Undescended testicles should be treated as young as possible, and adults who have had an undescended testicle need to self-examine regularly, because the risk from testicular cancer increases in an undescended testicle.

Warts
The skin of the scrotum is usually rough and creased. Small, cauliflower-like, raised lumps may be warts and should be treated by a doctor, usually in a genitourinary medicine (GUM) clinic. Do not attempt to remove them yourself.

Tiny, smooth bumps on the scrotum and shaft of the penis are normal and are simply hair follicles or sweat glands. These tend to stick out more when the scrotum is tight, as in cold weather, and are particularly noticeable on the erect penis where they cause a disproportionate amount of unnecessary concern.

Hernia
A loop of bowel can protrude through gaps in the abdominal wall and form a swelling or hernia at the join between the thigh and abdomen (inguinal region). In some cases, the hernia may move into the scrotum. Men are much more likely to develop an inguinal hernia than women because of a potential weakness in the abdominal wall at the groin. If a lump in the scrotum is an inguinal hernia, the impulse from a cough may be felt in the scrotum. However, men will often be totally unaware of such a hernia until it becomes very large or if it strangulates (cuts off its blood supply), causing sudden pain.

Learning to lift correctly, keeping active and watching your weight will reduce your risk of a hernia. Once a hernia has developed, a truss will prevent strangulation by keeping the bowel where it belongs, but surgery is invariably the best option.

Hydrocele/varicocele
A soft lump in the scrotum, especially if you can get your fingers between it and the testicle, is most likely to be a hydrocele. This is a collection of sterile fluid in the cord attached to the testicle, which is invariably harmless. Left untreated, a hydrocele can grow to a large size and cause discomfort, so they are usually best drained early. Varicoceles are similar, except they are caused by enlarged blood vessels. Both may require surgical removal in severe cases.

Neither condition is dangerous except in very rare cases when they become infected or put pressure on blood vessels.

Infection
Tenderness and heat that develops slowly in one or both testicles, especially with testicular swelling or raised body temperature, may be caused by an infection. The organism causing the infection is not necessarily sexually transmitted, since the testicles and scrotum are just as prone to infection as any other part of the body. A prolonged, untreated infection can damage your testicles and reduce your fertility, so it is worth getting treatment promptly.

Antibiotics are usually the only treatment required. Infections that affect the whole body can sometimes cause pain and swelling in the testicles. Mumps and glandular fever are good examples, although even flu and the common cold can cause an aching sensation in the testicles. Paracetamol can help reduce the pain that goes with this symptom.

Injury
Most men have suffered the painful experience of a blow to the testicles. Generally, the danger from any permanent damage recedes as the pain diminishes. If the pain persists for more than a few hours, or if you pass blood in your urine, you should get checked out as an emergency because bleeding into the testicles can be serious.

Applying a cold compress (which should be covered to prevent any damage from intense cold) for no longer than five minutes will ease the pain. Continuous injury from a poorly constructed, or badly adjusted, bicycle saddle can damage the testicles. Protective gear should be worn for all contact and other risky sports.

Torsion
The spontaneous twisting of a testicle cuts off its own blood supply, and is unlikely to go unnoticed. Severe pain, swelling and tenderness in one testicle are often accompanied by vomiting. The 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.

No cause has been established for torsion, although your risk is increased if it has happened before. The surgeon may decide to stitch both testicles loosely to the scrotum to prevent twisting in the future.

Testicular cancer
See our 'Testicular cancer' factsheet.

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