Painful lump on the testicle

Overview

Your testicles (balls) should feel smooth and firm (not hard), with no bumps or lumps. If your balls or scrotum (the bag of skin that holds your balls) have changed in how they look or feel, or if you develop a lump, it’s important to see a doctor.

Lumps on the testicles can be painful or painless, and vary in size or texture, depending on the cause.

Causes of lumps on testicles

There are many different reasons why you may develop a lump on your testicles. Most lumps are harmless, but it’s important to get them checked out just in case it’s a sign of something more serious.

Get to know what feels normal for you and see your GP if you notice any changes.

Here are a few of the more common causes, along with possible treatments and when to see a doctor.

Fluid around the testicle (hydrocele)

Hydrocele occurs when fluid gathers around the scrotum, causing swelling that can feel like a water-filled balloon. It can affect all age groups, particularly newborn babies.

The main symptom is painless swelling in one or both testicles, although they can be uncomfortable or feel heavy if they get very big.
The swelling usually goes away on its own in newborns. In older people, a hydrocele may have no underlying cause but may be the result of an infection, epididymitis, a testicular tumour or a minor injury.

To diagnose a hydrocele, your doctor will examine you and may also request an ultrasound.

Hydroceles aren’t usually a cause for concern. Surgery is generally only needed if the hydrocele becomes painful or causes problems.

Varicose veins above the testicle (varicocele)

Varicoceles are varicose veins that appear near your testicles. They don’t usually have any symptoms, but you might feel them and occasionally they can cause heaviness or a dragging sensation, or sometimes an ache in your scrotum or groin. Varicocele can occur on either side of your scrotum, but they’re more common on the left.

Varicoceles can be linked with fertility problems although this is not a common concern. See a doctor urgently if your varicocele is painful, if it doesn't reduce when you lie down or if you have one only on the right side. They will do a physical examination and may confirm a diagnosis with an ultrasound.

Surgery may be recommended if they cause discomfort. Otherwise, they can be left as they are.

Epididymal cyst

An epididymal cyst is a lump caused by the collection of fluid in the epididymis. The epididymis is a tube that sits along the outside of your testicles.

Epididymal cysts aren’t anything to worry about. They can feel tender, but they don’t usually cause any pain.

If you think you may have an epididymal cyst, see your doctor. They will do a physical examination and may also request an ultrasound.

Epididymal cysts don’t usually need treatment unless they become painful or affect your daily activities. However, if the cyst is large, your doctor may refer you to a specialist to either shrink, drain or remove it.

Report any pain to your doctor.

Epididymitis

Epididymitis happens when the soft tube at the back of the testicles (the epididymis) becomes swollen and painful.

You might notice that you have:

• sudden or gradual pain in one or both of your testicles
• a warm, tender and inflamed scrotum
• a fluid-filled lump or swelling around your testicle (a hydrocele)
• trouble peeing
• a yellow, white or green discharge coming from your penis

If the whole of your scrotum is red and tender, you may have an inflammation of both the epididymis and testis, called epididymo-orchitis.

The most common cause of epididymitis is a

(STI), such as or gonorrhoea. This is especially the case in people under the age of 35.

A less common cause of epididymitis is a

(UTI). This is more likely if you have:

• a urinary catheter
• an enlarged prostate gland
• recently had surgery on your groin, bladder or prostate gland

See a doctor or go to your local sexual health clinic if you think you might have epididymitis.

You may need to have tests, including:

• urine and blood tests
• a groin examination
• a rectal examination
• a swab taken from your urethra (pee tube)

If your epididymitis is due to an infection, you may be prescribed antibiotics. Make sure you finish the course of antibiotics, even if you feel better.

You should start to feel better in a few days, but a full recovery can take up to 2 weeks. If your epididymitis is due to chlamydia or gonorrhoea, it’s important that you don’t have sex until your treatment is finished and your partner has also been treated. Otherwise, you risk spreading the infection.

While you’re recovering, there are a few things you can do to ease pain and inflammation:

• take painkillers. If you’re not sure which painkiller is right for you, speak to your pharmacist
• wear supportive underwear
• hold a cold pack to your groin (or a pack of frozen peas wrapped in a tea towel)

A twisted testicle (testicular torsion)

Testicular torsion is a painful swelling that happens suddenly when your testicle becomes twisted. This is a medical emergency because it cuts off the blood supply and can cause the testicle to die if it’s not treated quickly. Surgery is needed as soon as possible to untwist the testicle.

The main symptom of a twisted testicle is severe pain. Other symptoms can include:

• nausea
• vomiting
• tummy pain
• swelling of the scrotum
• a slight fever
• the need to pee frequently

You may be at higher risk of testicular torsion if you’re under 25 years old. Occasionally it's caused by trauma – for example, during exercise.

Call an ambulance or go to the hospital emergency department If you think you may have a twisted testicle. The doctor who sees you will examine you and look at your medical history to check for previous testicular pain or swelling. They may recommend an ultrasound to help determine whether you need surgery to untwist the testicle.

The sooner a twisted testicle is seen to, the better the chances of saving it. If surgery is delayed or if the doctor finds the testicle is unhealthy or badly damaged, it may need to be removed.

Less common causes of a lump on the testicles

Testicular cancer

is not a common cause of a lump on the testicle. However, it’s important to get a lump or swelling on the testicle seen by a doctor as soon as you notice it. The earlier cancer is caught, the easier it is to treat.

Mumps

Pain and swelling of the testicle can affect some people who get

after puberty. The swelling usually happens suddenly, affecting one testicle, and may also feel warm and tender.

Inguinal hernia

An

is where either fatty tissue or a part of your bowel protrudes into your groin. This can cause the scrotum to increase in size.

When to see a doctor about a lump on the testicle

Call an ambulance or go to the emergency department if you get sudden, unbearable pain in your testicles. This pain could be because your testicle has become twisted. This is a medical emergency and needs to be treated as soon as possible.

You should make an appointment to see your doctor as soon as possible if you have:

• swelling in your scrotum or in one or both testicles
• a lump on your testicle
• discharge from your penis
• continued aching or pain in your testicles
• a change in the shape or feel of your testicles
• 1 testicle that’s become larger than the other

Outlook for lump on the testicle

The outlook depends on the cause. Minor problems such as cysts and hydroceles don’t usually cause any problems

Infections with antibiotics will usually improve with antibiotics. You should start to feel better in a few days. A full recovery can take up to 2 weeks.

Surgery to remove a lump on the testicle won’t usually take long to recover. You might be in a bit of pain or discomfort afterwards, but this can be relieved with painkillers. You might need to take some time off work and avoid exercise and heavy lifting for a little while.

Testicular torsions or twisted testicles have better outcomes when they are treated very quickly. If left too long, the testicle can become badly damaged and may need to be removed.

Testicular cancer has a high cure rate, particularly if it's treated early. However, in some cases it can be life-threatening, so always get any lumps or swellings checked by a doctor.

Key takeaways

• a lump on the testicle isn’t usually a sign of anything serious
• cancer is rarely the cause of a lump on the testicle, but it’s best to get any lumps checked by a doctor just in case
• cysts and infections can be common causes of painless lumps on the testicle
• treatment for a lump on the testicle varies depending on the cause
• if you get sudden, unbearable pain in your testicle, you should go straight to the emergency department