Hard & Soft, Pea Sized Lump in Scrotum: Causes, Symptoms, Diagnosis

The scrotum is the sac-like structure that holds male testicles. It is suspended below the penis, a feature that makes it conducive for sperm production in the testicles. The scrotal skin is usually rough and with little bumps.

Now and then a lump or swelling can occur on or inside the scrotum. This can be worrying but in most cases it is caused by harmless conditions. You might also be experiencing a painful lump in the scrotum after vasectomy.  All the same, medical screening is advised in the advent of a lump on scrotum skin. This article is detailed on Hard, Soft, Pea Sized Lump in Scrotum: Causes, Symptoms, Diagnosis and treatment options.

Possible causes of lump on scrotum skin

Any of the following can be responsible for a lump on scrotum skin:


This is a form of cyst that develops due to accumulation of sperm in the epididymis. The epididymis is located on to the back of the testicles. Spermatocele lumps can be felt on the scrotum.


Hydrocele develops when the layers of the tissue that form the testicle accumulates with fluid. This leads to formation of a painless lump that can be felt on the scrotum.


Epididymitis is caused by inflammation of the epididymis. The resulting lump is usually painful and can be felt by touching the upper side of the testicles on scrotum.


Hematocele is almost similar to hydrocele. Only that in this case, blood rather than fluid accumulates in the sac that surround the testicles.


Varicocele forms through the same process that forms varicose veins on lower legs. Here, blood veins in the scrotum enlarge. Most cases of varicocele develop on the left scrotal side. If left untreated, varicocele can lead to depletion of oxygen in the testicles and result in infertility.

Testicular torsion

Testicular torsion leads to formation a very painful lump on scrotum skin. It is caused by trauma or injury to the testicles, which causes them to twist inside scrotal skin. It is considered a medical emergency and should be treated immediately.


Orchitis is commonly caused by the mumps virus and other viral infections. It leads to inflammation of the testicles. In some cases, the infection may be caused by bacteria. The epididymis will also inflame in such case.

Testicular cancer

Testicular cancer can begin with a hard lump on scrotum. Although it is not a common type of cancer, screening is necessary to rule it out.


Inguinal hernia occurs when a part of the bowel pokes through weak skin in the groin area to the scrotum. Lumps due to hernia tend to disappear when one is lying on their backs.

Sebaceous cysts

A hard lump on scrotum under the skin could be caused by a sebaceous cyst. These are usually painless but can become painful if irritated. Close inspection will show a yellowish appearance and sometimes a foul odor. Cysts are harmless and common causes of lump on the wrist under the skin, on the scalp and in the armpit.

Lipoma and fibroma

Lipoma occurs due to formation of fat deposits under the skin. Resulting lumps feel soft and rubbery to touch. Fibroma is a disorder of the connective tissue.


STIs can cause swelling and sores on the scrotal skin. This includes warts.

Symptoms of lump on scrotum

A normal testicle feels firm to touch. It should not, however, begin to feel hard. The surface should be smooth and without any bumps. On top of the testicles, you will feel a highly coiled spongy structure. That is the epididymis. It should run all the way to the back of each testicle. One of the testicles will most likely be hanging lower than the other. Testicles should not feel painful to touch.

A pea sized lump on the testicle is not normal. The same can be said about any form of swelling or bump in and on the scrotum. All these are definite indications of initial stages of testicular cancer.

If you feel a sudden sharp pain and a lump on your testicles, it could be due to testicular torsion. This is especially if you have been involved in some kind of accident. A painful soft lump could also be due to inflamed epididymis due to infections.

If some tube-like structures are to be felt on top of one of the testicles, it could be due to varicocele.

A lump that is not attached to any tissue in the scrotum is probably a lipoma lump. It is harmless and should not make you concerned.

Diagnosis for lumps on scrotum skin

You can rely on the symptoms and online pictures to work out which type of scrotal masses you are dealing with. Even so, medical diagnosis should have the final word. In a clinic or hospital, a doctor will rely on any of the following:

Physical examination

Physical examination involves feeling the scrotum for any presence of a lump. This is best done when the testicles are fully relaxed, such as on a cool day.


Ultrasound involves use of sound waves to map the size and position of a lump. It can also show if the testicles are located in their normal positions.

Blood tests

Blood tests are necessary when a lump on the scrotal skin is accompanied by signs of an infection. They can also be used to check for cancerous cells in the blood.


X-ray is usually necessary if there are reasons to associate a lump on the scrotum with cancer of the testicles. It is used to check if tumors have formed on other parts of the body.

Urine test

A urine test can be considered to check for presence of bacteria or viruses. This is mostly in case of other symptoms such as fever, chills or swollen lymph nodes.


Rarely will a biopsy be necessary for diagnosis of lump in the scrotum. Biopsies involve cutting a small piece of skin and lab-testing it for signs of infections or cancer.

Treatment for lumps in scrotum

A lump on the scrotum sack that doesn’t cause pain, swelling, discomfort or signs of diseases can be left on its own. Most will heal even without treatment.

A painful, swollen or itchy lump can be treated with painkillers and antihistamines. Anti-inflammation medications such as steroids can also be considered where necessary. This applies to most cases of inflammation including painful lump under chin or even in armpit.

A lump on top of scrotum skin due to an infection should be treated with antiviral or antibacterial medications. This is usually seen in the case of epididymitis and orchitis.

A big lump in the scrotum can be removed surgically. Such a lump could lead to complications such as infertility if left untreated.

Cancerous lumps require special medical treatment. In most cases, a therapeutic approach is considered first rather than a stronger treatment approach.

Is a pea sized lump in scrotum a sign of cancer?

Testicular cancer is not that common. When it occurs, it is very much treatable especially if noted early enough.

Early signs of testicular cancer revolve around formation of a pea-sized lump in scrotum. However, not all such lumps will mean cancer of the testicles.

All cancer lumps keep growing if left untreated. It is therefore probable that the lump will be pea-sized for not long. In the initial stages, cancer lumps are often painless. They feel attached to tissue and immovable.

With time, the cancer cells will travel to other body parts, starting with the lymphatic system. This will prompt signs such as swollen lymph nodes and delayed recovery from illnesses. By the time the cells affect other organs such as stomach, liver, brain and lungs, the patient will experience signs like voice hoarseness, weight loss, confusion, belly pain or lump on right and left side of neck.

Transillumination will confirm if indeed the lump in the scrotum is a tumor or not. It involves shining a bright light to the lump. A hard lump due to a tumor will not allow the light to pass through. Be sure to report any case of a lump on top of scrotum or inside the scrotal sac to your doctor.

Self-examination for lump on scrotum sac and testicles

Some experts remain skeptical on whether self-examination for scrotal lumps does reduce mortality due to such masses. However, it is known that early detection of cancer lumps increases chances of recovery.

To perform a self-exam, start with observing your scrotum in a mirror. A big lump or one on top of scrotum will be noticeable.

From there, hold your scrotal sac between your fingers and the thumb. Feel the scrotum skin for any bumps. After that, gently roll the testicles between your fingers. Remember the things we earlier said about how a normal or abnormal testicle should feel like. This exam is best performed in the shower, when the testicles are most relaxed.

Consider learning more on topics such as small lump on my eyelid, causes of breast cancer, harmful or harmless lumps on skin and so on. You find that cases of cancer and other types of lumps are on the rise in the world today.