- Testicular lumps can come from many causes — including skin conditions, infections, cysts, structural issues, and cancer — so location, texture, and symptoms help guide what they might be.
- Some sexually transmitted infections, such as chlamydia or gonorrhoea, can inflame the epididymis or testicle and cause painful swelling, especially when you also have urinary symptoms or fever.
- Because different conditions present similarly, seeing a doctor and getting appropriate assessment — including STD screening when relevant — helps identify the cause early and prevent complications.
A noticeable lump over the testicles can be a great worry to men. It is a common finding in men. Able to understand what the red flag symptoms are important to avoid delay in treatment.
This article strives to facilitate understanding of symptoms and to seek medical assistance appropriately.
How to evaluate testicular lumps?
To simplify, we can evaluate the testicular swelling whether it is 'on top' of the skin, or 'beneath the skin'. Swelling or lesions that are on top of the skinare usually felt superficial, or 'stuck-on', with possible skin surface changes- itching, roughness, color changes.
Those lesions that are beneath the skin tend to feel deeper, with a possible smooth skin surface. Lesions beneath the skin may require deeper palpable to feel it (may need 'deep-pressing' of 2-3 fingertips to feel the lesions)
Testicular lumps that are painful are suggestive if inflammation or infection.
We summarised the possible differentials of testicular lumps as below:
Lumps on the skin surface
Raised lumps
| Infection | FolliculitisFungal infectionHerpes Simplex Virus (blisters)Warts (HPV)Molluscum Contagiosum |
| Non-infectious | Skin tagsMoleBlood vessel (Angiokeratoma)Ageing spot (Seborrheic keratosis) |
Depressed lumps
| Infection | Herpes Simplex Virus (ulcers) |
| Non-infectious | Trauma/Injury/Scratch |
Lumps underneath the skin
The skin surface of the swelling is usually smooth
| Infection | BoilsBacterial STDs (epididymitis) |
| Non-infectious | CystCalcium depositionHerniaVaricocele/ HydroceleTorsionCancer |
As these are general guides to one's symptoms, ultimately it is imperative to get the testicular lump checked by your trusted healthcare providers to avoid delay of medical treatment.
Associated red flag symptoms such as fever, painful urination, surrounding lymph node swellings, unintentional weight loss, poor energy levels should not be neglected and should warrant further medical investigation.
Importantly:
In the case of an acute testicular swelling and pain persistent more than an hour, feeling sick one should not forget the possibilities of testicular torsion. This is a medical emergency where the testicle cords are being twisted and knotted together. Urgent surgical maneuver to reverse the twisting is key to prevent permanent infertility in particularly in young men. Hence, do seek medical help when concerned!
STD and testicular lumps
Testicular swelling can be associated with STDs. This is a condition known as epididymitis or orchitis whereby the connection tube behind the testicles (known as epididymis) or the testicle (orchid) itself is chronically inflamed and infected. One can present with a lump or swelling over the testicles with associated pain, fever, and abnormal urination symptoms.
STDs related epididymitis and orchitis are commonly associated with bacterial STDs such as Chlamydia trachomatis, Neisseria gonorrhea, syphilis, trichomoniasis, mycoplasma genetalium.
Early screening through a reliable STD test and prompt treatment of underlying sexually transmitted infections prevent irreversible complications such as permanent scarring of the reproductive organs and infertility.
Regular routine self-examination
Making self-check monthly into a habit is useful in understanding our body and be aware of any new changes on our body over time.
Self-testicular examination can be done easily via:
- Standing in front of a mirror, look out for any swelling over the testicles
- You can place your index and thumb finger over the right testicle and move the right testicle gently to feel for any lumps.
- Repeat step (2) on the left testicle.
What should we do if we have a testicular lump?
If you do notice there is a testicular lump(s), it is always beneficial to check with your doctor about the concerning area. Your doctor can guide you further if any tests or treatment are required for the lump.
What can we expect when we see our doctor?
Your doctor will obtain a history relevant to the testicular lump, associated sexual and social history, and significant past medical issues. Your doctor will then proceed to physically examine the genital area. This will involve visualisation of the genitalia - for any skin surface rash or swelling, urethral discharge, palpable of the groin and testicular region for concerning lumps and bumps.
Certain skin surface conditions may be even visualised better with dermatoscope (depending on availability of the clinic). In cases where there are concern of infection, your doctor may offer skin swab test, or even urine tests to evaluate further. In situation where there is structural concern of the deeper parts of the scrotum/testicle, your doctor may offer you ultrasound imaging to understand further.
What are the treatment of testicular lumps?
Treatment of testicular lumps will be depending on the cause of the condition. Frequently, testicular lumps are benign and may not require any treatment.
- In the event of concern of infection, anti-microbial or anti-viral medication may be required to treat the infection.
- Skin-related superficial testicular lumps can possibly be managed conservatively with topical cream ointment or moisturiser.
- In certain cases, bedside procedures such as cryotherapy, electrocautery procedure may be offered to manage superficial testicular lumps.
- Surgical intervention may be required if there is concern of structural cause of testicular lumps
- In the event of testicular cancer, treatment will involve multidisciplinary team with surgery, and possible combination of radio- or chemotherapy to manage the cancer.
When should I reach out to my doctor if I have concern about testicular lump?
- A visible or palpable lump on your testicles
- Testicular swelling
- A discomfort or pain over your testicle that does not go away
- Asymmetry in terms of testicular size
Understanding the cause of a testicular lump starts with a proper medical assessment. Whether it’s an infection, cyst, or something more serious, a timely check can make all the difference. Schedule your appointment today!
References:
- Rupp TJ, Leslie SW. Epididymitis. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
- Azmat CE, Vaitla P. Orchitis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
- Velasquez J, Boniface MP, Mohseni M. Acute Scrotum Pain. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
- Bryan ER, Kim J, Beagley KW, Carey AJ. Testicular inflammation and infertility: Could chlamydial infections be contributing? Am J Reprod Immunol. 2020 Sep;84(3):e13286.
- McConaghy JR, Panchal B. Epididymitis: An Overview. Am Fam Physician. 2016 Nov 1;94(9):723-726.
- Micallef M, Torreggiani WC, Hurley M, Dinsmore WW, Hogan B. The ultrasound investigation of scrotal swelling. Int J STD AIDS. 2000 May;11(5):297-302.
