Small Painful Lump on Testes- Epididymitis Vs Other Causes and Their Treatment

Q : I am a 28 year old male.  I have been feeling some dull aching pain in my right testicle for the last three days.  I thought it was probably because of my tight underpants.  Just a day ago, I realized there was a very painful small mass on the right testis.  When I touch, it hurts so much and I feel the pain all along the right side of the lower abdomen. I have no problem with urination, and my other testicle does not hurt.  I have been having protected sex, and I did so more than 4 months ago. I am quite worried, and would be happy if you help me to find out what the problem could probably be. Thanks.

Reply:

Though it would not be easy to say what exactly that lump is without actual physical exam, I’ll let you know about the common condition with this presentation.

Common Causes of a Small Lump Over the Testes

Epididymitis

This is infection of the  epididymis, a curved structure at the back of the testicle, in which sperms get matured and stored. Infection of this part presents with the onset of testicular pain. A lump is often found at the top of the testes.

The condition is often accompanied by swelling, redness, and warmth in the scrotal area. Fever can be present.

This is the most frequent cause of acute onset scrotal pain in your age group. The cause is bacterial infection. The bacteria in the urethra (urinary tube) back-track through the urinary duct and cause the condition. Moisture retention in the area can speed up the mechanism.

Sometimes, epididymitis can be related to orchitis in which the inflammation spreads to the testicles. Treatment is usually by antibiotics if an infection is suspected. The treatment of choice is often azithromycin and cefixime to cover both gonorrhea and chlamydia.

Torsion of the Testes

The spontaneous twisting of a testicle cutting off its own blood supply is called torsion. It is very painful. Swelling and tenderness in one testicle are often seen. This pain will not subside unless the testicle is manipulated into the correct position with surgery, which needs to be done within an hour or irreversible damage to the testicle can occur.

Spermatocele

This is a painless cystic lump on the testes. I’m listing it here because it can sometimes be painful. This is when it gets infected. It is formed by retention of watery fluid that contains spermatozoa in the head of the epididymis. It develops gradually. Examine yourself to see if the lump is cystic (fluid containing).

Testicular cancers

A testicle lump formed by cancerous process are mostly painless. So you need not worry about this condition unless you see any other sign/ symptom of cancer.

Varicocele

This is another probable condition with similar presentation. It is formed by abnormal enlargement of the vein that is in the scrotum, draining the testicles. You can self examine to see if the lump has a vascular (bloody) look. Lumps of varicocele are painful. There is a dragging-like pain within the scrotum.

Any injury or trauma to that region

Injury may also lead to swelling of testes due to inflammation, hematoma and edema.

Treatment of Lumps on Testes

Treatment would depend on the cause of the lump. You can get yourself examined by a doctor for diagnosis.

If it is epididymitis, as it looks so, antibiotics have to be taken.
Try relieving pain by elevation of the scrotum and cold compresses, applied regularly to the scrotum.
Take Care,
Buddy M.D.

Medical Advice (Q&As) on “Small Painful Lump on Testes- Epididymitis Vs Other Causes

  1. Kevin

    I got out the the shower and I saw something weird about my left teste. It is not swelling or anything but I did notice a ball like lump on it. I felt it an it is hard I think. I also think, but not sure, that it is attached to the teste. After I was trying to feel it there is a dull pain on it, but it goes away. I’m really scared and don’t know what to do. Please help. Also I am 16.

    Reply
    1. Buddy M.D. Post author

      This could be an Epididymal cyst. There’s nothing to worry.

      However, it’s better to get it examined by a doctor for diagnosis.

      Let us know about it.

      Reply
      1. Kevin

        I’m not completely ruling out going to the doctor, but I’d rather not. I looked up what is most likely cancer and it said a pea sized lump but it like 3 peas in size.

        Reply
        1. Buddy M.D. Post author

          Be watchful. The lump is likely to regress in size gradually.

          If you see it growing in size or become hard, you may see a doctor.

          Reply
    2. Lewis

      Hello, 2 years ago i have an epiidiymal cyst checked out by the doctors it wasn’t on the testicle but free floating, it was a cyst and I stopped worrying. Now however I have found underneath this cyst a small sand sized bump, it’s sore to touch and is on the back of the testicle I’m really worried because it’s on the testicle that it may be something serious. I can’t really feel it because it’s sore to touch, any ideas of what it may be?

      Reply
      1. Buddy M.D. Post author

        See a doctor. You may need antibiotics for this. If left as well, the infection may spread inside the testicular tissue.

        Reply
    3. Otash

      Hey Budy
      Two weeks ago I noticed a small lump slightly hard next to the main vein on my left testicle. Its causes some degree of pain especially when I sleep. When standing my penus presses against where the lump is. I am 38 years old and I am freaking out. Please advise what this would be and what can I do

      Reply
      1. Buddy M.D. Post author

        This one is very likely to be a cyst.

        Let us us if it’s movable, red, painful or itchy? Is it growing in size?

        Reply
  2. Kev

    My groinal area has been hurting and my lower glands have been swollen for about a week now, none of my other glands around my body have swollen and I have had sharp pains from my hip to my thigh on the right side (I’m a guy if that helps at all)

    Reply
    1. Buddy M.D. Post author

      Feel it gently. Is it smooth to touch or irregular? Is it attached to the underlying structures or movable?

      Reply
      1. Kevin

        It is attached but it feels like the lump is on the outside of it. It just feels attached not like it’s growing out of it. And it is smoth.

        Reply
        1. Buddy M.D. Post author

          Doesn’t appear anything serious. Most likely, it’s a cyst there. It may be a sebaceous cyst or if it’s big, may be epididymal.

          Needs a physical exam for diagnosis.

          Reply
          1. Buddy M.D. Post author

            If it hurts, it’s likely to be infected. You’ll need to see a doctor, as antibiotics would be required.

  3. Jackson

    Heya Buddy MD I have had this (I assume to be) well I can’t assume anything, but I have had a hurting pain in my left testicle, and I have read up on it, I’m assuming it’s either a spermatocele (or how ever you pronounce it) or just some kinda pain, but it’s been here for about 3-4 days, and it only hurts when touched on a specific part, not a constant pain but only when toched on that spot, any ideas?

    Reply
  4. Rohit

    Hey Buddy, from this past week I have this pea sized bump on top of my right testicle, it is inside the scrotum and I can feel it. It is attached to the testicle and also it hurts to touch. I’m worried if it is cancer?

    Reply
    1. Buddy M.D. Post author

      Is it-
      smooth or irregular?
      hard or soft?
      seems to be attached to the underlying tissue or is freely movable?

      Reply
  5. Jeff

    I have has a small pea sized bump on the top of my right testicle it isnt attached to the ball it’s like in the epididymitis and it’s been there for like 2 weeks and it hurts when I feel it. It’s really stressing me out because I keep thinking it’s cancer can you help by telling me what it is. Also I’m only 18

    Reply
  6. Jamie

    Hi buddy m.d, I have a hard lump ontop of my right testicle exactly next to the epididymis around the size of a bean. I also have what feels like a swelling of the cords, the lump has a dull ache at times and can change size and go smaller than a pea, I’ve had this for a number of years and have relatively good Heath other than this problem… any advise as to what this could be would be appreciated. Thanks

    Reply
  7. joe

    Greetings, I’ve had a recurring pain emanating from the epididymis for the last month . I have been to two urologists. One of them had me do an ultrasound in the testicle areas and nothing was found. they both felt the testicle area and found no Lumps. they both said that nothing was found and that it should clear up on its own. Just wondering if you have any advice on what it might be. I’m not convinced that it’s nothing. If it were, them why does it hurt a lot.

    Reply
      1. Anonymous

        The affected area is not red or swollen. No problems with urination either. Another symptom that started a week ago is that when I get this pain, legs feel like the circulation gets affected and they feel tingly. Before any of this started I noticed like a small Pea sized lump on my inner rectal area and felt some discomfort. That cleared up and then the testicle pain started. Don’t know if this has anything to do with the testicle pain.

        Reply
        1. Buddy M.D. Post author

          The testicular region appears normal.

          May be any of your nerve, supplying the testicular surface and descending down to your leg is somewhat irritated or pulled. Do you lift heavy weights or exercise lot?

          Reply
  8. Joe

    I do not exercise a lot or lift weights. I’m mobile but just the usual walking and stuff. One thing I noticed is that i can feel like a bulge on the part where the spermatic cord connects to the testicle and it feels tender and hurts. Like the pain is reminding from there.

    Reply
    1. Buddy M.D. Post author

      If you can so well localize the spot, may be the epididymis is inflamed there. It may be a localized trauma or focus of infection.

      Reply
  9. Mdphd88

    I have noticed stony hard lump inside my testicle 5 days ago. Not changing in size. I feel it is in the testicle and not in outside structures. It is small approximately 0.5 cm. Round and has a smooth surface and is painful to touch. I am 28 and I am concerned if it is a cancer.

    Reply
  10. E

    Hello. About 6 or 7 months ago I sent myself to the ER because of testicular pain. I agreed to an STD test and luckily I do not have that. I took an ultra sound and they did say I have a very small vercoecele. The nurse suggested I wear underwear. Now, just a few weeks ago the pain started coming back to me on and off in my left testicle. Today for the first time I felt a lump underneath and behind the teste which caused immediate pain upon touching. I don’t have money or insurance to get this looked at. Is there anything I can do? I don’t know if it’s possible that the vercoecele is worse. Will producing an orgasm fix or make it worse? I am hurting and trying to be gentle but I have to move around a lot tomorrow. Thank you…

    Reply
    1. Buddy M.D. Post author

      This one is very likely to be an aggravated varicocele. Such swellings gravitate to get bigger with time. The only way is giving them ample support by wearing fits cotton underwears.

      Sex may worsen it. Try lying down supine whenever possible to avoid straining it more.

      Correction needs a consult with a surgeon.

      Reply
      1. E

        Thank you for your reply. I have an appointment with a Dr. The pain was not as bad today as it was yesterday and i don’t feel the node behind the testicle like I did yesterday. I am slightly feverish today. It could be the new job. Is it possible that a varicocele could make you more prone to an epydidimal cyst? Thank you for your time and your help.

        Reply
  11. Yuv

    Hello..i have a rice size lump in my left testicle..its very painful..the pain goes and come again..already when to a doctor 3 times..they gave me antibiotic..but still the result is the same..its still paining..please what is it??

    Reply
  12. TS

    Hi, I have a tiny bump what feels like on the of the top of my left testicle. It is not noticeable until you actually feel for it. It is the size of a grain of rice or smaller and is hard. It is painful and sensitive to the touch. I am 23 years old. Any thoughts? Thanks.

    Reply
    1. Buddy M.D. Post author

      Any pain or pressure felt during urination or masturbation? If not, this one is very likely to be a cyst in there. Nothing needs to be done. Most of them regress on their own with time.

      Reply
      1. Dan Hutchin

        I have a lump on my right teste about the size of a pea it’s soft, painful to the touch and often hurts when running or jumping. My teste is also noticiby softer then the left one and almost feels as though it’s falling apart. Any ideas?….

        Reply
        1. Buddy M.D. Post author

          This may be an infection cyst over your testes. Antibiotics are needed at the earliest.

          You may start applying mupirocin/ bactroban ointment over it, thrice daily. If you see no effect in a day or two, oral antibiotics may be needed.

          Reply
  13. Abdullah

    I wore a tight underwear and slept uncomfortably all night due to that. Next morning I had pain in my left testicle. Upon inspection, I found a hard pea sized lump on top of left teste that seems to be attached to the testicle. It’s painful to touch and feels smooth and round. If I move the testicle, it moves along with it. It’s painless when not touched for 30 mins and afterwards. I never felt that lump before or may be I didn’t notice until now. But it doesn’t seem to be epididymis to me as it seems to be attached to testes. Appointment with doctor is booked after 3 days. I’m freaking out if it’s testicular cancer it something else.

    Reply
    1. Buddy M.D. Post author

      Appears to be an infected sebaceous cyst. Very unlikely to be cancer.

      You may start applying mupirocin/ bactroban ointment over it, till you visit your doctor. Wear lose cotton bottoms and avoid friction over the lump.

      Reply
  14. Darren

    Hi, I have dull pain in groin area on inside of my leg. i felt a hard pin sized bump on the back of my right testicle by the cord the goes to it..it feels uncomfortable to touch..im very worried

    Reply
  15. Colin

    I have been having testicular pain for some time now. Just noticed an very small lump had the size of a BB on my left tistical directly under the epididymis. Pain comes and goes. Any idea as to what it might be?

    Reply
    1. Buddy M.D. Post author

      Likely to be a pimple/ cyst. You may start applying an antibiotic ointment over it daily.

      Is the testicular pain confined to some area or generalized?

      Reply
        1. Buddy M.D. Post author

          Needs to be examined for diagnosis. Since you’ve mentioned throbbing pain, there are chances of this being an infected cyst. Antibiotics may be needed.

          Reply
  16. Von

    I know for sure that I have Varicocele, but recently I am experiencing pain on the top of the left testicle(same side as the Varicocele). There is general discomfort, but it’s only painful to touch the specific spot. The pain is not in any other area and I would not consider the pain severe, although it’s bad enough that I know something is not right. I have not experienced this pain before regarding the Varicocele.. I have had pain related to the Varicocele, but it was more in the veins and not on the testicle. The pain has persisted for two days. I am nearly 25 years old. Should I be concerned about Epididymitis?

    Reply
  17. Mike

    Noticed on the top side of my left testicle a lump about the size of a marble , seems attached , slightly squishy. Inner of top left leg is sometimes sore, as well as lower stomach aching almost like a gassy buildup.

    Reply
    1. Buddy M.D. Post author

      Looks like a epididymal swelling. May be a cyst there. However, you’ll need to be examined for exact diagnosis.

      Do update us about what it is.

      Reply
  18. Mac

    I noticed a large lump above my left testicle and under the skin. It was painful and inflamed. To me it appeared like a large ingrown hair or a cyst, so I attempted to squeeze and pop it. I was mostly unsuccessful, only achieving drainage on one side of the lump. After this, almost immmediately the entire area became much more firm to the touch and slightly enlarged. It remained like this for a day or 2, and has since regressed in size. There is still a scab. The lump is still colored red and it is definitely not gone. However, the pain is essentially gone. What could this be?

    Reply

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