Epididymal Cyst: Causes, Symptoms, and Treatments

Man with an epididymal cyst consulting with his doctor.

Epididymal cysts are fluid-filled sacs that develop in the epididymis, a coiled tube located at the back of the testicle that stores and transports sperm. These cysts are generally benign and non-cancerous, and they do not affect fertility. However, they can cause discomfort and pain, especially if they grow large in size.

The exact cause of epididymal cysts is unknown, but they are thought to develop due to blockages in the tubes that transport sperm from the testicles to the urethra. They are more common in men over the age of 40, but they can occur in men of any age. In most cases, epididymal cysts do not require treatment, but if they cause pain or discomfort, or if they grow in size, medical intervention may be necessary.

Treatment options for epididymal cysts include watchful waiting, pain management, and surgical removal. The decision to remove the cyst depends on the size, location, and symptoms of the cyst, as well as the overall health of the patient. In some cases, cysts may recur after surgical removal, and further treatment may be necessary. It’s important for men to seek medical attention if they notice any changes or abnormalities in their scrotum or testicles.

Understanding Epididymal Cysts

The exact cause of epididymal cysts is not known, but they are thought to develop when the epididymis becomes blocked or damaged. This can cause fluid to build up and form a sac. Epididymal cysts are not contagious, and they do not increase the risk of developing testicular cancer.

Symptoms of epididymal cysts may include a small, painless lump in the scrotum or a feeling of heaviness in the testicle. However, many men with epididymal cysts do not experience any symptoms at all. In some cases, epididymal cysts may be mistaken for other types of scrotal masses, such as spermatic cysts or hydroceles.

Diagnosis of epididymal cysts typically involves a physical examination of the scrotum and a review of the patient’s medical history. In some cases, imaging tests such as ultrasound may be used to confirm the presence of a cyst.

Treatment for epididymal cysts is usually not necessary unless the cyst is causing discomfort or affecting fertility. In such cases, surgery may be recommended to remove the cyst. However, surgery carries a risk of complications, and it may not be necessary if the cyst is not causing any problems.

Causes of Epididymal Cysts

The exact cause of epididymal cysts is unknown, but several factors may contribute to their development.

In some cases, epididymal cysts may be caused by an infection or inflammation of the epididymis. This can occur due to a bacterial or viral infection, which can cause the epididymis to become swollen and inflamed. Inflammation can also occur due to injury or trauma to the scrotum.

Another possible cause of epididymal cysts is a blockage in the epididymal ducts, which can prevent the flow of fluid and cause it to accumulate in the epididymis. This blockage can be caused by a variety of factors, including scar tissue, injury, or congenital abnormalities.

In some cases, epididymal cysts may be a result of a bacterial infection, which can cause the epididymis to become inflamed and swollen. This can lead to the formation of cysts, which can be filled with pus or other types of fluid.

Overall, the exact cause of epididymal cysts is not fully understood, and it’s likely that multiple factors contribute to their development. While they are typically benign and do not require treatment, it’s important to seek medical attention if you experience any symptoms or are concerned about the presence of a cyst.

Impact on Fertility and Sexual Health

Epididymal cysts are usually benign and don’t affect fertility or sexual health. However, in rare cases, a large spermatocele can cause discomfort or pain during sexual activity.

Fertility is not affected by spermatoceles because they don’t interfere with the production or transport of sperm. Spermatoceles are filled with fluid, not sperm, so they don’t affect the quantity or quality of semen.

There is no evidence to suggest that spermatoceles are a risk factor for infertility. In fact, many men with spermatoceles are able to father children without any issues.

If a spermatocele is causing discomfort or pain during sexual activity, it may be necessary to treat it. In some cases, a large spermatocele can put pressure on the testicle, causing pain or discomfort. In these cases, surgical removal of the spermatocele may be recommended.

Symptoms and Detection

Epididymal cysts are typically asymptomatic and are often discovered during a routine physical exam. However, some men may experience discomfort or pain in the scrotum. The following symptoms may indicate the presence of an epididymal cyst:

  • A small, painless lump on the testicle or epididymis
  • Heaviness or discomfort in the scrotum
  • Swelling or enlargement of the scrotum
  • A feeling of pressure in the scrotum

If a man experiences any of these symptoms, he should see a healthcare provider for an evaluation.

During a physical exam, the healthcare provider will examine the scrotum and testicles for any abnormalities, such as lumps or swelling. They may also perform a testicular self-exam to check for any changes in the size or shape of the testicles.

If an epididymal cyst is suspected, the healthcare provider may order an ultrasound to confirm the diagnosis. An ultrasound is a non-invasive imaging test that uses sound waves to create images of the scrotal contents.

It’s also possible for men to perform a self-examination of the testicles to detect any changes or abnormalities. Men should perform a testicular self-exam once a month and report any changes to their healthcare provider.

It’s important for men to be aware of any changes in their scrotum and to seek medical attention if they experience any symptoms or discomfort.

Differentiating Epididymal Cysts from Other Conditions

When a man experiences a lump or swelling in the scrotum, it can be concerning. However, not all lumps or masses are cancerous or even harmful. Epididymal cysts are one such condition that can cause a scrotal mass. It’s important to differentiate epididymal cysts from other conditions that can cause similar symptoms.

Below are some conditions that can be mistaken for epididymal cysts:

  • Spermatocele: A spermatocele is a benign cyst that forms in the epididymis and contains fluid and sperm cells. It’s often difficult to differentiate between a spermatocele and an epididymal cyst by physical examination alone. The only difference is that the spermatocele contains fluid and sperm cells.
  • Testicular Cancer: Testicular cancer can present as a lump or swelling in the testicle or scrotum. It’s important to note that testicular cancer is a rare condition and accounts for only 1% of all male cancers.
  • Hydrocele: A hydrocele is a fluid-filled sac that forms around the testicle. It can cause swelling and discomfort in the scrotum.
  • Epididymitis: This is an inflammation of the epididymis, which can cause pain and swelling in the scrotum.
  • Tumor: A tumor can be benign or malignant and can cause a mass in the scrotum. It’s important to have any new or growing masses evaluated by a healthcare provider.
  • Hernia: A hernia occurs when an organ or tissue pushes through a weak spot in the muscle or tissue that holds it in place. Inguinal hernias can cause a bulge in the groin or scrotum.
  • Varicocele: A varicocele is a condition in which the veins in the scrotum become enlarged. It can cause discomfort and swelling in the scrotum.
  • Testicular Torsion: A testicular torsion is a medical emergency in which the testicle twists, cutting off blood flow to the testicle. It can cause severe pain and swelling in the scrotum.
  • Inguinal Hernia: This occurs when part of the intestine or other tissue protrudes through a weak spot in the abdominal muscles. It can cause a bulge in the groin or scrotum.
  • Scrotal Masses: This is a general term used to describe any lump or swelling in the scrotum. It can be caused by a variety of conditions, including those listed above.
  • Abnormal Tissue: Any abnormal tissue growth in the scrotum can cause a mass or lump. It’s important to have any new or growing masses evaluated by a healthcare provider.

It’s important to differentiate epididymal cysts from other conditions that can cause similar symptoms. A healthcare provider can help diagnose the underlying cause of a scrotal mass and recommend appropriate treatment.

Questions to Ask Your Urologist

When seeking treatment for an epididymal cyst, it’s important to have a clear understanding of the condition and the treatment options available. Patients should feel comfortable asking their urologist questions to ensure they are making informed decisions about their health.

Here are some questions that patients may want to consider asking their urologist:

  • What is an epididymal cyst and how is it diagnosed?
  • What are the treatment options for an epididymal cyst?
  • What are the risks and benefits of each treatment option?
  • How long does treatment take and what is the recovery time?
  • Will the cyst come back after treatment and what can be done to prevent it?
  • Are there any lifestyle changes or home remedies that can help manage symptoms?
  • What are the chances of complications from the cyst or the treatment?
  • How often should follow-up appointments be scheduled?

Patients should also feel free to ask any additional questions that come to mind during their appointment. It’s important to have a clear understanding of the condition and the treatment options available in order to make informed decisions about their health.

Treatment Options for Epididymal Cysts

Epididymal cysts are typically benign and do not require treatment unless they cause discomfort or affect fertility. Treatment options for epididymal cysts depend on the severity of the symptoms and the individual’s overall health.

Aspiration

Aspiration is a minimally invasive procedure that involves draining the fluid from the cyst using a needle and syringe. This procedure is typically performed under local anesthesia and can be done in a doctor’s office. Aspiration is a temporary solution, and the cyst may refill with fluid over time.

Antibiotics

Antibiotics may be prescribed if the cyst is infected or if the individual has a fever. Antibiotics can help to reduce inflammation and prevent the spread of infection. However, antibiotics alone cannot treat an epididymal cyst and are typically used in conjunction with other treatments.

Surgery

Surgery is the most common treatment for epididymal cysts. The procedure involves removing the cyst and the affected portion of the epididymis. Surgery is typically performed under general anesthesia and requires a short hospital stay. The recovery time for surgery varies but is generally around two weeks.

Watchful Waiting

Watchful waiting is a common approach for individuals with small, asymptomatic epididymal cysts. This approach involves monitoring the cyst over time and only pursuing treatment if the cyst grows or becomes symptomatic.

Prevention and Self-Care

While epididymal cysts are typically benign and don’t require treatment, there are some steps individuals can take to prevent them from forming or becoming more severe.

Prevention

There is no surefire way to prevent epididymal cysts from forming, but there are some things that individuals can do to decrease their risk. These include:

  • Practicing safe sex to reduce the risk of sexually transmitted infections (STIs) that can cause epididymitis, which is inflammation of the epididymis that can lead to cysts
  • Avoiding injury to the scrotum, which can cause swelling and inflammation that may lead to cyst formation
  • Maintaining good overall health through regular exercise, a healthy diet, and avoiding smoking and excessive alcohol consumption

Self-Examination

Performing regular self-examinations of the testicles can help individuals detect any changes or abnormalities early on. This can include feeling for lumps or bumps, changes in size or shape, or any pain or discomfort. If any changes are detected, individuals should schedule an appointment with their healthcare provider for further evaluation.

Health Tips

In addition to the above prevention and self-examination tips, there are some general health tips that may help with overall testicular health. These include:

  • Wearing protective gear during sports or other activities that may put the scrotum at risk for injury
  • Maintaining good hygiene to prevent infection or inflammation of the epididymis
  • Regularly checking for and treating any STIs
  • Scheduling regular check-ups with a healthcare provider to monitor testicular health and detect any issues early on

Overall, while there is no guaranteed way to prevent epididymal cysts from forming, individuals can take steps to reduce their risk and maintain good testicular health through regular self-examinations and healthy lifestyle habits.

References
  1. https://www.chop.edu/conditions-diseases/epididymal-cyst-and-spermatocele
  2. https://patient.info/mens-health/scrotal-lumps-pain-and-swelling/epididymal-cyst
  3. https://thocc.org/health-community/health-resources/health-library/detail?id=tv7861spec&lang=en-us
  4. https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Epididymal%20cyst.pdf
  5. https://www.urologygroupvirginia.com/urologic-care/testicular-scrotal-disorders/epididymal-cysts
  6. https://medpix.nlm.nih.gov/case?id=ac67709e-c6ca-4fb0-a849-43ddc4e8e490
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