A scrotal mass is a lump or bulge that can be felt in the scrotum, the sac that contains the testicles.
Causes, incidence, and risk factors
A scrotal mass can be benign (generally harmless) or malignant (cancerous). Benign scrotal masses include:
- Varicocele - a varicose vein along the spermatic cord
- Hydrocele - fluid collection in the scrotum
- Hematocele - blood collection within the scrotum
- Spermatocele - a cyst-like mass within the scrotum that contains fluid and dead sperm cells
Scrotal masses can be caused by inflammatory or infectious diseases (for example, epididymitis), physical injury to the scrotum, herniation (inguinal hernia), or tumors.
- Sertoli-Leydig cell tumor
- Testicular cancer
- Painless or painful bulge or lump within the scrotum (testicle lump)
- Enlarged scrotum
Signs and tests
During a physical examination, the doctor may feel a mass within the scrotum that has a variety of possible features:
- Tender or non-tender
- Uniform, smooth, twisted, or irregular
- Fluctuant, firm, or solid
- Typically only on one side
The inguinal lymph nodes in the groin may (or may not) be enlarged or tender on the affected side.
The following tests may be performed to help diagnose a scrotal mass:
- Ultrasound of the scrotum
- Biopsy on masses that are surgically removed
To discover any lumps as early as possible, all men should perform testicular self examination each month.
ALL scrotal masses need to be evaluated by a primary health care provider. Hematoceles, hydroceles, and spermatoceles are usually benign and do not require treatment. Sudden, temporary conditions may respond to local comfort measures and, in some situations, antibiotics or pain relievers.
A scrotal support (jock strap) may provide some relief of the pain or discomfort associated with the scrotal mass. A hematocele, hydrocele, or spermatocele may occasionally require surgery to remove the collection of blood, fluid, or dead cells.
The majority of conditions that cause scrotal masses are either of no consequence or can be easily treated. Even testicular cancer has a high cure rate with early diagnosis and treatment. Nevertheless, any scrotal mass must be evaluated promptly by a qualified physician. Any delay in diagnosing cancer can reduce the ability to cure it.
- Varicoceles may lead to infertility.
- Hematoceles, hydroceles, and spermatoceles may return after surgery.
- Some aggressive forms of testicular cancer may metastasize (move to other organs such as the lungs or liver) before a scrotal mass is large enough to be detected.
Calling your health care provider
Call your health care provider if you find any kind of lump or bulge within your scrotum.
- Scrotal masses linked to sexually transmitted diseases (for example, epididymitis) may be prevented by practicing safe sex.
- Scrotal masses resulting from injury may be prevented by wearing an athletic cup during sports.
- Monthly testicular self examination can catch testicular cancer early, and improve the chances of curing it. All men 15 years or older should learn how to perform testicular self examination.
by Dave R. Roger, M.D.