Most testicular lumps and swellings are not caused by cancer, but every new lump or unexplained change should be assessed by a healthcare professional. Early examination can identify the cause and ensure prompt treatment when needed.

What is a testicular lump?

A testicular lump is a new swelling, firm area or change felt in a testicle or within the scrotum—the skin sac that contains the testicles.

The testicles are not always identical. It is common for one to be slightly larger or hang lower than the other. The soft tube behind each testicle, called the epididymis, is also a normal structure.

What matters is noticing a new change that is not normal for you.

Changes that should be checked

Arrange a medical assessment if you notice:

• A lump in or on a testicle
• Swelling of one or both testicles
• A testicle becoming larger
• A change in shape, firmness or texture
• A feeling of heaviness in the scrotum
• Persistent aching or discomfort
• A new collection of fluid or swelling
• A change that remains after an injury

A painless lump still needs to be examined. Testicular cancer can sometimes appear as a painless lump or swelling, and treatment is generally more effective when the condition is identified early.

Having one of these symptoms does not mean that you have cancer. Many testicular lumps have other causes, but it is not possible to confirm the cause by touch alone.

When is it an emergency?

Go to the nearest emergency department immediately if you experience:

• Sudden, severe pain in a testicle
• Testicular pain with nausea or vomiting
• Testicular pain accompanied by abdominal pain
• Pain that continues while resting
• Rapid swelling or a testicle sitting higher than usual

These symptoms can be caused by testicular torsion, where the testicle twists and its blood supply is reduced. This is a medical emergency, and prompt treatment is important.

Do not wait for the pain to disappear or attempt to treat sudden severe testicular pain at home.

What can cause a lump or swelling?

Possible causes include:

• A fluid-filled swelling around the testicle
• A cyst near the epididymis
• Enlarged veins within the scrotum
• Infection or inflammation
• An inguinal hernia
• Injury
• Testicular torsion
• Testicular cancer

Only a healthcare professional can determine the likely cause.

What happens during the medical assessment?

The healthcare professional will ask when you first noticed the change, whether it is painful and whether you have experienced injury, fever, urinary symptoms or other concerns.

They may examine the abdomen, groin, scrotum and testicles. Depending on the findings, you may be referred for:

• An ultrasound scan
• Urine or blood tests
• Infection testing
• Assessment by a urology specialist

An ultrasound is painless and can help distinguish between different causes of a lump or swelling.

How to become familiar with your testicles

Checking regularly can help you recognise what is normal for you.

The easiest time is during or shortly after a warm bath or shower:

1. Support the scrotum in the palm of your hand.
2. Gently examine one testicle at a time.
3. Roll it carefully between your thumb and fingers.
4. Notice its usual size, shape and texture.
5. Feel the soft tube behind the testicle so that you recognise it in future.
6. Seek medical advice if you find a new lump, hard area or unexplained change.

Do not squeeze firmly or repeatedly examine a painful area.

Do not delay because of embarrassment

Healthcare professionals regularly assess testicular and scrotal concerns. A confidential examination usually takes only a short time and may provide reassurance or allow treatment to begin promptly.

Do not attempt to diagnose a testicular lump through an internet search or treat it with unprescribed medicines.

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Medical notice: This article provides general information and does not diagnose the cause of a testicular lump. Every new or unexplained lump should be assessed by a qualified healthcare professional. Sudden severe testicular pain requires emergency medical attention.

Sources: NHS—Testicle lumps and swellings, NHS—How to check your testicles and US National Cancer Institute—Testicular cancer symptoms.