. Current Urology Reports. 2016.
• Dohle GR, et al. EAU Guidelines on Male Infertility. European Association of Urology. 2022. Available at: https://uroweb.org/guideline/male-infertility/
• American Urological Association (AUA) Guideline on the Management of Testicular Torsion. Available at: https://www.auanet.org
• Albers P, et al. EAU Guidelines on Testicular Cancer. European Association of Urology. 2023. Available at: https://uroweb.org/guideline/testicular-cancer/
• Kollin C, Ritzén EM. Cryptorchidism: a clinical perspective. Pediatric Endocrinology Reviews. 2014;11 Suppl 2:240-250.