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Scrotal masses
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Scrotal masses

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Scrotal masses have various causes, including cysts, infection, inflammation, inguinal hernia and tumors. The tumors may be noncancerous (benign) or cancerous (malignant). Tumors growing within the testicles most often are malignant, whereas those located elsewhere within the scrotum are usually benign. Because of the possible severity of the scrotal mass, it's important to have a doctor check out any swelling or lumps. Specific causes of scrotal masses include:

  • Epididymitis. This infection in the tubular coil (epididymis) that collects sperm from the testes produces pain in the top and rear of the scrotum. The pain is generally severe and develops gradually over several hours or days. Fever and swelling also are common.

  • Spermatic cyst (spermatocele). This common type of painless, benign cyst develops adjacent to the epididymis near the top of the testicle.

  • Hydrocele. This soft, usually painless swelling in the scrotum is a collection of watery fluid in the sheath that holds the testicle. Normally this sheath contains just enough fluid to lubricate the testicle. When the body produces too much fluid or can't absorb enough fluid, the excess liquid creates a hydrocele. Hydroceles are a common cause of scrotal swelling and may occur on one or both sides. Hydroceles may occur at any age, but occur most often in older men.

  • Varicocele. Enlarged (varicose) veins cause this painless, benign source of scrotal swelling, more commonly on the left side. Blood backs up in the veins leading from the testicles because of a problem with valves inside the veins. The swelling is painless, and the area feels like a bag of worms. This sensation may disappear when you lie down. The varicocele itself isn't serious, but it may contribute to infertility.

  • Orchitis. This inflammation of the testicle is often due to a bacterial infection or the mumps virus. It involves pain and swelling in the scrotum along with a feeling of added weight in the scrotum. Orchitis may also occur when there's an infection of the prostate or the epididymis. Many less common diseases may have orchitis among their manifestations. Orchitis can permanently damage one or both testicles, resulting in diminished size of the testicle, inadequate hormone production and infertility.

  • Inguinal hernia. An inguinal hernia develops when abdominal contents, usually the small bowel, protrude through a weak point of the abdominal wall in the groin area, where the blood vessels and ducts from the testicles enter the abdominal cavity. The result is a bulge in the groin area that may extend into the scrotum and be painful or uncomfortable.

  • Cancer of the testicle. This condition is serious and identified by a lump or swelling within a testicle, sometimes accompanied by a heavy feeling in a testicle. If detected and diagnosed early, this type of cancer often is treatable.

When to seek medical advice

See your doctor if you detect any pain, swelling or lumps in your testicles or groin area, especially if these signs and symptoms last longer than one to two weeks. Make an appointment with your doctor even if a lump in your testicle isn't painful. Only a small percentage of testicular cancers are painful initially.

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