What is causing your testicle lump?

You should always check out any lumps in your testes and scrotum

Lumps, pain and swelling in the testicles, the male sex organs which make sperm and the sex hormone testosterone, are extremely common but usually benign and nothing to worry about. Most can be treated with simple measures including painkillers, wearing supportive underwear or antibiotics. Surgery is needed only in a minority of cases.

What could be the cause?

Only 1% of all cancers that occur in men are testicular cancer, mostly affecting men aged 15 to 49. Although testicular cancer does occur in older men too, it's much less common in old age.

Although the odds are positive, don't give your lump or swelling the benefit of the doubt and assume it's benign - get it checked out. Luckily, a simple ultrasound scan can usually differentiate between testicular cancer and a range of benign problems. If you notice pain or swelling, you can book a Testes and Scrotum Scan directly with Ultrasound Direct. You can also visit your GP, who can refer you for a scan, but you could face long waiting times. Ultrasound Direct provides a comprehensive diagnostic scan report, so you can show that to your GP to speed up your next steps.

The Testes and Scrotum Scan uses ultrasound waves to assess the superficial tissue of the scrotum (the bag of loose skin that surrounds the testes), the testicles, epididymis, and the spermatic cord.

Benign causes of pain and swelling in the testes

Be reassured in most cases the root cause of your problem will not be cancer and will be completely benign and non-life threatening, although still capable of causing you discomfort and/or pain. Possible benign causes of swelling and pain include:

  • Varicoceles: These are enlarged, dilated and swollen veins in the scrotum, similar to varicose veins in other parts of the body. These don't normally need treatment unless they get larger or painful. If they do start to cause problems, possible treatment options include: either open surgery or keyhole surgery to tie or clip the testicular veins or another procedure called radiological embolisation, a method of blocking the veins and making them less obvious and eventually causing the varicocele to shrivel away.

  • Hydroceles: These are swellings caused by a build-up of fluid around the testicles. In most cases they don't need treatment. Sometimes though, the fluid needs to be drained by making a small incision (under anaesthetic) in the scrotum, that is then stitched-up with dissolvable sutures.

  • Epididymal cysts: These are spherical lumps caused by a collection of fluid in the epididymis, the tube that stores and carries sperm. They're normally harmless and don't need treatment, but if they get too large or cause pain or discomfort you may be offered surgery to remove them. Antibiotics may be used to treat infections of the epididymis as a result of sexually transmitted infections or urinary tract infections.

  • Epididymo-orchitis: Inflammation of the epididymis and testicles. This can occur as a complication of mumps and also as a result of STIs and UTIs and will usually resolve within 1-2 weeks. Taking painkillers and wearing supportive underwear can help ease the discomfort. If the infection is caused by an STI or UTI a course of antibiotics may be needed.

  • Inguinal hernias: This is where fatty tissue or part of your bowel pokes through into the groin enlarging the scrotum. You may be referred to a surgeon to discuss having surgery to push the bulge back into place and strengthen the weakness in the abdomen wall.

Sudden and severe painful swellings

A sudden and severely painful swelling of the testicle can be a sign of a medical condition called testicular torsion (twisting of the spermatic cord) and the blood supply is interrupted. It's a medical emergency and requires urgent surgery; so if you experience severe pain go straight to your GP or Accident and Emergency Department. The condition can only be confirmed via an exploratory operation, and if the testicle is found to be twisted, the surgeon can untwist the blood supply.

Testicular cancer

Testicular cancer symptoms include a lump or swelling in part of one of the testicles. Around 20% of men with testicular cancer will also experience a sharp pain. Another symptom is the scrotum feeling heavy. If cancer has spread to the lymph nodes at the back of the abdomen, back pain may also be experienced.

Testicular cancer is usually diagnosed by examination, blood tests and an ultrasound scan of the testes and scrotum. A scan can differentiate between a solid tumour and other types of benign lumps.

Treatment involves removal of the affected testicle, a procedure called orchidectomy. You can have an artificial testicle implant made of saline or silicone implanted at the same time. You may also need chemotherapy and/or radiotherapy depending on your pathology results. Survival outlook for testicular cancer is one of the best for all cancers with 98% of men surviving five years or more after diagnosis.