Dear doctor, I have noticed a cyst just above my testicle which is painful at times. Is there anything I should be concerned about?

For the past month I have noticed a cyst just above my testicle which is painful at times. I’m a relatively healthy 51 year old male, is there anything I should be concerned about?

Scrotal swellings are very common urological conditions. The vast majority of swellings in the scrotum are benign and should not give cause for concern. A simple ultrasound scan will usually differentiate between benign and cancerous swellings.

• Infection (epididymo-orchitis): the scrotum will be swollen, red and painful. It may also cause fever, urinary frequency and painful micturition. Epididymo-orchitis is treated with antibiotics and rarely requires hospital admission.
  
  
• Hydrocele: occurs when there is excess fluid around the testicle. The testicle is diffusely swollen and painless. Surgical treatment is recommended if there is a significant discomfort or very large swelling.
  
  
• Epididymal cyst: are benign fluid filled cysts arising from the epididymis which is a small gland behind the testis. It is thought that 30% of men have epididymal cysts. They are painless, however, they can cause dragging pain depending on the size. Surgical treatment is not usually indicated as it may increase the pain and discomfort.
  
  
• Sperm granuloma: arises as a result of sperm leakage following a vasectomy. They are small and tender swellings at the back of the testis. Surgical treatment is not recommended unless they cause significant problems.
  
  
• Varicocele: the enlargement of veins in the scrotum. The incidence is in the region of 15% of adult male. Varicocele is more common on the left side of the scrotum because of differences in how blood circulates from each side. They may cause dull ache and dragging sensation. They can be corrected by embolisation (occluding the veins using small particles) or surgical repair. Varicocele may be linked to infertility in men, however, the impact of varicocele correction on increased fertility is currently unclear.

• Testicular cancer: usually present as a painless lump in the testicle. Some men may experience pain and swelling. Mainly affects men between 20-50 years old.

Men are advised to self-examine their testes regularly. If you find a lump inside the scrotum you should contact your GP immediately for further advice. Seek emergency medical care if you develop sudden onset pain in your scrotum.

Find out more about Mr Mohamed Ismail, Consultant Urologist practising at Spire Portsmouth Hospital.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.