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SHOOTING PAIN with lump in left testicle.

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Hello!

A little less than 2 months ago, I noticed a small, painless lump just below my left testicle. Obviously, it gave my reason to be concerned, so I immediately scheduled an appointment with my family doctor. Two days later (on the 24th of June I believe), I went to my appointment, and he examined both testicles and the lump as well. He seemed very confident that it was nothing at all to worry about and that it was most likely a "spermatocele" which could easily go away within the next week or two. He said that IF it doesn't go away in another week or so, I could get an ultrasound just to be extra sure that it is nothing else, but, with great confidence, he assured me that it was 99.9(something)% likely that it was nothing to worry about at all and that I should be fine (and not need an ultrasound).

For the first week after my appointment, not much changed. During the second week, I thought that perhaps it had begun to shrink just a bit. I was fairly relieved and thought "it should be gone now before too long."

About three and a half weeks after my appointment, it was still there. I began to get a bit worried, so I called the doctor's office and talked with a nurse over the phone about what was happening. It was still painless and very much separate from the testicle, but it was still there (even if it was about the same size or smaller). She delivered my message to the doctor I had seen, and he said that there seemed to be no need for an ultrasound and that I should just let it be and let nature take its course.

Since that point, I have noticed it change slightly in shape/consistency. Sometimes it seems to be harder, and other times it seems to be almost the feeling of a small cluster of veins (yet still cyst-like). It seems to have either stayed the same size or gotten just a bit smaller, but I'm not entirely sure which.

About two to three days ago, I noticed that my left testicle has begun to ache ever so slightly, but it's just enough to be rather annoying. When I sit down or when I lay in bed, I tend to notice that "aching" feeling less; when I walk around for a while, it seems to ache more. It is not "painful" at all in the sense that it is a "shooting pain" or anything like that; it just "aches" and sort of "hurts" a bit. Also, I've noticed that, just above my right testicle, there seems to be a tube or vessel of some sort that seems "harder" than usual. It doesn't seem to be a cyst or anything of that sort (if it is, it's incredibly small); it just seems to be one random tube that is a bit harder than usual. The other testicle is completely fine.

Some additional information that may be helpful: I am 21 years old patientold and in pretty excellent health otherwise. I stay active (go to the gym 3 times a week on average-- not an exaggeration, I promise), and I intentionally try to eat healthy every day. I'm also 6'7" tall and about 190-195 lbs. I have had no serious medical problems to date, and I am not on any medications of any kind.

I'm asking online first because I just got back to my college campus (which is 5 hours away from home) to begin RA training, and, unfortunately, they don't have a doctor visit the campus until classes start up (and training is another 10 days yet). I'd prefer not to go to the hospital or anything of that sort if this is not a big deal (I've read that spermatoceles can potentially stick around for a while and that they can even begin to ache in some cases). If it is a big deal, however, I want to know so I can take care of it. Thank you!

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 25 Doctors Online

Hello.
Thank you for posting your query at DoctorSpring.com
I understand your concern.
A careful physical examination is extremely important and if your doctor felt after palpation that it is spermatocele, then the other serious conditions can be ruled out. Spermatocele presents as a painless lump, and your description makes it more likely since you can feel a tube which is enlarged as you said. The other causes that could have caused this is testicular torsion which is an acute painful condition and has been ruled out, or an infection and inflammation following an insect bite, but there is no such history. The other possibility is a varicocele but it is very easy to pick up varicocele as due to pulsations, the swelling will feel like a bag of worms. Your doctor would have picked it up clinically and it has been ruled out too.
Spermatoceles occur when there is a block in the tube which carries semen, and is a painless epididymal cyst. In most cases they do not need any treatment and they do not cause any harm. Only some patients get pain and in those cases, Tylenol or Advil is advised to control the pain. But just to confirm an Ultrasound of the Scrotum, is the initial diagnostic test of choice and it is better you discuss with your doctor and get it done. In some cases, it can cause enough discomfort and hence it has to be operated upon. The only reason doctors want to wait and do not want to operate is that the swellings are too close to the vas deferens and hence there can be injuries to the vas deferens, which can affect fertility. Hence the doctors want to wait and watch rather than taking an aggressive approach right away.
In your case, it is better you get an Ultrasound first to confirm the diagnosis. The Ultrasound will give us a much better picture about the dimensions and exact site of the swelling. Meanwhile you can take Tab. Tylenol to relieve your pain and discomfort.
Feel free to discuss further,
Regards.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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