Scrotal Bumps, Cysts and Lumps
Bumps may appear on scrotum for variety of reasons. We may broadly divide them into 2 categories:
- Bumps over the surface of the scrotal skin
- Lumps inside the scrotum sac
Let’s start with the bumps that appear over the surface of scrotum. As we will see, many of these are part of normal skin texture and some are simply benign individual variations.
Normal Hair Follicle Bumps on Scrotal Skin
It is very important to know about the normal skin texture of the scrotal sack. Most of the hair bumps, that guys worry about, are the normal hair follicles. They look raised because the scrotal skin is thinner as compared to the skin elsewhere in the body.
These are normal, but frequently become a cause of worry just after puberty when hair start to appear on the genitals.
Rarely one of these hair follicles may become inflamed, sometimes when one tries to pluck or shave the hair, leading to folliculitis. The follicle may also get infected with bacteria called staphylococcus aureus.
It appears as white-headed pimple around the hair follicle that may be itchy. It may later turn red and painful.
It may disappear on its own with proper hygiene, but sometimes require medical treatment. Warm compress, few times a day, may provide some relief. If it doesn’t improve with supportive measures or get worse, then an antibiotic treatment may be required.
These are visible oil-secreting sebaceous glands that are found in large percentage of population. These are considered normal structural variant rather than a disease. Sebaceous glands secrete oily substance called sebum, that keeps the skin smooth and lubricated.
Fordyce spots appear as small, red or white bumps on the scrotal skin, that are typically painless. They are considered benign and require no treatment.
Other Possible Causes of Bumps on the Scrotum
These are extremely common in youth. They are painless, unless they get infected. They are small, firm to hard to touch.
Pimples are left as such unless they give some symptom. A painful pimple may be infected and may be treated with topical antibiotic creams.
Wart or Herpes Infection
Such conditions are almost always painful. You need not worry about them, unless you’ve had recent sex with somebody infected.
They may present as an ulcer or a bump. The lesion has a tendency to spread to adjoining areas.
This fungal infection presents with circumscribed itchy rash consisting of multiple, pinpoint pink bumps. The rash is raised, reddish pink, flaky and very itchy. You may read more about jock itch rash.
Causes of Lumps Inside the Scrotum
Till now, we have discussed the possible causes of bumps present over the scrotal skin surface. Now, we will discuss the causes of lumps inside the scrotal sac. These include:
Spermatocele is an abnormal cystic growth of the epididymis, a coiled tube on the upper side of testicle, that transports and stores sperms. This abnormal sac or spermatic cyst contains dead sperm cells and fluid. This usually does not cause pain.
Spermatocele doesn’t usually require treatment. But sometimes it may grow large and tense. Then it may require surgery.
Varicocele is an abnormally swollen or knotty varicose vein present along the spermatic cord. Essentially, it’s an enlargement of the veins that drain the testicles.
Usually it doesn’t produce any symptoms. Rarely it may produce pain that may be perceived as dull discomfort or heaviness. It may increase on prolonged standing or later in a day after exertion. It may get relieved after rest.
Mostly varicocele doesn’t require any treatment. If the pain is mild then it may get relieved by resting with lying on your back. You may also take pain medications. If the pain is severe or accompanied by swelling or infertility problem, then you may need to undergo a surgery.
Hematocele is a collection of blood in the pouch. It occurs after surgery or injury involving this area. It may also get consolidated and become hard with time. There may be some discomfort as well.
If it is small and painless, then foot elevation and bed rest may be sufficient. Otherwise surgery is performed to drain the accumulated blood. Ultrasound is done to diagnose the type of swelling.
Hydrocele is a sac filled with fluid around the testicle. It usually leads to smooth and uniform enlargement of the scrotum.
Epididymitis is a pain and inflammation of a curved and coiled structure at the back of testicle called epididymis. It normally stores and carries sperms.
An inguinal hernia occurs when there is a protrusion of abdominal contents through a weak area in the abdominal wall that passes via inguinal canal (groin) into the scrotum.
Testicular torsion occurs when testicle rotates and twists the spermatic cord through which it is suspended. This results in cutting off the blood supply to the testes and consequent necrosis.
Injury to the Scrotum
An injury may also lead to the swelling due to oozing of fluid and blood at the site of trauma.
Testes sometimes is affected with an abnormal growth of tissue due to tumor or cancer.
For further evaluation, the following may be asked on examination:
- Does the lump hurt when touched or squeezed?
- How does the swelling feel- liquid, firm, or solid?
- Is it smooth, twisted, or irregular in looks?
- Does it seem attached to underlying tissues like testicles or the glands?
- Self examine your groins to see if there are any enlarged lymph glands.
Call for Attention
A testicular mass is always a cause for attention and should be evaluated right away. The primary concern in such cases is testicular cancer. Hence, if the lump seems to arise from testicle or attached to it, get it examined by a doctor immediately.
Making a Diagnosis
The doctor will examine the lump. The following tests may be done to help diagnose a scrotal mass:
- Ultrasound of the scrotum
- Biopsy of the lump