1 What is Spermatocele?

A spermatocele, also known as a spermatic cyst, is milky or clear fluid containing sac (cyst) that forms in the epididymis. Epididymis is a tube-like structure located at the back of the testicle that stores and carries.

A spermatocele usually doesn't cause pain and is benign (non-cancerous). It may also contain sperm.

Although the exact cause hasn't been identified, spermatocele is believed to occur due to obstruction in one of the sperms-carrying tubes.

Spermatocele is a benign condition that does not cause infertility and does not need any treatment.

However, surgical removal of a spermatocele is necessary if it becomes enlarged and causes discomfort.

2 Symptoms

You may not experience signs and symptoms even if you have spermatocele.

A spermatocele may not grow and remain unchanged in size or it may grow big which can cause following symptoms:

  • Pain or discomfort in the testicle where spermatocele has developed
  • A sensation of heaviness in the testicle that contains spermatocele
  • A lump behind and above the testicles

Visit your doctor if you detect spermatocele while inspecting testicle by yourself. Seek prompt medical advice if you have pain or inflammation in your scrotum.

If you find any lump in the scrotum, seek medical advice to determine whether the lump is formed due to cancer. Among the different causes of testicular pain, few require prompt medical attention

3 Causes

The exact cause of spermatocele has not been identified yet. Spermatocele is thought to occur due to obstruction in tubes of the epididymis.

The epididymis is responsible for storage and transportation of sperm from the testicle.

Trauma and inflammation may be associated with the obstruction in the epididymis.

4 Making a Diagnosis

Making a diagnosis of spermatocele is done by performing several tests.

Your doctor may refer you to a urologist (a specialist in treating diseases of the urinary tract and reproductive system in men).

Make sure your doctor knows about your symptoms and any other medical condition that you may have.

You may ask following questions to your doctor:

  • What could be probable causes of my symptoms?
  • What tests do I need?
  • Is this condition temporary or long lasting?
  • Will the spermatocele affect my sex life?
  • Will this condition affect my fertility?
  • Do I need treatment?
  • What are my treatment options and side effects of each option?
  • How long after surgery can I resume my normal activities?
  • How long after surgery can I resume my sexual activity?

A clear talk with your doctor can optimize the therapy and improve the outcomes.

Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

  • What are your symptoms?
  • How often do the symptoms bother you?
  • When did you start experiencing the symptoms?
  • How severe are your symptoms?
  • Does any factor improve or worsen your symptoms?
  • Do you remember any trauma to your scrotal area?

Over-the-counter painkillers, such as acetaminophen or ibuprofen, may be taken if you are experiencing pain due to spermatocele.

The diagnosis is likely to begin with a physical examination. Generally, spermatocele doesn’t cause pain. But during a physical examination, you might feel pain.

Other diagnostic tests that are likely to be performed are:

  • Transillumination: A light is allowed to pass through scrotum in this test. If spermatocele is present, it will light up. If there is the presence of a tumor, it will not shine.
  • Ultrasound: Ultrasound is usually opted if transillumination doesn’t give a conclusive diagnosis. Ultrasound can also be used to identify other causes of inflammation in the scrotum.

5 Treatment

In most of the cases, spermatocele is painless and is not associated with the complication. Hence, treatment may not be required.

Over-the-counter pain reliever, such as acetaminophen or ibuprofen, may be taken if you experience pain.

Surgical treatment: The surgical removal of spermatocele from epididymis is called spermatocele ectomy. You may be given local or general anesthesia for this procedure.

A small cut is made in the scrotum to remove the spermatocele. You may use specially designed undergarment to protect the site of the incision.

After consulting with your doctor, you may:

  • Apply ice packs on the scrotum to reduce inflammation
  • Take painkiller for few days
  • Schedule a follow up after about two weeks

Injury to epididymis or vas deferens (the tube that transports sperm) during surgery may affect your fertility. There is a possibility of recurrence of spermatocele.

Aspiration, with or without sclerotherapy: Aspiration may be performed alone or in combination with sclerotherapy. But this treatment option is rarely opted.

It involves draining the fluid out by using a needle. Aspiration is chosen if spermatocele reappears. Sclerotherapy is usually performed after aspiration.

The liquid inside the sac, after aspiration, is replaced by irritant through injection. The irritating chemical then damages the spermatocele and reduces the incidence of recurrence.

However, this procedure is associated with increased risk of damage to epididymis. So, sclerotherapy is chosen if you do not wish to have children or have passed that phase.

There is probability of reappearance of spermatocele.

6 Prevention

Spermatocele cannot be prevented. You should inspect your scrotum at least once in a month to detect any abnormal changes.

If you find any unusual changes, like a lump, in the scrotum, seek medical advice. You may learn to perform self-examination of testicle from your doctor.
The ideal time for testicular self-inspection is either during or after a warm bath or shower. Warmth helps to relax the scrotum.

The detection of any abnormal changes becomes easier when the scrotum is relaxed.

Following instructions should be followed for self-examination of scrotum:

  • Stand in front of the mirror
  • Check if there is any swelling on the skin of scrotum
  • Hold each testicle in such a way that your index and middle fingers are under the testicle and thumbs on the top. Glide your thumbs and fingers as if you were to roll the testicle. Remember that the testicles are usually smooth, oval shaped and somewhat firm. Usually, one testicle is slightly larger than the other.

Frequent testicular self-examination can make you aware of any abnormal changes. Your testicles are examined by the doctor when you have a physical exam.

7 Risks and Complications

Age is the main risk factor for spermatocele. As your age increases, your risk of having spermatocele also increases. If your age is between 20 and 50, you are more likely to develop spermatocele. 

Usually, spermatocele is not associated with complications. Surgery might be performed if spermatocele causes your pain or discomfort.

Your fertility may be impaired due to injury to epididymis or vas deferens while performing surgery.

Although it is unlikely, recurrence could be another complication of a spermatocele.