Table of ContentsView AllTable of ContentsSymptomsInfertility RiskComplicationsDiagnosisSelf-ExamTreatmentPrognosis
Table of ContentsView All
View All
Table of Contents
Symptoms
Infertility Risk
Complications
Diagnosis
Self-Exam
Treatment
Prognosis
Aspermatoceleis a fluid-filledcystthat develops in a coiled, tubular structure inside thetesticlescalled theepididymis.It is a common, typically pain-free condition mainly affecting older males.The fluid inside the cyst will be milky or clear and contain dead sperm cells (spermatozoa).
A spermatocele is usuallybenign(noncancerous), and does not increase the risk oftesticular cancerorinfertility. If the cyst is causing discomfort, over-the-counter (OTC) pain relievers may be prescribed. Medical procedures, including surgery, may be recommended if the spermatocele is exceptionally large or painful.
The article describes the symptoms and causes of spermatoceles, including how this common urological condition is diagnosed and treated.
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A Note on Gender and Sex TerminologySpermatoceles affect people born with a penis, who are typically assigned male at birth.Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “male," “man,” and “boy” as the sources use them.
A Note on Gender and Sex Terminology
Spermatoceles affect people born with a penis, who are typically assigned male at birth.Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “male," “man,” and “boy” as the sources use them.
Spermatoceles affect people born with a penis, who are typically assigned male at birth.
Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “male," “man,” and “boy” as the sources use them.
What Are the Symptoms of a Spermatocele?
A spermatocele usually causes no pain. In some people, there may be a sense of heaviness or fullness in thescrotum(the sac of skin that houses the testicles). But for the most part, a spermatocele will beasymptomatic(without symptoms) and may only be discovered during atesticular self-examor while bathing or showering.
The cyst itself will feel soft, smooth, and painless. In most cases, there will be a single cyst, typically smaller than 1 centimeter (cm), equal to about one-third inch. On rare occasions, a spermatocele has been know to grow as large as 5 cm (2 inches).
If a spermatocele is especially large, it can cause a dull, aching, or “dragging” pain (rather than a sharp pain). The pain may be more noticeable at the end of the day.
As a rule of thumb, spermatoceles are not a serious medical issue.
Spermatocele vs. Epididymal CystA spermatocele can also be referred to as an epididymal cyst. With that said, an epididymal cyst can affect children before and after puberty. A spermatocele is distinct in that it only occurs after puberty, when sperm cells are produced.
Spermatocele vs. Epididymal Cyst
A spermatocele can also be referred to as an epididymal cyst. With that said, an epididymal cyst can affect children before and after puberty. A spermatocele is distinct in that it only occurs after puberty, when sperm cells are produced.
Do Spermatoceles Cause Infertility?
Spermatoceles are not associated withinfertility. A two-year study published in theAmerican Journal of Men’s Healthreported that among 65 men with spermatoceles, the presence of the cyst did not cause a lowersperm count or qualitycompared to men without spermatoceles.
This is because the cysts tend to develop at the head of the epididymis, closest to the testicle.This is where up to 15 tiny tubes called efferent ducts transport sperm from the testicles to the main body of the epididymis.If one or several of these tubes are blocked, sperm can still make their way through the remaining tubes.
However, if a cyst is large or develops elsewhere in the epididymis, it can cause the complete obstruction of sperm.Even so, the remaining testicle is usually more than capable of producing enough sperm to produce a pregnancy in a partner.
Complications of Spermatoceles
In rare situations, a spermatocele can cause a medical emergency known asepididymal torsion. This is when a large spermatocele rotates, twisting the epididymis and cutting off the blood flow,
If not treated within six to eight hours, epididymal torsion can causenecrosis(tissue death) and irreversible damage to the epididymis. More importantly, it may increase the risk oftesticular torsion, a condition in which the spermatic cord (which supplies blood to the testicle) twists, causing possible loss of the testicle.
It is important to seek emergency care if you experience signs of epididymal torsion, which may be indistinguishable from testicle torsion.
Symptoms include:
Torsion of a spermatocele is a rare occurrence, with no more than eight cases reported in the medical literature.
Causes of Testicular Pain You May Not Know
What Causes a Spermatocele?
Spermatoceles is a relatively common condition affecting 30% of males, usually in those over age 40.The highest incidence is between the ages of 65 and 74.Younger males and adolescents can also be affected, albeit less commonly.
It is not entirely clear what causes spermatoceles or why some people get them and others don’t. The location of most of the cysts suggests a few explanations.
Spermatoceles typically develop in the network of tubes at the head of the epididymis.If the walls of one of these tubes weaken, an abnormal pouch called adiverticulumcan form. Over time, sperm cells can start to accumulate in the pouch, causing it to expand and eventually form an enclosed capsule known as a cyst.
A spermatocele can also develop if an injury, infection, or surgery blocks the epididymis. Some cases areidiopathic(meaning of unknown origin) and may form spontaneously in the absence of any instigating event.
The only known risk factor for spermatoceles is older age.
How Are Spermatoceles Diagnosed?
The diagnosis will involve reviewing your medical history and performing a physical exam. During the physical exam, the urologist will palpate (lightly touch) the mass to determine whether it is hard or soft, free-moving or fixed, or painful or nonpainful.
The urologist may also hold a penlight against your scrotum to see if the mass is solid or fluid-filled (a technique known as transillumination).If light passes through the mass, the test is positive for a fluid-filled structure, likely a spermatocele, or possibly ahydrocele(fluid around the testis).
The combination of a soft, free-moving, and painless mass with a positive transillumination test may be enough to diagnose a spermatocele.
Even so, most urologists will confirm the diagnosis with a noninvasivetesticular ultrasound, which visualizes the cyst using high-frequency sound waves.
If there is still any doubt, the urologist may perform anaspirationin which a needle is inserted through the skin and into the cyst to remove a sample of fluid. If the mass is a spermatocele, dead sperm cells will be found in the fluid.
These tests can help differentiate spermatoceles from similar conditions such as:
Spermatocele vs. Varicocele vs. Hydrocele
Although spermatoceles,varicoceles, and hydrocelescan easily be mistaken for each other, a varicocele will often feel like a “bag of worms” when palpated,while a hydrocele will feel more like a water-filled balloon with no palpable mass.
What Are the Signs of Testicular Cancer?
How to Perform a Scrotal Self-Exam
Although a mass in your scrotum may be harmless, there is a chance that it could be something more serious, like cancer. This is why organizations like the American Urological Association (AUA) recommend monthly testicular self-exams (also known as scrotal self-exams) to find abnormalities that might otherwise go undetected.
The AUA recommends teaching children how to do self-exams while in their teens, following the guidelines:
If you find any lumps, bumps, or growths, make note of where they are and what they feel like, and report this to a healthcare provider.
Treatment Options
Spermatoceles do not go away on their own but are rarely a cause of concern. Moreover, they don’t need to be treated if you have no pain. Your healthcare provider will simply advise you to continue to do self-exams and report any changes you find.
It is only when a spermatocele is causing pain, getting larger, or causing you distress that treatment may be needed.
Medical Treatment
No medications can shrink or eliminate spermatoceles. Medications are used solely for pain relief and/or to reduce swelling when needed.
Typically, OTCnonsteroidal anti-inflammatory drugs (NSAIDs)likeAdvil or Motrin (ibuprofen)andAleve (naproxen)are the first-line treatment. If the pain is severe, a prescription NSAID likeCelebrex (celecoxib)may be recommended.Your healthcare provider will advise you on how to use these correctly.
If you have unrelentingchronic pain, atricyclic antidepressantlikeElavil (amitryptiline)orPamelor (nortriptyline)may be prescribed.
Another option is toapply a cold compressto your scrotum for 10 to 15 minutes to treatacute pain. Be sure to place a thick cloth between the compress and your skin and to keep the compress moving to prevent frostbite. A safer option may be to soak a washcloth in ice water and apply it to the scrotum.
Minimally Invasive Procedures
If conservative treatments fail or a spermatocele is especially large, your urologist may recommend the following in-office procedures:
Smaller spermatoceles (under 2 cm) are less likely to experience recurrence.
Surgery
If a cyst is especially large, surgery may be pursued to remove it altogether. This carries significant risks and requires a skilled surgeon who can remove the spermatocele without compromising your fertility.
The most common procedure, called aspermatocelectomy, involves the excision (removal) of the cyst along with a portion of the epididymis. The surgery is performed on anoutpatient basisin a hospital or specialized surgical center and using eitherlocalorgeneral anesthesia.
Only a small incision in the scrotum is involved. You can usually return home after the procedure and shower 24 hours later. You will be asked to wear a jockstrap for a week to support the testicle.Scrotal swelling can last anywhere from two to 21 days.
A Word From VerywellThe spermatocelectomy procedure can be done with an operating microscope (a microsurgical approach) to minimize the chance of infertility or obstruction of the epididymis.—MATTHEW WOSNITZER, MD, MEDICAL EXPERT BOARD
A Word From Verywell
The spermatocelectomy procedure can be done with an operating microscope (a microsurgical approach) to minimize the chance of infertility or obstruction of the epididymis.—MATTHEW WOSNITZER, MD, MEDICAL EXPERT BOARD
The spermatocelectomy procedure can be done with an operating microscope (a microsurgical approach) to minimize the chance of infertility or obstruction of the epididymis.
—MATTHEW WOSNITZER, MD, MEDICAL EXPERT BOARD
What to Do If Testicular Pain Won’t Go Away
What’s the Outlook?
Generally, the outlook is good if you’ve been diagnosed with a spermatocele. Most people can live with spermatoceles without any impairment of their health, fertility, or quality of life.
The picture may be different if you require more aggressive treatment.
With aspiration and sclerotherapy, the success rates hover around 85%.Although repeat treatment can be pursued, many authorities, including the Urology Care Foundation (UCF), advise against this in people who want to preserve their fertility as it can irreparably damage the epididymis.
The risk may even be greater with spermatoceletomy, in which 10 of every 25 treated individuals experience recurrence.
Moreover, studies suggest that the rate of complications may be as high as 27%, causing damage not only to the epididymis but also to thevas deferens(the tube that receives and stores sperm in anticipation of ejaculation). People who are overweight or haveobesityare at the greatest risk.
For these reasons, you need to approach surgery with caution, weighing the benefits and potential risks with your urologist.
Summary
A spermatocele is a benign cyst containing dead sperm cells that forms in a coiled tube in your scrotum called the epididymis. It is typically painless and doesn’t increase the risk of infertility. While the cause of spermatoceles is poorly understood, the condition is generally regarded as harmless.
A spermatocele doesn’t need treatment unless it causes pain. If a cyst is large and/or painful, over-the-counter painkillers, procedures like aspiration and sclerotherapy, or a surgery called spermatocelectomy may be used.
Care needs to be taken when embarking on more invasive procedures as they may affect your fertility. Expert consultation with a urologist is needed.
24 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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