7 Common Symptoms of Scrotal Masses You Should Know

Scrotal masses are abnormal lumps or swellings that develop in or around the scrotum, the pouch of skin that holds the testicles. These masses can vary in size, texture, and location, and may occur in men of any age. While discovering a lump in the scrotal area can be alarming, not all scrotal masses are cancerous. Many are benign conditions such as cysts, hernias, or fluid collections.

Understanding the symptoms of scrotal masses is crucial for early detection and proper medical evaluation. Some masses may be painless and discovered incidentally during self-examination, while others may cause discomfort or other noticeable changes. Regardless of the symptoms, any new lump or swelling in the scrotal area should be evaluated by a healthcare provider promptly to determine the underlying cause and appropriate course of action.

In this article, we’ll explore the most common symptoms associated with scrotal masses to help you recognize potential warning signs and understand when medical attention is necessary.

1. Palpable Lump or Mass

The most common and noticeable symptom of a scrotal mass is the presence of a palpable lump that can be felt during self-examination or bathing. This lump may vary significantly in characteristics depending on the underlying cause.

The lump may feel:

• Small and pea-sized: Some lumps on the testicle skin or within the scrotum may be as small as a pea or rice grain, particularly in early stages
• Firm or hard: Testicular tumors often feel solid and may be attached to the testicle itself
• Soft or fluid-filled: Cysts or hydroceles typically feel softer and may be moveable
• Smooth or irregular: The surface texture can provide clues about the nature of the mass

The location of the lump is also important. It may be on the testicle itself, attached to the epididymis (the tube behind the testicle), or within the scrotal skin. Some men describe finding a painless lump on the testicle during routine self-examination, while others may notice it while showering or dressing.

2. Scrotal Swelling or Enlargement

Swelling or enlargement of the scrotum is another hallmark symptom of scrotal masses. This swelling may affect one side of the scrotum or both, and can range from subtle to quite pronounced.

The swelling may present as:

• Asymmetry: One side of the scrotum appears noticeably larger than the other
• Gradual increase: The scrotum slowly enlarges over weeks or months
• Sudden swelling: Rapid enlargement that occurs over hours or days, particularly with conditions like testicular torsion or infection
• Fluctuating size: The swelling may change in size throughout the day, especially with hernias that may be more prominent when standing

Fluid accumulation, such as in hydroceles or varicoceles, often causes a softer, more generalized swelling, whereas solid masses tend to create more localized enlargement. The skin of the scrotum may appear stretched and shiny when significant swelling is present.

3. Pain or Discomfort

While many scrotal masses are painless, particularly testicular tumors in their early stages, pain and discomfort are common symptoms that accompany certain types of scrotal masses.

The pain characteristics may include:

• Dull ache: A persistent, nagging discomfort in the scrotum or lower abdomen
• Sharp pain: Sudden, severe pain that may indicate testicular torsion or acute infection
• Heaviness: A sensation of pressure or weight in the scrotum, particularly noticeable when standing or walking
• Tenderness to touch: The mass or surrounding area may be sensitive when pressed or examined
• Radiating pain: Discomfort that extends to the groin, lower back, or abdomen

Infectious conditions like epididymitis or orchitis typically cause more significant pain, while benign cysts and tumors are often painless. However, even painless lumps require medical evaluation, as the absence of pain does not indicate that a mass is harmless.

4. Heaviness or Dragging Sensation

Many men with scrotal masses report a feeling of heaviness or a dragging sensation in the scrotum. This symptom is particularly common with larger masses or fluid collections.

This sensation may be described as:

• Weighted feeling: The scrotum feels heavier than normal, especially when standing or walking
• Pulling sensation: A feeling of the scrotum being pulled downward
• Discomfort when active: The heaviness may worsen during physical activity or at the end of the day
• Relief when lying down: The sensation often improves when reclining, particularly with varicoceles

Varicoceles, which are enlarged veins within the scrotum, commonly cause this heavy, aching feeling. Large hydroceles (fluid collections) can also create significant heaviness due to the weight of the accumulated fluid. This symptom, while not typically severe, can affect quality of life and physical activities.

5. Changes in Testicle Texture or Consistency

Alterations in the normal texture and consistency of the testicle or scrotal contents represent an important symptom of scrotal masses. Normal testicles should feel smooth, slightly firm, and uniform in texture.

Abnormal changes may include:

• Hardness: Areas of the testicle that feel significantly harder than surrounding tissue
• Irregularity: A bumpy or uneven surface instead of the normally smooth contour
• Firmness variations: Some areas feeling softer or harder than others
• Nodularity: Multiple small lumps or nodules palpable within the scrotum
• Difference between testicles: One testicle feeling noticeably different from the other in terms of texture

These textural changes can be subtle and may only be noticeable to someone familiar with their normal anatomy through regular self-examination. Any persistent change in how the testicle or scrotum feels should prompt medical evaluation, as early detection of abnormalities significantly improves outcomes for serious conditions.

6. Redness, Warmth, or Skin Changes

Visible changes to the scrotal skin can accompany certain types of scrotal masses, particularly those associated with inflammation or infection.

Skin-related symptoms include:

• Redness: The scrotal skin may appear pink, red, or even purple, indicating inflammation or increased blood flow
• Warmth: The affected area feels warmer to the touch compared to surrounding skin
• Shiny or stretched skin: The skin may appear taut and glossy when significant swelling is present
• Visible veins: Enlarged, prominent veins may be visible through the scrotal skin, particularly with varicoceles
• Skin thickening: The scrotal skin may become thicker or more leathery in chronic conditions
• Translucency: When a light is shone through the scrotum (transillumination), fluid-filled masses like hydroceles may allow light to pass through

These skin changes are more commonly associated with infectious or inflammatory conditions such as epididymitis, orchitis, or abscess formation. However, any persistent skin changes warrant medical attention to rule out serious underlying conditions.

7. Associated Systemic Symptoms

In some cases, scrotal masses may be accompanied by systemic symptoms that indicate a more serious or infectious process affecting the body beyond just the local area.

These systemic symptoms may include:

• Fever and chills: Elevated body temperature indicating infection or inflammation
• Nausea and vomiting: Particularly common with testicular torsion, a medical emergency
• Fatigue and malaise: General feeling of being unwell or lacking energy
• Urinary symptoms: Pain during urination, increased frequency, or blood in urine may accompany infections
• Abdominal pain: Discomfort in the lower abdomen or groin area
• Unexplained weight loss: May occur with testicular cancer or other serious conditions
• Night sweats: Excessive sweating during sleep, which can be associated with certain tumors

The presence of systemic symptoms alongside a scrotal mass typically indicates a more urgent medical situation requiring prompt evaluation. Conditions like testicular torsion, which causes severe pain, nausea, and vomiting, constitute surgical emergencies. Infectious processes causing fever require timely antibiotic treatment to prevent complications.

Main Causes of Scrotal Masses

Scrotal masses can result from numerous underlying conditions, ranging from benign to potentially life-threatening. Understanding the common causes helps contextualize the symptoms and emphasizes the importance of proper medical evaluation.

Benign Causes

• Hydrocele: A collection of fluid around the testicle, creating a painless swelling that can transilluminate (allow light to pass through)
• Varicocele: Enlarged veins within the scrotum, often described as feeling like a “bag of worms,” typically more prominent when standing
• Spermatocele: A cyst in the epididymis containing fluid and dead sperm cells, usually painless and located above and behind the testicle
• Epididymal cyst: A fluid-filled sac in the epididymis, similar to a spermatocele but without sperm content
• Inguinal hernia: A portion of intestine protruding through the abdominal wall into the scrotum, may cause a bulge that increases with straining
• Hematocele: Blood collection around the testicle, often following trauma or surgery

Infectious and Inflammatory Causes

• Epididymitis: Inflammation of the epididymis, often caused by bacterial infection, resulting in pain, swelling, and tenderness
• Orchitis: Inflammation of the testicle itself, which may result from viral infections (such as mumps) or bacterial spread
• Abscess: A collection of pus within the scrotum, usually painful with associated redness and fever

Serious or Potentially Malignant Causes

• Testicular cancer: A solid tumor arising from the testicle, typically presenting as a painless, hard lump within the testicle itself
• Testicular torsion: Twisting of the testicle that cuts off blood supply, causing severe pain and swelling—this is a medical emergency requiring immediate surgery
• Paratesticular tumors: Rare tumors arising from tissues surrounding the testicle

Accurate diagnosis requires medical evaluation including physical examination, ultrasound imaging, and sometimes blood tests. Never attempt to self-diagnose, as many conditions present with similar symptoms but require different management approaches.

When to See a Doctor

Given the wide range of possible causes for scrotal masses, knowing when to seek medical attention is crucial:

• Immediate emergency care: Sudden, severe testicular pain with or without swelling, nausea, and vomiting (possible testicular torsion)
• Urgent evaluation (within 24-48 hours): New lump or mass in the scrotum, painful swelling with fever, redness and warmth of the scrotum
• Routine but prompt evaluation: Painless lump discovered during self-examination, gradual enlargement of the scrotum, persistent heaviness or discomfort, any change in testicle size, shape, or texture

Regular self-examination of the testicles is recommended for early detection of abnormalities. Performing this examination monthly, preferably during or after a warm shower when the scrotal skin is relaxed, allows men to become familiar with their normal anatomy and quickly identify changes.

Prevention Strategies

While not all scrotal masses can be prevented, certain strategies can reduce risk and ensure early detection of problems:

Regular Self-Examination

Monthly testicular self-examination is the most important preventive measure. Examine each testicle individually, rolling it gently between your fingers to check for lumps, swelling, or changes in texture. Familiarity with your normal anatomy makes it easier to detect abnormalities early.

Protective Measures

• Wear protective gear: Use athletic supporters and protective cups during contact sports to prevent traumatic injury to the scrotum
• Practice safe sex: Use condoms and maintain monogamous relationships to reduce the risk of sexually transmitted infections that can cause epididymitis
• Maintain good hygiene: Regular washing of the genital area helps prevent infections

Prompt Treatment of Infections

Seek timely medical care for urinary tract infections, prostatitis, or sexually transmitted infections, as these can spread to the epididymis and testicles if left untreated.

Vaccination

The MMR vaccine provides protection against mumps, a viral infection that can cause orchitis and testicular swelling in adolescents and adults.

Healthy Lifestyle

Maintaining overall health through proper nutrition, regular exercise, and avoiding tobacco may reduce the risk of certain conditions, including testicular cancer.

Medical Follow-Up

If you have risk factors for testicular cancer (such as undescended testicle history, family history, or previous testicular cancer), discuss appropriate screening schedules with your healthcare provider.

Frequently Asked Questions

Can a testicular lump be normal?

The epididymis, a normal structure that sits behind and above each testicle, can sometimes be mistaken for a lump. However, any new mass that wasn’t previously present should be evaluated by a doctor, even if it’s ultimately found to be benign.

Are all lumps in the testicle cancerous?

No, most testicular lumps are not cancerous. Common benign causes include cysts, hydroceles, and varicoceles. However, because testicular cancer is a possibility and is highly treatable when caught early, all lumps should be examined by a healthcare provider.

Why is my testicular lump painless?

Many scrotal masses, including most testicular tumors and cysts, are painless in their early stages. The absence of pain does not indicate that a lump is harmless, which is why medical evaluation is essential for any new mass.

How quickly do I need to see a doctor for a lump in my testicle?

If you discover a painless lump, schedule an appointment with your doctor within a week or two. If you experience sudden, severe pain, swelling with fever, or other concerning symptoms, seek immediate medical attention as these may indicate conditions requiring urgent treatment.

Can scrotal masses go away on their own?

Some scrotal masses, such as small hydroceles or mild varicoceles, may remain stable or occasionally resolve without treatment. However, you should never assume a mass will disappear on its own without first having it evaluated by a healthcare professional to rule out serious conditions.

What is the difference between a lump on the testicle skin versus inside the testicle?

Lumps on the scrotal skin may be sebaceous cysts, skin tags, or other dermatological conditions. Lumps within the testicle itself are of more concern as they could represent testicular tumors. An experienced physician can distinguish between these during examination, and ultrasound imaging provides definitive clarification.

Can stress or lifestyle factors cause testicular lumps?

Stress and lifestyle factors do not directly cause most scrotal masses. However, maintaining good overall health, avoiding trauma, and promptly treating infections can help prevent some causes of scrotal swelling and masses.

Are scrotal masses more common at certain ages?

Different types of scrotal masses occur more frequently at different ages. Testicular cancer is most common in men aged 15-35 years, while inguinal hernias are more common in older men and infants. Hydroceles can occur at any age but are common in newborns and older adults.

Can a scrotal mass affect fertility?

Some scrotal masses can impact fertility. Varicoceles are associated with decreased sperm quality in some men. Large masses, infections, or testicular torsion that damages the testicle can also affect fertility. If you have concerns about fertility, discuss them with your healthcare provider during evaluation.

What tests will my doctor perform to diagnose a scrotal mass?

Your doctor will typically perform a physical examination, including inspection and palpation of the scrotum. Scrotal ultrasound is the primary imaging test used to characterize masses. Blood tests, including tumor markers for testicular cancer, may also be ordered depending on the findings.

References:

• Mayo Clinic – Testicular Cancer
• Urology Care Foundation – Testicular Cancer
• American Cancer Society – Testicular Cancer Signs and Symptoms
• NHS – Lumps in the Testicles
• Johns Hopkins Medicine – Testicular Disorders
• StatPearls – Scrotal Masses
• UpToDate – Approach to Scrotal Masses