Symptoms of the Scrotum and Testes

Lumps in the scrotum

Feeling a lump can be alarming, but most are not cancer. The key question is whether the lump is in the testicle or separate from it.

Any lump that is in the testicle, or that you cannot tell apart from it, needs an ultrasound.

Swelling of the scrotum

Swelling can be on one or both sides:

• Fluid: hydrocele, or generalized swelling from heart, kidney or liver failure.
• Hernia: bowel or fat descending into the scrotum.
• Infection: epididymitis, orchitis (including mumps), or skin infection.
• Injury: bleeding into the scrotum or testicle.
• Torsion: rapid painful swelling.
• Allergic or skin reactions.

Pain in the scrotum

Pain ranges from a mild ache to a surgical emergency. The most urgent cause is testicular torsion. Other causes are epididymitis, injury, kidney stones, hernias and varicoceles. For a full guide to causes and red flags, see pain in testicles.

Skin and itching problems

• Jock itch (tinea cruris): an itchy red rash with a raised edge in the groin folds, usually sparing the scrotum itself.
• Candida (yeast): red, moist rash that does involve the scrotum, with small satellite spots, more common in diabetes.
• Eczema, psoriasis and contact dermatitis.
• Scabies and pubic lice: intensely itchy bumps.
• Sexually transmitted infections: genital warts, herpes sores and syphilis ulcers.
• Angiokeratomas: small, harmless red-purple spots common with age.
• Fournier's gangrene: rare, rapidly spreading infection with severe pain, swelling, skin discoloration and fever.

Testicle size and position problems

• Undescended testicle (cryptorchidism): a testicle that has not moved into the scrotum by birth. Many descend by 6 months; if not, surgery (orchiopexy) is usually done before 18 months to protect fertility and allow cancer checks.
• Retractile testicle: a testicle that moves up into the groin with cold or touch but can be brought down. Usually harmless, but it needs monitoring.
• One testicle hanging lower than the other: normal, usually the left.
• Small or shrinking testicles: can be due to low testosterone, Klinefelter syndrome, previous mumps orchitis, anabolic steroid use, varicocele or torsion.

How to check your testicles

Once a month, after a warm shower when the scrotum is relaxed:

1. Hold each testicle between thumb and fingers and roll it gently.
2. Feel for lumps, hard areas or changes in size or texture.
3. Find the epididymis, the soft tube at the back and top. This is normal and should not be mistaken for a lump.
4. See a doctor about any changes.

It is normal for one testicle to be slightly larger than the other.

How doctors assess scrotal symptoms

A doctor will ask about the onset, pain, injury, sexual history, urinary symptoms and fertility, then examine you standing and lying down. They may shine a light through a swelling (transillumination). Scrotal ultrasound is the main test and shows whether a lump is inside the testicle, whether it is solid or fluid, and blood flow. Urine tests and STI tests are done for suspected infection. Blood tumor markers (AFP, hCG and LDH) are checked if cancer is suspected.

Treatment overview

• Cysts and small hydroceles: usually no treatment; surgery if large or uncomfortable.
• Varicocele: supportive underwear; surgery or embolization for pain or fertility problems.
• Epididymitis: antibiotics, rest, support and pain relief.
• Hernia: surgical repair.
• Torsion: emergency surgery.
• Testicular cancer: removal of the testicle (orchiectomy), sometimes with chemotherapy or radiotherapy. Cure rates are very high.
• Skin conditions: antifungal creams, steroid creams, or STI treatment.

Frequently asked questions

What are common problems with the testicles?

Common problems include epididymal cysts, hydroceles, varicoceles, epididymitis, hernias, injuries and skin rashes such as jock itch. Testicular torsion and testicular cancer are less common but important to recognize quickly.

Is a lump on my testicle cancer?

Most scrotal lumps are not cancer. Lumps separate from the testicle are usually cysts. A firm lump or hard area within the testicle itself needs prompt ultrasound, because testicular cancer usually presents this way and is highly curable when found early.

Why is my scrotum swollen but not painful?

Painless swelling is often a hydrocele (fluid), a varicocele (enlarged veins), an epididymal cyst or an inguinal hernia. Painless testicular cancer can also cause swelling. Any new swelling should be checked by a doctor.

Why does my scrotum itch?

Itching is usually caused by jock itch, a yeast infection, sweating and friction, eczema or contact dermatitis. Scabies and pubic lice also cause intense itch. Antifungal creams treat jock itch; persistent itch or sores need a doctor's review.