What is an Epididymal Cyst?
An epididymal cyst is a fluid-filled sac that develops in the epididymis, a small coiled tube located behind the testicle that stores and carries sperm.
Epididymal cysts are benign (non-cancerous) and are a common cause of lumps in the scrotum. They can occur in men of any age but are most often seen in middle-aged men.
When the cyst contains sperm, it is sometimes called a spermatocele.
Epididymal Cysts
Symptoms
Many epididymal cysts cause no symptoms and are often discovered incidentally.
Possible symptoms may include:
A small lump or swelling in the scrotum
A soft, smooth swelling above or behind the testicle
A feeling of heaviness in the scrotum
Mild discomfort if the cyst becomes large
Epididymal cysts are usually painless and do not affect the testicle itself.
Causes
The exact cause of epididymal cysts is often unknown.
They may develop when tubes within the epididymis become blocked, leading to fluid accumulation.
In some cases, cysts may develop after:
Inflammation of the epididymis (epididymitis)
Injury to the scrotum
Previous infections
How are Epididymal Cysts Diagnosed?
Diagnosis usually involves a physical examination by your doctor.
Physical Examination
Your doctor will examine the scrotum to assess the lump and determine whether it is separate from the testicle.
Ultrasound Scan
A scrotal ultrasound is often performed to confirm the diagnosis.
Ultrasound helps to:
Confirm that the lump is a fluid-filled cyst
Ensure the testicle itself is normal
Exclude other conditions such as testicular tumours
Ultrasound is a safe and painless imaging test.
Do Epididymal Cysts Need Treatment?
Most epididymal cysts do not require treatment if they are small and not causing symptoms.
In many cases, doctors recommend observation only.
When is Treatment Recommended?
Treatment may be considered if the cyst:
Becomes large
Causes pain or discomfort
Continues to increase in size
Causes concern or cosmetic issues
Treatment Options
Surgical Removal
The most effective treatment is surgical removal of the cyst (epididymal cyst excision).
This procedure is usually performed under general anaesthetic.
During the operation:
A small incision is made in the scrotum
The cyst is carefully separated from the epididymis and removed
Most patients go home the same day.
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Aspiration
Occasionally, fluid may be removed using a needle. However, this is not commonly recommended, as the cyst often returns.
Possible Risks of Surgery
Although surgery is generally safe, possible risks include:
Bleeding or scrotal swelling
Infection
Recurrence of the cyst
Damage to the epididymis (rare), which may affect fertility
Your doctor will discuss these risks before the procedure.
Recovery After Surgery
After surgical removal:
Mild swelling or bruising of the scrotum is common
Discomfort usually improves within a few days
Supportive underwear may be recommended
Strenuous activity should be avoided for 2–3 weeks
Full recovery usually occurs within a few weeks
When to Seek Medical Advice
You should see a doctor if you notice:
A new lump in the scrotum
Rapid enlargement of a scrotal swelling
Pain in the testicle or scrotum
Sudden severe testicular pain (this may indicate a different condition requiring urgent treatment)
Any new scrotal lump should be assessed by a healthcare professional to rule out other causes.
If you have concerns about a lump in the scrotum or symptoms related to epididymal cysts, please discuss them with your doctor or urologist.
