Mass in Scrotum
A scrotal mass is any lump or swelling within the scrotum. While many causes are benign, any new mass requires prompt evaluation as testicular cancer, though rare, is most common in young men and highly treatable when caught early. Masses may be painless or painful, solid or fluid-filled, and can affect one or both sides of the scrotum.
⚠️ Seek Emergency Care For:
- Sudden severe testicular pain (possible torsion)
- Rapidly growing or enlarging mass
- High fever with scrotal swelling
- Nausea and vomiting with testicular pain
- Testicular trauma with immediate swelling
- Red or purple discoloration of scrotum
- Inability to find or feel testicle
- Severe swelling affecting walking or urination
Definition and Overview
The scrotum contains the testicles, epididymis (sperm storage tubes), blood vessels, and spermatic cord. A mass can develop from any of these structures. While testicular cancer is a primary concern, especially in men aged 15-35, most scrotal masses are benign. However, early evaluation is crucial as testicular cancer has excellent cure rates when detected early.
Scrotal masses vary in their characteristics. Some are fluid-filled (cystic), while others are solid. They may be attached to the testicle itself or surrounding structures. The ability to get above the mass (separating it from the groin) and whether light passes through it (transillumination) helps determine the type of mass.
Common Causes
Benign Fluid Collections
- Hydrocele: Fluid around testicle
- Spermatocele: Sperm-filled cyst
- Epididymal cyst: Clear fluid cyst
- Hematocele: Blood collection
- Pyocele: Infected fluid
- Lymphocele: Lymph fluid collection
Vascular Conditions
- Varicocele: Enlarged veins ("bag of worms")
- Testicular torsion: Twisted blood supply
- Torsion of appendix testis: Twisted remnant
- Thrombosed vessels: Blood clots
- Aneurysm: Vessel bulging (rare)
Infections/Inflammation
- Epididymitis: Epididymis infection
- Orchitis: Testicular infection
- Abscess: Pus collection
- Mumps orchitis: Viral infection
- STI-related: Gonorrhea, chlamydia
- Tuberculosis: Rare in developed countries
Tumors and Masses
- Testicular cancer: Germ cell tumors
- Lymphoma: Blood cancer
- Leukemia: Blood cell cancer
- Metastases: From other cancers
- Lipoma: Fatty tumor
- Adenomatoid tumor: Benign growth
Risk Factors for Testicular Cancer
- Age: Most common in men 15-35 years old
- Undescended testicle: Even after surgical correction
- Family history: Father or brother with testicular cancer
- Previous testicular cancer: In other testicle
- Klinefelter syndrome: Genetic condition
- HIV/AIDS: Increased risk
- Race: More common in white men
Associated Symptoms
Scrotal masses may occur with other symptoms:
- Testicular pain: Varies by cause
- Heaviness: Dragging sensation
- Swelling: One or both sides
- Groin pain: Radiating discomfort
- Abdominal pain: With advanced cancer
- Back pain: Lymph node involvement
- Breast enlargement: Hormonal effects
- Fever: With infection
- Nausea: With torsion
- Urinary symptoms: Difficulty urinating
When It's Serious
Red Flag Symptoms
- Hard, painless mass attached to testicle
- Rapid growth or size change
- Mass that doesn't transilluminate (let light through)
- Associated weight loss or fatigue
- Back or abdominal pain
- Breast tissue enlargement (gynecomastia)
- Young age (15-35 years)
- Family history of testicular cancer
Characteristics Suggesting Cancer
- Firmness: Hard, irregular surface
- Fixed: Doesn't move separately from testicle
- Painless: Usually not painful
- Unilateral: Usually one side only
- Non-transilluminating: Solid, not fluid
Diagnostic Approach
Physical Examination
- Careful palpation of both testicles
- Assessment of mass characteristics
- Transillumination test
- Examination of groin and abdomen
- Checking for lymph nodes
Diagnostic Tests
- Scrotal ultrasound: First-line imaging
- Blood tests: Tumor markers (AFP, hCG, LDH)
- CT scan: Staging if cancer found
- MRI: Complex cases
- Surgical exploration: If diagnosis unclear
- Biopsy: Rarely done (risk of spread)
Testicular Self-Examination
How to Perform
- Best done monthly after warm shower
- Stand in front of mirror
- Examine each testicle separately
- Roll testicle between thumb and fingers
- Feel for lumps, changes in size or consistency
- Note that one testicle may be slightly larger
- Find the epididymis (soft tube behind testicle)
- Report any changes to doctor promptly
Home Care Tips
Comfort Measures
- Wear supportive underwear
- Apply ice packs for swelling
- Take over-the-counter pain relief
- Avoid heavy lifting
- Rest when needed
- Elevate scrotum when lying down
- Avoid tight clothing
- Limit strenuous activities
Monitoring
- Track size changes
- Note pain levels
- Watch for new symptoms
- Document for doctor visit
- Take photos if helpful
- Don't delay evaluation
- Follow up as directed
- Report changes promptly
Prevention
- Regular self-exams: Monthly checks
- Early treatment: Of undescended testicle
- Protective gear: For contact sports
- Safe sex: Prevent STI-related masses
- Mumps vaccine: Prevents orchitis
- Avoid trauma: Careful with activities
- Good hygiene: Reduce infection risk
- Regular check-ups: Annual physical exams