Testicle lump

A testicle lump is a bump, swelling, or change in shape felt in a testicle or nearby tissue. The testicles sit inside the scrotum, the loose skin sac below the penis.

Many testicle lumps are caused by non-cancerous conditions, such as fluid-filled cysts or enlarged veins. However, it can be difficult to tell whether a lump is in the testicle or in the tissue around it. Any new lump or lasting change should be examined by a healthcare professional.

A lump does not automatically mean cancer. Testicular cancer is less common than several other causes, but it is important to rule it out because treatment is usually most effective when started early.

Sudden pain and swelling are different from a painless, slowly noticed lump. They can sometimes be caused by testicular torsion, where the testicle twists and loses its blood supply. This is an emergency.

A lump may be hard, firm, rubbery, or soft. It may be painless or tender. You might notice one small bump or a more general swelling of one side of the scrotum.

Other possible changes include:

• One testicle becoming larger, heavier, or firmer
• A smooth swelling around the testicle
• A soft group of enlarged veins
• Red or warm scrotal skin
• Aching in the testicle, groin, or lower abdomen
• A bulge that becomes clearer when standing, coughing, or straining

It is normal for one testicle to hang lower or be slightly larger than the other. At the back of each testicle is the epididymis, a soft, coiled tube that stores sperm. It can feel like a ridge or small cord and may be mistaken for a lump.

Even so, do not rely on touch alone to decide what a new change is.

Epididymal cysts and spermatoceles are fluid-filled lumps arising from the epididymis, usually above or behind the testicle. They are often smooth and painless. A spermatocele contains fluid and sperm, but it is also usually harmless.

Hydrocele is a collection of fluid around a testicle. It commonly causes smooth swelling rather than a distinct bump. The scrotum may feel heavy but is not always painful.

Varicocele means enlarged veins in the scrotum. It may feel like a soft bundle of cords, sometimes described as a “bag of worms.” It is often easier to feel while standing and is more common on the left side.

Epididymitis or orchitis means inflammation of the epididymis or testicle. Infection is one possible cause. Symptoms may include tenderness, warmth, swelling, pain when urinating, discharge from the penis, or fever.

Inguinal hernia occurs when tissue from the abdomen pushes through a weak area into the groin and sometimes the scrotum. The bulge may become more noticeable when you cough, lift, or stand.

Injury or bleeding can cause swelling, bruising, or a tender lump. Even a minor injury may make an existing lump easier to notice.

Testicular cancer may cause a firm, usually painless lump within a testicle. Other possible changes include enlargement, heaviness, or a difference in firmness. These changes can have other causes, but they need prompt assessment.

Testicular torsion usually causes sudden, severe pain and swelling rather than a slowly developing lump. It happens when the spermatic cord twists and cuts off blood flow to the testicle.

Go to an emergency department now if you have:

• Sudden, severe testicle pain or swelling
• Testicle pain with nausea, vomiting, or abdominal pain
• A testicle that suddenly sits higher or at an unusual angle
• A painful groin or scrotal bulge that becomes hard or cannot be pushed back
• Severe pain or rapidly increasing swelling after an injury

These symptoms may require treatment within hours. Do not wait to see whether they improve.

Seek same-day medical advice if swelling or pain is accompanied by fever, red or hot skin, pain when urinating, or discharge from the penis. Infection may need prompt treatment.

Book an appointment soon for any new lump, enlargement, change in firmness, or persistent ache, even if it is painless. A painless lump is not usually an emergency, but it should not be left until a routine check months later.

A healthcare professional will ask when you noticed the change, whether it hurts, and whether you have had an injury, urinary symptoms, fever, or sexual health concerns.

They will usually examine both testicles and the surrounding tissue. You may be examined while standing and lying down because hernias and varicoceles can change with position.

A scrotal ultrasound is often used. This painless scan uses sound waves to show whether a lump is solid or fluid-filled and whether it is inside or outside the testicle. Doppler ultrasound can also assess blood flow.

Urine tests or tests for sexually transmitted infections may be needed if infection is possible. If an ultrasound suggests a testicular tumour, blood tests may measure substances called tumour markers, and you will usually be referred promptly to a urology specialist.

Treatment depends on the cause and how much it affects you.

Small epididymal cysts, hydroceles, or varicoceles may only need monitoring. Surgery may be considered if they become large, painful, or cause other problems.

Bacterial infections are treated with antibiotics like amoxicillin or doxycycline chosen for the likely cause. If a sexually transmitted infection is found, sexual partners may also need testing or treatment.

A hernia may require surgical repair. Testicular torsion needs emergency surgery to restore blood flow. Suspected testicular cancer is managed by a specialist team; treatment commonly begins with surgery to remove the affected testicle.

While waiting for a non-emergency appointment, supportive underwear may reduce discomfort. A wrapped cold pack used for short periods may help after a minor injury. You may consider an over-the-counter pain reliever if it is safe for you and taken according to its label.

Do not squeeze, puncture, or try to drain a lump. Self-care should not delay assessment of a new change.

What happens next depends on where the lump is and what caused it. Many lumps outside the testicle are benign, meaning they are not cancerous, and may not need treatment.

Inflammation may improve after its cause is treated, although tenderness or swelling can take time to settle. Cysts, hydroceles, and varicoceles may remain stable or slowly change.

If an examination or ultrasound raises concern about cancer, referral and further testing are usually arranged promptly. Most testicular cancers respond well to treatment, particularly when found early.

Return for medical review if a known lump grows, becomes painful, changes in firmness, or causes new symptoms.

Can a normal structure feel like a lump?

Yes. The epididymis normally feels like a soft ridge behind each testicle. However, a new or uncertain lump should still be checked rather than assumed to be normal.

Is a painful lump more likely to be cancer?

Pain does not reliably identify the cause. Infection, injury, torsion, and cysts may hurt. Testicular cancer is often painless, but it can sometimes cause discomfort.

Can I tell whether a lump is inside the testicle?

This can be difficult, even with careful checking. An examination and ultrasound are more reliable than self-examination alone.

Should I keep checking the lump?

You can note changes in size, pain, or firmness, but repeated pressing may cause soreness. Arrange an appointment instead of monitoring a new lump indefinitely.