There are many causes of lumps or pain in the scrotum. Most lumps are not cancer, and many are not serious. However you should always see a doctor if you have pain, or a lump in this area.
What is the scrotum?
The scrotum is a loose bag of skin which hangs behind the penis in men and boys. Inside it are the two testicles (testes). The testicles make the male hormone, testosterone, and produce sperm (semen). The sperm passes along ducts in the testes to a tube called the epididymis where it is stored. Sperm then passes through another tube called the vas deferens. The vas deferens carries the sperm to the penis.
Boys and men should get to know what their testes usually feel like, so they will know if something has changed. See the separate leaflet called Get to Know Your Testes (Testicles).
What causes lumps or pain in the scrotum?
Swellings in the scrotum can be due to:
- Extra fluid inside.
- Abnormal tissue growing.
- Normal tissue which has become swollen, inflamed, or hard.
What are the symptoms of scrotal lumps?
The symptoms depend on the cause of the problem. Possible symptoms include:
- Noticing a lump which has not been there before.
- A sudden pain.
- A dull ache.
- Redness or warmth of the skin of the scrotum.
- The testicle (testis) or structures around it may be very tender.
- Swelling of the scrotum.
- Feeling sick (nauseated) or being sick (vomiting).
- Having a temperature, passing urine more frequently, or pus or blood in the urine (if the cause is an infection).
Common causes of pain or painful lumps in the scrotum
When a testicle twists around in the scrotum, the condition is called torsion of the testis. An emergency operation is usually needed to treat this condition.
It most commonly occurs in teenage boys. Newborn babies and younger children sometimes develop this problem. It is uncommon over the age of 25 but does occur sometimes in older adults.
The typical symptom is severe pain that develops quickly - within a few hours, often much more quickly. The pain is in the affected testis but you may also feel it in the middle of the tummy (abdomen). The affected testis soon becomes tender, swollen and inflamed.
See the separate leaflet called Torsion of the Testis for more information.
Epididymo-orchitis and orchitis
Epididymo-orchitis is an inflammation of the epididymis and/or testis. Epididymitis means inflammation of the epididymis. Orchitis means inflammation of a testicle. It is usually due to infection, most commonly from a urine infection or a sexually transmitted infection. It can also happen in boys who get mumps. It is common in men aged 15-30 and in men aged over 60. It does not occur very often before puberty.
Symptoms usually develop quickly - over a day or so. The affected epididymis and testicle swell rapidly and the scrotum becomes enlarged, tender and red. It can be very painful. There may be other symptoms if the epididymo-orchitis is a complication from another infection. For example: pain on passing urine if you have a urine infection; a discharge from the penis if you have a urethral infection; etc. As with any infection, you may have a high temperature (fever) and feel generally unwell. A course of antibiotic medicine will usually clear the infection. Full recovery is usual. Complications are uncommon.
See the separate leaflet called Epididymo-orchitis for more information.
A haematocele is a collection of blood around the testicle. This is usually painful, and may have been caused by an injury.
Common causes of painless lumps in the scrotum
A hydrocele is a collection of fluid in the scrotum.
Hydroceles vary greatly in size. Most hydroceles occur in adults and are most common in men aged over 40 years. Hydroceles are normally painless. Large hydroceles may cause discomfort because of their size. Some babies are born with a hydrocele. These usually improve without any treatment within the first year of life. An operation is usually only advised if the hydrocele persists after 12-18 months of age.
Most hydroceles develop for no apparent reason, are harmless, and can be left alone. If needed, a small operation can usually cure the problem.
A hernia is a lump which occurs from a weakness in the wall of the tummy (abdomen). Males have a small tunnel in the tissues of their groins which occurred when they were developing as a baby. This tunnel allowed the testicles to come down from the abdomen into the scrotum. Tissue from the intestines can also pass into this tunnel, forming an inguinal hernia. If you have an inguinal hernia, a sausage-shaped lump may be felt from the groin to the scrotum. It may go away when you lie down. This is because the tissue slips back along the tunnel to where it should be.
See the separate leaflet called Hernia for more information.
- An epididymal cyst is a fluid-filled sac which grows at the top end of the testicle. It is benign (ie not caused by cancer).The lump can be felt separate from the testicle. Men are most likely to develop these cysts around the age of 40.
- A spermatocele is a cyst which feels like an epididymal cyst but it is filled with sperm (semen).
See the separate leaflet called Epididymal Cyst for more information.
A varicocele is a collection of enlarged (dilated) veins (blood vessels) in the scrotum. It occurs next to and above one testicle or both of the testicles. Varicoceles are common. About 1 in 7 men develop a varicocele - usually between the ages of 15 and 25. Varicoceles are usually painless and usually cause no symptoms. No active treatment is needed in most cases.
See the separate leaflet called Varicocele for more information.
Testicular cancer is a cancer that arises from a testicle. Fewer than 4 in 100 lumps in the scrotum turn out to be cancer. Around half of all cases occur in men under 35 but testicular cancer rarely occurs before puberty. In most cases, the first symptom noticed is a lump that develops on one testicle. The lump is often painless but some people notice some pain or discomfort coming from the affected testicle.
See the separate leaflet called Testicular Cancer for more information.
Uncommon causes of scrotal swellings or pain
Other rare or less common causes include:
- Squamous cell carcinoma. This is a cancer of the skin of the scrotum.
- Generalised oedema. This occurs when there is too much fluid in the body as a whole.
- Sebaceous cysts. These are non-cancerous lumps under the skin.
- Syphilis. This is a sexually transmitted infection. It is not very common in the UK. It can sometimes cause soft lumps called gummas.
- Roundworms. Infection with worms can block the drainage system of the body's fluids.
- Henoch-Schönlein purpura. This is a condition that can cause a skin rash, tummy (abdominal) pain and joint pains. Sometimes the testicles can also become inflamed. It develops because of a reaction of the immune system to a trigger, commonly an infection. Most people who get Henoch-Schönlein purpura are children.
- Allergic rashes.
- Sarcoidosis. This is a condition where tiny lumps, known as granulomas, develop at various sites within your body due to inflammation. Usually it affects the lungs, but occasionally they happen in the scrotum.
- Hidradenitis suppurativa. These are repeated (recurrent) boils of the skin.
When to seek medical advice
You should always see a doctor if you notice any pain or swelling in your scrotum. If it is painful, you should seek advice urgently.
What tests are used for scrotal lumps or pain?
Your doctor will often be able to tell what kind of swelling it is from just examining you. For example, they may shine a light through your scrotum as fluid will light up. Or they may ask you to cough which may make a hernia more obvious. You will usually have an ultrasound scan to be sure of the cause and to find out whether you need any treatment or not. An ultrasound scan is a painless test that uses sound waves to create images of organs and structures inside your body. Sometimes a blood test may be helpful too.
What is the treatment for scrotal lumps or swellings?
The treatment totally depends on the cause. Often no treatment at all is needed. Other times - for example, in testicular torsion or testicular cancer - treatment is needed urgently. See each individual leaflet for further information on the different treatments. Always see a doctor to get advice about whether treatment is needed or not.
Dr Mary Harding
Dr Mary Harding
Dr Hayley Willacy