Most lumps of the scrotum are not cancerous. However, testicular cancer is the most common cancer of young men. It's always best to have any scrotal lumps evaluated by your doctor for peace of mind, or treatment, if required.
Epididymal cysts are very common and can be found at any age. They are fluid-filled cysts that grow from the epididymis and usually observed as a pea-sized lump at the top of the testicle, but are also known to grow larger.
Epididymal cysts are not dangerous, and can usually be left alone.
If epididymal cysts grow larger and bothersome, they can be removed with a minor surgery. The operation to remove epididymal cysts can cause scarring, which may affect the flow of sperm, affecting fertility. This is why this surgery should be avoided in men who are still going to
Epididymal cysts can be drained with a needle and syringe, but this is not recommended as the cyst will return, and there is the danger of infection.
A hydrocele is a build-up of fluid in the scrotum. Most develop for no apparent reason, are harmless and can be left alone. In a small number of cases, a hydrocele is due to an underlying problem with a testicle. An ultrasound scan can be done to rule out an underlying cause such as cancer in the testis.
If the hydrocele is causing discomfort, it can be cured with a minor surgery. Draining the hydrocele with a needle and syringe is possible, but the fluid almost always comes back. The outcome from surgery is far superior to needle drainage.
A varicocele is a swelling of the veins above your testicles, also known as varicose veins. It’s relatively common, and usually happens on the left side of the testicles.
Varicoceles first appear at puberty and can sometimes cause discomfort.
In men who are subfertile, a varicocele may be a contributory cause.
A varicocele can be treated by making a small incision in the groin to tie up the vein.
Epididymo-orchitis (inflammation/infection of the epididymis/testis)
Epididymitis is a painful swelling or inflammation of the epididymis (a thin, coiled tube connected to the testicles).
Your epididymis runs most of the way around your testicle, so you’ll often feel pain in your testicles. It can be difficult to tell if the pain and swelling is coming from your epididymis, your testicle, or both.
Epididymitis can spread to the testis, at which point it is called epididymo-orchitis (EO)
EO happens after you’ve had a viral or bacterial infection. If you’re younger, the most likely cause is a sexually transmitted infection, such as chlamydia. If you’re older, epididymitis is often because of the bacteria that cause urinary tract infections, such as E. coli.
Sometimes this condition can develop after a vasectomy or an injury to your epididymis. It can happen to cyclists because of an injury from the saddle, but this is rare.
EO is treated with antibiotics and pain-killers. Cold compresses often help with the swelling.
Testicular torsion happens when a testicle twists in the scrotum. This cuts off the blood supply, and causes swelling. Unless the condition is treated quickly, the testis can die.
Testicular torsion is most common in teenagers or young adults. Sometimes it happens because the testicle is not securely attached to the wall of the scrotum, making it more likely to twist and block the blood supply.
Torsion can be triggered by physical and sexual activity. Sudden, severe testicular pain should be checked at the nearest hospital straight away (even if it is in the middle of the night). The first few hours are vital if the testicle is to be saved.
Testicular torsion is a medical emergency, and needs immediate surgery to relieve the pain and to save the testis.
The longer the testicle is without a blood supply, the lower the chance of being able to save it. During surgery the other testicle should also be fixed in position to stop it twisting.