Men's Health

What Is an Epididymal Cyst?

An epididymal cyst is a fluid-filled cyst that occurs near the top and behind the testicle.

What Is an Epididymal Cyst?

Overview

An epididymal cyst or a spermatocele is a benign cyst that usually develops in the epididymis. The epididymis is a long, coiled tube that collects, stores, and transports sperm from the testes. Approximately 30 percent of males develop this condition in their lives.

Another term for an epididymal cyst is a spermatic cyst. These cysts are generally painless and noncancerous. They are filled with milky to clear fluid, which might also contain sperm. Epididymal cysts tend to be common, but do not require treatment nor affect male fertility. However, if the cyst becomes large enough to disrupt daily normal activities and cause discomfort, doctors might suggest surgery. 

Symptoms

In most cases, an epididymal cyst does not cause any signs or symptoms. However, you might notice a general enlargement of your scrotum or feel an extra mass or lump on top of the testicle. If the lump becomes large enough, other symptoms may include any of the following:

  • Fullness above and behind the testicle
  • Discomfort, pain, or tenderness in the affected testicle
  • Heaviness or pressure at the base of the penis

Causes

Although the exact cause of epididymal cysts is still not clear, experts say that cyst development might be due to an obstruction in the tubes that transport sperm.

Risk Factors

Epididymal cysts tend to commonly appear in approximately 30 percent of adult males. These testicular masses are often discovered during self-examination or when men undergo imaging tests for other medical conditions.

There are not many known risk factors when it comes to epididymal cyst development. However, an increased risk was seen in men whose mothers had taken a synthetic estrogen medication called diethylstilbestrol (DES) during pregnancy to prevent pregnancy complications, such as miscarriage and premature labor. In 1971, the use of this medication was stopped due to concerns regarding women’s risk of developing a rare form of vaginal cancer.

Diagnosis

An epididymal cyst is not usually painful, but you might feel discomfort during a physical examination, particularly when the doctor tries to examine or palpate the mass. The following tests may also be performed to properly diagnose your condition:

  • Transillumination: In this test, the doctor will shine a light through the scrotum to check for solid masses. If what you have is an epididymal cyst, the light usually shines through since it is filled with fluid rather than a solid mass.
  • Ultrasound:  An ultrasound can help determine and confirm if the testicular lump is a cyst or a mass, which may be a benign or malignant tumor. This imaging test uses high-frequency sound waves to create images of structures and is often used to rule out other causes of scrotal swelling, such as testicular tumors.
  • Other Laboratory Tests: To check if inflammation and infection are present, your doctor may also order laboratory tests, such as urinalysis and a complete blood count (CBC).

Treatment

Treatment is not usually required if an epididymal cyst does not change its size or when it gets smaller since the body can reabsorb the fluid. 

Pain Medications

There is no specific medication for the treatment of epididymal cysts. However, when the lump is causing you pain, over-the-counter analgesics, such as acetaminophen (Tylenol) or ibuprofen (Advil), and other pain medications may be prescribed. If your doctor suspects an infection, antibiotics are prescribed.

Spermatocelectomy

If the lump has become large enough causing you discomfort, it can be surgically removed as an outpatient procedure. The surgical removal of an epididymal cyst or spermatocele is called a spermatocelectomy. However, surgery is not usually recommended for the treatment of epididymal cysts since they tend to recur after surgery. 

Aspiration and Sclerotherapy

Although rarely used, other treatment options include aspiration and sclerotherapy. Aspiration involves the insertion of a special needle into the cyst to aspirate the fluid.

If the cyst recurs, the doctor might repeat aspirating the fluid followed by the injection of an irritating agent into the sac. This treatment is called sclerotherapy. The injected chemical agent enables scarring of the sac, which reduces the risk of cyst recurrence. However, there is also a chance of damage to the epididymis when this treatment method is employed. 

Complications

It is unlikely for an epididymal cyst to cause complications. However, men who have undergone surgery for the removal of the cyst may develop possible complications.

The surgical procedure might damage certain parts of the male reproductive system, such as the epididymis or the vas deference (the duct that transports sperm from the epididymis to the ejaculatory duct) and reduce fertility. Although uncommon, epididymal cysts may also come back after surgery. 

Prevention

There is no known way to prevent the development of an epididymal cyst. For this reason, it is important to perform scrotal self-examinations at least once a month to detect any changes or masses in your scrotum.

The presence of new testicular lumps should be promptly evaluated by your doctor. To improve your chances of finding a mass, you can ask your doctor on how to perform a testicular self-exam at home. 

How to Do a Testicular Self-Exam 

Most people find it easier to perform a testicular self-exam during or after a warm bath or shower. Warm water can help relax the scrotum, making it easier to detect any unusual changes. The basic steps are:

  1. Hold one testicle and gently roll it between your thumb and finger.
  2. Examine any changes in the size, shape, and consistency of your testicles, along with checking the presence of any bumps or hard lumps.
  3. Repeat the first two steps with your other testicle. 

When to See a Doctor

Regularly conducting a self-exam will enable you to become more familiar with any changes in your testicles. Although performing self-exams is a good health habit, it cannot substitute for a doctor’s examination. If you happen to find a lump, consult your doctor right away to help rule out serious medical conditions, such as testicular cancer

Call your doctor if you have swelling and pain in your scrotum. There are a number of causes when it comes to testicular pain. In some cases, testicular pain may require immediate medical attention. 

References

Spermatocele (Epididymal Cyst). (December 2017) https://www.uwhealth.org/health/topic/special/spermatocele-epididymal-cyst/tv7861spec.html

What Are Spermatoceles (Spermatic Cysts)? (n.d.) https://www.urologyhealth.org/urologic-conditions/spermatoceles

Spermatocele. (n.d.) https://my.clevelandclinic.org/health/diseases/17492-spermatocele

Spermatocele. (February 2018) https://www.mayoclinic.org/diseases-conditions/spermatocele/symptoms-causes/syc-20377829

Testicular Masses. (February 1998) https://www.aafp.org/afp/1998/0215/p685.html

Key Takeaways

  • An epididymal cyst is a fluid-filled cyst that occurs near the top and behind the testicle. 
  • Approximately 30 percent of males develop this condition in their lives.
  • Although an epididymal cyst can be a nuisance, it is not cancerous, and having it does not increase your risk of testicular cancer