Spermatocele: Causes, Symptoms and Treatments

Doctor holding a spermatocele medical report.

What is a Spermatocele?

A spermatocele is an abnormal cyst that forms in the epididymis, which is a small and coiled tube found on the testicle that stores and transports the sperm. A spermatocele is noncancerous, typically painless, and is normally filled with fluid that may or may not contain sperm.

Although it is uncertain why spermatoceles form, it is possible that they may be caused by a blockage in one of the multiple tubes within the epididymis that receives and transports sperm from the testicle.

Also known as spermatic cysts, spermatoceles are not uncommon. They don’t normally affect fertility or require treatment. Your doctor may recommend surgery if a spermatocele becomes so large that it causes discomfort.

Spermatocele Symptoms

A spermatocele will not typically accompanied by any symptoms and may remain small in size. However, you might feel the following symptoms if your spermatocele grows too large.

  • The affected testicle may have pain or discomfort.
  • A heavier feeling in the testicle due to the spermatocele
  • A sensation of fullness above and behind the testicle

Diagram of testicles showing the appearance of a spermatocele

When should you see a doctor?

Since a spermatocele isn’t usually accompanied by any symptoms, you might only discover it in a self-examination or during a routine physical exam by a doctor. To rule out serious conditions like testicular cancer, it’s best to have your doctor to examine any scrotal mass.

Additionally, if you feel any pain or swelling in the scrotum, consult your doctor immediately. Testicular pain can be caused by a variety of conditions, some of which require immediate treatment.

Spermatocele Causes

It is not known what causes spermatoceles. Spermatoceles could be caused by a blockage of one of the many tubes in the epididymis, which collect and transport sperm from the testicle.

Are There Any Risk Factors to Avoid?

Currently, there aren’t many risk factors that are known to lead to a spermatocele. It is known that the risk of spermatoceles is higher in men whose mothers received the drug DEA (diethylstilbestrol) while pregnant in order to prevent miscarriage or other complications.

This drug’s use was discontinued in 1971 because of concerns over an apparent increased risk to women of rare vaginal cancer.(1)

Do Spermatoceles Cause Any Complications?

It is unlikely that a spermatocele will cause complications. That said, if your spermatocele causes pain or has become large enough to cause discomfort, then you may need surgery to remove it.

It is possible that the epididymis and vas deferens (a tube that carries sperm from the epididymis to the penis) could become damaged as a result of surgical removal. Fertility can be negatively impacted if either is damaged.(2)

A second possibility is the potential of the spermatocele returning, although this is rare.

Can You Prevent Spermatoceles?

While there is no way to prevent spermatoceles from occurring, it is important to perform self examinations of the scrotum at least once a month to spot any changes. You should immediately have any new mass detected in your scrotum checked by a doctor.

A doctor will be able to instruct you on how to perform a self-examination of your testicles. This can increase your chances of detecting any unusual masses.

How Perform a Testicular Self-Exam

One of the best times for performing a scrotal exam is after taking a hot shower or a bath. You’ll be more able to find any abnormalities since the heat of the water will relax the scrotum. Then take the following steps:

  • Look at your scrotum in the mirror. Check for swelling on or around the scrotum.
  • Using both hands, examine each testicle. Gently place the testicles between your thumbs and fingers, with the thumbs on top.
  • Roll the testicle gently between your thumbs and your fingers. Keep in mind that the testicles are generally smooth, egg-shaped, and somewhat firm. It’s not uncommon that one testicle may be somewhat larger than the other. Keep in mind that the epididymis (the cord that runs from the top of the testicle) is a normal feature of the scrotum.
  • Regularly performing this type of examination will help you become more familiar with your scrotum and could alert you to any potential problems. You should immediately call your doctor if you notice any lumps.

Performing a self-exam on a regular basis is a good habit to develop. However, it is not a substitute for a doctor’s exam. When you go for a physical examination, your doctor will usually check your testicles.

Getting A Diagnosis

A physical exam is required to diagnose a spermatocele. A spermatocele is not usually painful but you may experience some discomfort when the doctor examines the area.

Additionally, the following diagnostic tests may also be performed:

  • Transillumination Test – This procedure is performed in a dark room, with a bright light shined through the scrotum to see the structures inside. A spermatocele will show up as a fluid-filled mass and not solid.
  • Ultrasound – When a transillumination test does not clearly reveal a cyst, an ultrasound can be used to help determine the cause. An ultrasound uses high-frequency sound waves to generate internal images of the body. It can be used to rule out tumors or other causes for swelling of the scrotum.

Available Treatments

A spermatocele won’t usually disappear by all by itself, but most spermatoceles don’t require any treatment. They don’t usually cause any pain or complications. Your doctor may recommend that you take over-the-counter pain medication such as aspirin or ibuprofen if you experience discomfort.

Medicines

The only medicinal treatment available to treat spermatoceles is oral medication to relieve pain and reduce swelling. There is currently no drug available to prevent or cure spermatoceles.

Minimally invasive treatments

Although rarely used, there are two minimally invasive procedures available:

  • Aspiration – Using a needle, your doctor will pierce the spermatocele and drain the fluid.
  • Sclerotherapy – A procedure where the doctor injects an irritation agent into the cyst. This in turn encourages healing and helps to prevent future fluid accumulation.

While these treatments have been demonstrated to work, but they’re not typically recommended. This is due to a risk of potentially damaging the epididymis which could lead to fertility issues.(3)

Additionally, it is not uncommon for spermatoceles to reappear later on.

Surgery

A procedure called a spermatocelectomy is the most commonly used treatment for spermatoceles. The goal of spermatocelectomy is to remove cysts from the epididymis and preserving the reproductive system.

A spermatocelectomy is an outpatient procedure, meaning you won’t be required to stay overnight in a hospital. This procedure can be performed with either general or local anesthesia and normally takes less than one hour.

In certain cases, a portion or even all of the epididymis might have to be removed as well as the cyst.

Conclusion

Most men will not experience any adverse effects from a spermatocele. However, if you do happen to experience discomfort or pain, a spermatocelectomy will likely offer relief.

Keep in mind that this procedure could potentially put you at risk for complications that could impact your fertility. Even after surgery, it is possible that the spermatocele could reappear.

Talk with your doctor about the benefits and risks of these treatment options. Also, make them aware of any questions or concerns you might have, including how treatment could affect your fertility.


References:

  1. https://www.mayoclinic.org/diseases-conditions/spermatocele/symptoms-causes/syc-20377829
  2. https://www.healthline.com/health/mens-health/spermatocele#treatment
  3. https://www.ncbi.nlm.nih.gov/pubmed/11435841
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