Often the first concern of a man who notices a lump in the scrotum is that he has a testicular cancer, but in reality, other causes are more common. These include a hydrocoele, and an epididymal cyst. If the testicle is painful and swollen, then there may be an infection of it and the epididymis, a condition known as epididymitis.

Hydrocoele

A hydrocele is an accumulation of clear fluid around the testicle. A hydrocele causes a painless enlargement in the scrotum on the affected side and is thought to be due to the defective absorption of fluid secreted between the two layers of the tunica vaginalis, a membrane which surrounds the testicle and usually has a thin film of fluid within.

A hydrocele feels like a small fluid filled balloon inside the scrotum. It is smooth and can vary greatly in size. Hydroceles are normally painless and harmless. Large hydroceles cause discomfort because of their size. As the fluid of a hydrocele is transparent, light shone through a hydrocele may be visible from the other side.

Epididymal cyst or spermatocoele

An epididymal cyst or spermatocele is a cyst of the head of the epididymis which is distended with a milky fluid that contains spermatozoa. They are the most common cause of a swelling in the scrotum, and can vary in size from a few mm to several centimetres. They are generally not painful. However, some men may experience discomfort from larger spermatoceles.

Epididymal cysts can be discovered as incidental scrotal masses found on examination of the testicles. They may also be discovered by self-inspection by the patient. Some patients describe that on examination they have found a third testicle.

Finding a painless, cystic mass above the testicle will usually indicate that an epididymal cyst is the cause of the swelling, but confirmation with an ultrasound is recommended.

Only large, symptomatic cysts required any treatment, and the recommended treatment is excision of the cyst. For more information on this, please click here . Smaller cysts, or those which do not cause symptoms, are best left alone.