Testicular lumps and pain

What are testicle lumps and pain?

A testicle lump is any swelling, firmness, or change in shape you notice in or around one of your testicles, sometimes alongside aching, discomfort, or a feeling of heaviness. These are common, and most turn out to be harmless, but every single one is worth getting looked at by a GP.

What usually causes testicle lumps and pain?

The most frequent causes are fluid-filled and generally harmless:

• a hydrocele, where fluid gathers around the testicle
• an epididymal cyst or spermatocele, a small fluid-filled sac on the tube that sits behind the testicle
• a varicocele, enlarged veins above the testicle, which can bring a heavy or aching sensation

Other causes include:

• epididymitis, an infection of that same tube, often linked to a urinary infection or a sexually transmitted infection
• orchitis, inflammation of the testicle itself, sometimes following mumps
• testicular torsion, where the testicle twists and cuts off its own blood supply, most often in children and young men
• a groin hernia that extends down towards the scrotum without actually starting there
• rarely, a solid nodule following a previous vasectomy, or, in very rare cases nowadays, tuberculosis or syphilis
• testicular cancer, which is more likely in testicles that were previously undescended, injured, infected, or unusually soft and small

Are there different types of testicle lumps?

Where and how a lump feels gives real clues about what it's likely to be:

• Fluid-filled swellings, like a hydrocele or epididymal cyst, tend to feel smooth and soft, and light can often be shone straight through them.
• Lumps sitting on top of the testicle, or in the structures around it, are much more likely to be one of the benign causes above.
• A firm lump felt inside the testicle's own tissue is a different matter: roughly nine times out of ten, this turns out to be a cancer, which is exactly why any change like this needs an urgent GP appointment.
• A swelling that seems to come from your groin rather than your scrotum is more likely to be a hernia than anything testicular.

How are testicle lumps and pain diagnosed?

It helps to know what's normal for you, so it's worth checking yourself occasionally, ideally at a time when you feel warm and comfortable, such as straight out of the bath or shower. Using a mirror can help. Gently roll each testicle between your fingers in turn, feeling both the testicle itself and whatever else you can feel around it.

Your GP will examine your testicles by sight and touch and may shine a light through your scrotum. Light will pass easily through a fluid-filled cyst but not through a solid lump. Most people are then referred for an ultrasound scan, which is usually enough to tell a harmless cause apart from a cancerous one. If cancer seems possible, you'll be referred urgently to a specialist, typically seen within two weeks.

How are testicle lumps and pain treated?

Plenty of causes need no treatment at all if they're not bothering you and aren't getting bigger. Fluid-filled swellings such as a hydrocele or cyst are usually only operated on if they become painful, very large, or cosmetically troublesome. Infections like epididymitis are treated with antibiotics, while mumps-related inflammation of the testicle usually just needs painkillers while it settles by itself. Suspected torsion is a genuine surgical emergency requiring immediate admission and an operation to untwist and save the testicle.

If cancer is confirmed, the usual approach is to remove the affected testicle, sometimes followed by chemotherapy or radiotherapy depending on what further tests show. An artificial replacement is available too, whether you'd rather have it fitted during the same operation or wait until later. The outlook is generally excellent. With early diagnosis and treatment, more than 95 in 100 men are cured, even in cases where the cancer has already spread beyond the testicle by the time it's found.

When should you see a doctor?

Book a GP appointment for any new lump, swelling, or change in the shape, size, or feel of a testicle, one testicle becoming noticeably bigger than the other, or an ache that simply won't go away. These are common, everyday reasons to be seen, and catching cancer early makes a genuine difference to how straightforward treatment is.

Go to A&E or call 999 straight away if you have sudden, severe testicle pain, pain that comes with nausea, vomiting, or tummy pain, or pain that's lasted over an hour or hasn't eased with rest. These point towards torsion, where time really matters for saving the testicle.