Scrotal masses

A scrotal mass is any lump or area of swelling in the scrotum, the skin sac that holds the testicles. The lump may be in a testicle, in the tissues around it, or in the scrotal skin.

Many scrotal masses are caused by non-cancerous fluid collections, cysts, or enlarged veins. However, you cannot reliably tell the cause by touch alone. A new lump should be examined, even if it is small and painless.

Sudden pain and swelling need more urgent attention. They can sometimes occur when a testicle twists and loses its blood supply, called testicular torsion.

A scrotal mass may affect one or both sides. It can be painful, tender, or completely painless.

You may notice:

• A smooth or firm lump
• General swelling or one side appearing larger
• A heavy or dragging feeling
• An ache that is worse after standing or activity
• A soft cluster of enlarged veins
• Red, warm, or thickened scrotal skin
• A bulge extending down from the groin

The swelling may change when you stand, lie down, cough, or strain. A lump above or behind a testicle may come from the epididymis, a coiled tube that stores and carries sperm.

A lump that seems to be within the testicle itself needs prompt medical assessment, whether or not it hurts.

Common causes include fluid-filled swellings and changes in structures around the testicle.

A hydrocele is fluid around a testicle. It often causes smooth, painless swelling and may make the scrotum feel heavy.

An epididymal cyst or spermatocele is a fluid-filled lump arising from the epididymis. It is usually felt above or behind the testicle and is often painless.

A varicocele is a group of enlarged veins. It may feel like a soft bundle of cords and can become more noticeable while standing. Some cause a dull ache or dragging feeling.

Scrotal skin can also develop blocked glands, cysts, or inflamed hair follicles.

Less common causes include an inguinal hernia, where bowel or fatty tissue pushes through the groin into the scrotum. Infection of the epididymis or testicle can cause pain, swelling, warmth, fever, urinary symptoms, or discharge from the penis. Bleeding and swelling can also follow an injury.

A testicular tumour may cause a firm lump, enlargement, or a change in how a testicle feels. It is less common than benign causes, but it is important to rule out promptly.

Urgent causes include testicular torsion and a trapped hernia. These can interrupt blood flow and require emergency treatment.

Go to an emergency department now if you develop sudden, severe pain in one testicle, especially with swelling, nausea, vomiting, or a testicle sitting higher than usual. Do not wait to see whether it settles. Testicular torsion is time-sensitive.

Emergency care is also needed for a painful groin or scrotal bulge that becomes firm or cannot be pushed back, particularly with vomiting, abdominal pain, or difficulty passing stool or gas. This may be a trapped hernia.

Seek same-day medical care for:

• Rapidly worsening pain or swelling
• Fever with a red, hot, or tender scrotum
• Pain after a significant injury
• Scrotal pain with burning urination or penile discharge
• New pain in someone who is generally unwell

Book a prompt appointment for any new lump, firm area, persistent swelling, or change in a testicle. Painless lumps still need assessment. A known mass should also be reviewed if it grows, becomes painful, or changes in texture.

A clinician will ask when you noticed the mass, whether it hurts, and whether it changes with standing, coughing, or lying down. They may ask about injuries, urinary symptoms, sexual health, previous surgery, and fertility concerns.

The examination usually includes the scrotum, testicles, epididymis, and groin. You may be examined while standing and lying down.

An ultrasound is often used. It creates images with sound waves and can show whether a mass contains fluid, involves enlarged veins, or is within the testicle. Doppler ultrasound also measures blood flow.

Depending on your symptoms, you may need urine tests, tests for sexually transmitted infections, or blood tests. If a testicular tumour is suspected, specialist assessment and specific blood tests may be arranged. No single blood test can rule it out.

Treatment depends on the cause, the amount of discomfort, and whether the mass is changing.

Small, painless hydroceles, epididymal cysts, and varicoceles may only need monitoring. Surgery or another procedure may be considered if they become large, painful, or affect daily life. A hernia may need surgical repair.

Bacterial infections are treated with antibiotics like amoxicillin or doxycycline chosen for the likely cause. Testicular torsion requires emergency surgery. A suspicious testicular mass is assessed by a urology specialist, who will discuss the appropriate treatment.

Until you are assessed, supportive underwear may reduce mild pulling or heaviness. A cold pack wrapped in cloth can help after a minor injury, but do not place ice directly on the skin. Over-the-counter pain medicine may help if it is safe for you; follow the label or ask a pharmacist.

Do not squeeze, puncture, or try to drain a lump. Self-care should not delay urgent assessment for sudden pain.

Many scrotal masses are benign and remain stable or improve after treatment. Some can persist for years without causing harm.

If monitoring is recommended, note changes in size, firmness, discomfort, or the shape of the testicle. Return for review if anything changes.

Most benign masses do not affect fertility. Some varicoceles, infections, testicular conditions, and their treatments can affect sperm production. If fertility matters to you, raise this before planned treatment so your options can be discussed.

Can I tell what the lump is by feeling it?

Not reliably. Fluid, veins, cysts, hernias, and solid lumps can overlap in how they feel. An examination and ultrasound may be needed.

Is a painless lump less concerning?

Pain does not determine whether a lump is serious. Many harmless masses are painless, but testicular tumours can also be painless. Arrange a prompt appointment.

Can an infection cause a scrotal mass?

Yes. Infection can enlarge the epididymis or testicle and may cause tenderness, warmth, fever, urinary discomfort, or discharge. It usually needs same-day assessment.

Is one testicle normally lower than the other?

Yes. It is common for one testicle to sit slightly lower or be a little larger. A new change in size, shape, firmness, or position should still be checked.