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Testicular Masses

The Weekly Jockstrap – When "my nut hurts" means you need to rush to the ER…

For most people, having big balls is either a joke, a point of pride, or maybe even a crappy tee-shirt company from the 90s. But in some cases, it is a serious situation that can affect the quality of life, signal a life-threatening testicular cancer, or even put you at risk of losing a nut.

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So, how can you sort these things out? When should you see a doctor? When should you rush to the emergency room? Let’s talk about the things that can threaten your nuts. What can grow down there? What can happen to them?

"My nutsack is growing."

Assuming you’ve completed puberty, this is not a normal situation. There are a few benign (non-cancerous) conditions that could be occurring if one of your balls seems to be growing. You will need to see your physician and probably will need an ultrasound to sort these out, but let’s go over them. A hydrocele is a collection of fluid that accumulates around the testicle in the scrotum.

In general, there is no danger with a hydrocele, but they can become greatly enlarged and bothersome.
Treatment options range from simply observing this condition, if it’s not too bothersome, to removing
the fluid with a needle, or even to a surgery to fix the underlying problem. If you’re carting your balls
around in a wheelbarrow (yes I’ve seen this) it’s time to have something done.

A spermatocele is a similar condition, but the fluid collects in a structure called the epididymis outside
the testis. This condition rarely gets significantly enlarged or bothersome and is usually found

“My balls are hurting.”

In contrast to the other two conditions I mentioned above, this one often is painful. A varicocele is a
condition where blood pools in the veins that drain the testicle. Most guys complain of a mass that is
classically described as a “bag of worms” that gets larger and more painful through the day. The pain
often lessens at night when the blood has a chance to drain. This condition can be more complex to
treat and usually requires surgery. An important additional note about varicocele is that it can cause
problems with sperm production and fertility, and may have some influence on Testosterone production
as well. Sperm production occurs best at a slightly lower temp than your body temp of 98.6, which is
why your testicles are outside your body and down in your scrotum. The pooled blood raises that temperature and can damage or kill your sperm. 

You can also develop infections in the testicle (orchitis), the epididymis (epididymorchitis), or the scrotum (cellulitis or an abscess).  Usually, these infections can be treated adequately with antibiotics as long as they are caught early.  Rarely, the infection progresses to a pocket of pus, called an abscess, and needs to be drained. Usually, infections come on quickly and make you feel pretty sick.  Fever is common. Often, especially with infections in the testicle, there is an underlying cause that needs to be addressed (for many guys, this problem is an enlarged prostate.)  

One of the most common benign testicular problems doesn’t require a visit to the urologist at all, and is easily cured:

“My jackass buddy punched me in the balls.”

Usually, this requires some time on the couch with a bag of frozen peas, and things will get better.  However, there are times when testicular trauma can do serious damage. If the pain and nausea aren’t improving in the hours after getting hit in the balls, you may need to see a doctor.  There are times when persistent bleeding causes a hematoma on the scrotum that can impair blood flow to the testicle. There are also cases (not that uncommon) of the testicle being ruptured from a trauma.  If you want to keep your nut, you may need surgery to save it.

“My nut is FU*%ing killing me.”

This condition (and the one below) should actually scare you. If you develop sudden terrible pain in
one nut, you may be having a testicular torsion. This is a condition where the cord twists and cuts off
blood flow to the testicle. The pain is significant. Nausea and vomiting are common. If this happens,
you need to rush to an emergency room. Typically, you have about 4-6 hours before that testicle is dead
and you need surgery to save it before this happens. For those of you with sons, this is a condition you
should discuss with them. I’ve taken out a fair number of dead nuts because young boys are too shy to
share this concern with their parents. Teaching them is important. Rush yourself, or your son, to the ER
if this might be you.

“What if it’s not benign?”

This is the reason it’s important to see a urologist quickly if you think something is going on with your
balls: not every condition is benign. Testicular cancer is one of the few types of cancer that occurs
across all age groups, and sadly, it can grow and spread quickly. This often occurs in young, healthy
people like Lance Armstrong or Tom Green. (He’s crazy because he’s Canadian, not because of his solitary nut.)


If you have a testicular mass that is concerning for cancer, there may be some lab work to check the “tumor markers” in your blood.  You will likely need surgery. I know that is a scary prospect, but it’s so crucial that you get checked. Way, WAY, too many guys wait too long due to fear of minor surgery or embarrassment about their scrotum.  Please don’t let this be you. In spite of its fast-growing nature, testicular cancer remains among the most curable types of cancer when caught early. These are doctor’s orders: play with your balls regularly. Once you’re done with that, do the testicular self-exam.   Instructions here:


Testicular cancer is another condition to discuss with your son.  By the time he sees the pediatrician in 6mo, it will be too late. See a doctor right away if you have concerns.  Not in two weeks. Testicular cancer can grow dramatically in two weeks. Right away!

Hopefully, this overview will help you keep your balls healthy, safe, and sound.  We welcome your questions below and will do our best to respond quickly.

Midtown Urology is centrally located at 38th and Lamar.  If we can help with any urologic-related issues for you or your family, please let us know.

This Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Midtown Urology

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