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Scrotal Mass and Pain

A scrotal mass is a lump or bump in the scrotum that you can feel. It may be due to a variety of conditions, and it may be painful. Any mass should be evaluated by your health care provider as soon as possible. Your doctor will talk with you about your medical history to see if you’ve experienced any trauma or injury or have had an infection in the area. Treatment will depend on the underlying cause.

What is a scrotal mass?

”Scrotal mass” is a general term for a lump or bump within the scrotum that you can feel. It may be located on the surface of a testicle or free floating within the scrotal sac. In most cases, a scrotal mass is benign (not cancer). Rarely, a scrotal mass may mean cancer is present. A scrotal mass may or may not be painful.

There are many potential causes for a scrotal mass, including:

  • Benign (non-cancer) conditions: these include collections of fluid, blood, or sperm cells (hematocele, hydrocele or spermatocele, respectively); dilated veins around the testicle (varicocele); cysts that may involve the testicles; and swelling in the epididymis.
  • Injury or infection: these include swelling that occurs after trauma to the testicles or scrotum; infections involving the testicle (orchitis) or epididymis (epididymitis); hernias; and testicular torsion (twisting of the testicle that cuts off its blood flow).
  • Cancer: while rare, testicular cancer is the most common cancer in younger and middle-aged men. It may also occur in older men and, rarely, younger boys. White men are more likely to develop testicular cancer than Black or Asian American men. Many cases of testicular cancer are first detected by a patient feeling a lump in their scrotum through self-examination.

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How is a scrotal mass diagnosed and evaluated?

Many scrotal masses may be easily found through physical examination. Benign conditions such as hematocele, hydrocele or spermatocele may first be noticed by the patient or their doctor during a routine physical. Your doctor may order a scrotal ultrasound or pelvic MRI to further assess the possible cause of the mass or swelling.

If your doctor suspects a testicular cancer, they will usually order a scrotal ultrasound and may also test your blood for proteins or enzymes called tumor markers which, when found in high levels, can indicate cancer is present. Based on this information, your doctor may order Abdominal & Pelvic CT or Abdominal & Pelvic MRI. Biopsy is not recommended as it carries a risk of spreading the cancer cells. If cancer is confirmed, your doctor may use medical imaging to determine the stage of cancer and whether it has spread to other locations in the body.

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How is a scrotal mass treated?

Treatment of a scrotal mass will depend on the underlying cause. Benign conditions may be treated with minimally invasive procedures, such as varicocele embolization. Injuries or infections may require surgery and/or medication.

If cancer is found, chemotherapy, radiation therapy or surgery may be prescribed depending on the type and stage of the tumor. Surgical removal of the testicle may be required.

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Which test, procedure or treatment is best for me?

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This page was reviewed on October 21, 2024

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