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Epididymal Cyst: Causes, Symptoms & Treatment Options in Singapore

Finding a lump in your scrotum can be concerning. If you’ve discovered a painless swelling near your testicle, you may have an epididymal cyst—a common and typically benign condition.

An epididymal cyst is a frequently encountered scrotal mass. Most require no treatment and cause no harm. This guide will help you understand what epididymal cysts are, their causes, symptoms, and the treatment options available in Singapore.

Dr. Nor Azhari Bin Mohd Zam
Dr. Nor Azhari Bin Mohd Zam

MBBS (NUS)|MRCS (Edin.)|MMed Surgery (NUS)|FAMS (Urology)

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Epididymal cyst Epididymal Cyst: Causes, Symptoms & Treatment Options in Singapore
Overview Types Causes Symptoms When to see a Urologist Diagnosis Treatment Complications Prevention FAQ Conclusion
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Overview
Types
Causes
Symptoms
When to see a Urologist
Diagnosis
Treatment
Complications
Prevention
FAQ
Conclusion

What is an Epididymal Cyst?

An epididymal cyst is a fluid-filled sac that develops in the epididymis (a coiled tube at the back of each testicle that stores and transports sperm).

These cysts contain clear fluid and are separate from the testicle. They typically range from a few millimetres to several centimetres in size. Epididymal cysts are benign—they are not cancerous and do not increase your risk of testicular cancer.

Epididymal cysts are quite common, particularly in men between 40 and 60 years of age. Many men develop these cysts at some point, though many remain unaware because they lack symptoms. The condition can occur in one or both testicles and may involve single or multiple cysts.

Types of Epididymal Cysts

Simple Epididymal Cysts

Simple epididymal cysts contain clear, watery fluid and have thin walls. These are the most common types and typically cause no symptoms. They appear as well-defined, smooth masses on ultrasound (a test using sound waves to create images of internal structures) and rarely require intervention.

Spermatoceles

A spermatocele is a specific type of epididymal cyst containing fluid mixed with dead sperm cells. This gives the fluid a cloudy or milky appearance. Spermatoceles usually develop in the head of the epididymis and are sometimes called spermatic cysts. They behave similarly to simple cysts and are equally benign.

Multiple Epididymal Cysts

Some men develop multiple cysts within one or both epididymides. These clusters may create a larger palpable mass but remain benign. Multiple cysts are managed the same way as single cysts, with treatment decisions based on symptoms rather than the number of cysts.

Causes & Risk Factors

Causes

The exact cause of epididymal cysts remains unclear. The most widely accepted explanation involves blockage of the efferent ductules—tiny tubes that carry sperm from the testicle to the epididymis.

When these tubes become blocked, fluid accumulates, forming a cyst. This blockage may result from:

  • Previous infection or inflammation of the epididymis
  • Prior trauma or injury to the scrotal area
  • Congenital abnormalities (structural differences present from birth) in the reproductive tract
  • Scarring from previous surgery in the groin or scrotal region

Risk Factors

Certain factors may increase your likelihood of developing an epididymal cyst:

  • Age: Men between 40 and 60 years are most commonly affected
  • Previous epididymitis: Past infection of the epididymis may contribute to cyst formation
  • Vasectomy: Some observations suggest a possible association with this procedure
  • In utero DES exposure: Men whose mothers took diethylstilbestrol (a synthetic oestrogen medication) during pregnancy may have an increased risk
  • Previous scrotal trauma: Injury to the scrotum may trigger cyst development
  • Occupational factors: Jobs involving prolonged sitting or pressure on the groin area

Epididymal cysts can develop in men with no identifiable risk factors. The condition is not related to sexual activity, hygiene practices, or lifestyle choices.

Signs & Symptoms

Many men have no symptoms and discover the cyst incidentally during a physical examination or an imaging study for an unrelated condition.

Mild Symptoms

With smaller cysts, you may notice:

  • A small, painless lump at the top or behind the testicle
  • A sensation of heaviness in the affected testicle
  • Slight awareness of a mass when sitting for prolonged periods
  • Discovery of the lump during self-examination

These mild symptoms typically don’t interfere with daily activities or cause significant discomfort.

Moderate Symptoms

As cysts grow larger, more noticeable symptoms may develop:

  • A clearly palpable, smooth mass that moves separately from the testicle
  • Dull aching or discomfort in the scrotum, particularly after physical activity
  • A feeling of fullness or a dragging sensation in the affected side
  • Mild discomfort when wearing tight clothing or during certain movements

At this stage, the cyst may be visible as a bulge in the scrotum, especially when standing.

Severe Symptoms

Large epididymal cysts can cause more significant symptoms:

  • Persistent scrotal pain or discomfort affecting quality of life
  • Difficulty with physical activities, exercise, or sexual intercourse
  • Psychological distress due to the visible swelling
  • Interference with daily activities due to the size of the mass

Even with severe symptoms, epididymal cysts remain non-cancerous.

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When to See a Urologist

Have any scrotal lump evaluated by a medical professional. Consult a urologist if you notice:

  • Any new lump or swelling in your scrotum, regardless of whether it’s painful
  • A scrotal mass that has grown noticeably in size
  • Pain, tenderness, or discomfort in your testicle or scrotum
  • Redness, warmth, or swelling suggesting possible infection
  • Symptoms affecting your daily activities or quality of life
  • Concerns about fertility or reproductive health

Prompt evaluation is essential. Other scrotal conditions, including testicular cancer, can present similarly. Only a proper medical assessment can confirm the diagnosis and rule out more serious conditions.

During your first consultation, the urologist will take a detailed medical history and perform a physical examination. Be prepared to discuss when you first noticed the lump, any associated symptoms, and your medical and surgical history. The examination is typically quick and should not be painful.

Diagnosis and Testing Methods

Diagnosing an epididymal cyst typically involves a combination of physical examination and imaging studies.

Physical Examination

The urologist will carefully examine your scrotum while you’re standing and lying down. Epididymal cysts have characteristic features:

  • They are typically located above or behind the testicle
  • They feel smooth, round, and well-defined
  • They can be distinguished from the testicle itself
  • They transilluminate (light passes through them) due to their fluid content

Transillumination involves shining a light through the scrotum. Fluid-filled cysts allow light to pass through, appearing as a red glow, while solid masses block the light.

Scrotal Ultrasound

Ultrasound is the primary imaging tool for evaluating scrotal masses. This test uses sound waves to create detailed images of the scrotum’s contents.

On ultrasound, epididymal cysts appear as:

  • Well-defined, round or oval structures
  • Completely fluid-filled (anechoic) without solid components
  • Located within or adjacent to the epididymis
  • Separate from the testicle itself

Ultrasound also allows the urologist to assess the testicles for any abnormalities and measure the cyst’s size for future comparison. The test takes approximately 15-20 minutes, and results are usually available immediately.

Additional Tests

In most cases, physical examination and ultrasound are sufficient. Occasionally, additional tests may be recommended:

  • Blood tests: Tumour markers (such as AFP, beta-hCG, and LDH—proteins that may be elevated in certain cancers) may be checked if there’s any concern about testicular cancer
  • MRI: Rarely needed but may help characterise complex or atypical cysts

No special preparation is required for these diagnostic tests. You can eat and drink normally beforehand and resume regular activities immediately after.

Treatment Options Overview

Treatment for epididymal cysts depends on the cyst’s size, symptom severity, and your personal preferences. Many cysts require no treatment at all.

Watchful Waiting

For small, asymptomatic epididymal cysts, watchful waiting is often the recommended approach. This involves regular monitoring without active treatment. Since epididymal cysts are benign and many remain stable in size, observation is a safe and reasonable option.

During watchful waiting, you’ll have periodic check-ups to monitor the cyst. Your urologist may recommend annual or biannual ultrasounds to track any changes.

Pain Management

When epididymal cysts cause mild discomfort, conservative measures can provide relief:

  • Over-the-counter pain relievers such as paracetamol or non-steroidal anti-inflammatory drugs (medications that reduce inflammation and pain)
  • Wearing supportive underwear to reduce the sensation of heaviness and minimise discomfort during physical activities
  • Applying ice packs to the scrotal area for temporary relief from pain or swelling

These measures address symptoms without the need for surgical intervention.

Aspiration

Aspiration involves using a needle to drain the fluid from the cyst. Healthcare providers perform this procedure in the clinic under local anaesthesia (numbing medication applied to a specific area). The urologist inserts a fine needle into the cyst and withdraws the fluid, causing the cyst to collapse.

The effects are usually temporary. The cyst often refills within weeks to months because the cyst wall remains intact. Healthcare providers typically reserve aspiration for men who are not suitable candidates for surgery or who need temporary relief.

Sclerotherapy

Sclerotherapy combines aspiration with injection of a sclerosing agent—a substance that irritates the cyst wall and causes it to scar and collapse. This aims to provide longer-lasting results than aspiration alone.

Healthcare providers perform the procedure under local anaesthesia. After draining the cyst, the urologist injects the sclerosing agent and may manipulate the scrotum to ensure the solution contacts the entire cyst wall. Outcomes vary, and some men may require repeat procedures.

Surgical Excision (Spermatocelectomy)

Surgical removal of the epididymal cyst, called spermatocelectomy or epididymal cystectomy, is a treatment option. Healthcare providers may recommend this procedure for men with symptomatic cysts that significantly affect their quality of life.

Healthcare providers typically perform the surgery as a day procedure under general or regional anaesthesia (medication that causes temporary loss of sensation or consciousness). The urologist:

  • Makes a small incision in the scrotum
  • Carefully separates the cyst from the surrounding epididymal tissue
  • Removes it completely
  • Closes the incision with dissolvable sutures

Recovery involves:

  • Rest for several days
  • Wearing supportive underwear
  • Avoiding strenuous activities for two to four weeks

Many men return to work within a week, depending on the nature of their job. Potential risks include bleeding, infection, and, rarely, damage to the epididymis that could affect fertility on that side.

Dr Azhari can assess your specific situation and discuss suitable treatment approaches.

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Complications if Left Untreated

Epididymal cysts are benign and do not become cancerous. In many cases, leaving them untreated causes no harm. Small, asymptomatic cysts may remain stable for years or even decades without causing problems.

For cysts that do grow, several complications may arise:

  • Increasing Discomfort: Larger cysts may cause progressively more pain or heaviness, affecting your ability to exercise, work, or engage in intimate activities.
  • Psychological Impact: A visible or palpable scrotal mass can cause anxiety and distress. Some men experience concern about their condition, even after being reassured of its benign nature.
  • Infection: Epididymal cysts can occasionally become infected. Infection causes sudden pain, redness, and swelling, requiring antibiotic treatment and potentially surgical drainage.
  • Fertility Considerations: Large cysts or multiple cysts may theoretically affect sperm transport, though a significant impact on fertility is uncommon. Men with fertility concerns should discuss this with their urologist.

Surgical treatment also carries risks, including the possibility of affecting fertility on the treated side. Your urologist will help you weigh the benefits of treatment against potential complications of both intervention and observation.

Prevention

There is no proven way to prevent epididymal cysts from developing. Since the exact cause remains unclear, healthcare providers cannot recommend specific preventive measures.

General measures that may support reproductive health include:

  • Protecting the Scrotum

    Wearing appropriate protective gear during contact sports or activities that risk scrotal injury may reduce trauma-related risk factors.

  • Prompt Treatment of Infections

    If you develop symptoms of epididymitis (such as pain, swelling, or tenderness in the scrotum) or other genital infections, seeking prompt medical treatment may reduce the risk of complications that could contribute to cyst formation.

  • Regular Self-Examination

    Regular testicular self-examination helps you become familiar with your normal anatomy. This enables earlier detection of any changes, including both benign cysts and more serious conditions.

  • Routine Health Check-ups

    Regular medical examinations allow for monitoring of any scrotal abnormalities and timely intervention when needed.

Men who have undergone vasectomy or have other risk factors should be aware of the possibility of developing epididymal cysts and report any new scrotal lumps to their doctor.

Frequently Asked Questions

Is an epididymal cyst the same as testicular cancer?

No, epididymal cysts are completely different from testicular cancer. An epididymal cyst is a benign, fluid-filled sac that develops in the epididymis—the tube behind your testicle. Testicular cancer is a solid tumour that originates within the testicle itself. Epididymal cysts do not increase your risk of developing testicular cancer. Ultrasound imaging can reliably distinguish between the two conditions.

Can an epididymal cyst affect my fertility?

In most cases, epididymal cysts do not affect fertility. The cyst develops in the storage area for sperm, not the testicle where sperm is produced. Small cysts typically have no impact on sperm production or delivery. Very large cysts or surgical removal of cysts may theoretically affect fertility on the affected side, but the other testicle generally compensates.

Will my epididymal cyst go away on its own?

Epididymal cysts rarely resolve spontaneously. Once formed, they typically remain stable or gradually increase in size. Small cysts may stay unchanged for years without causing problems. Complete spontaneous resolution is uncommon.

Is surgery always necessary for an epididymal cyst?

Surgery is not always necessary. Treatment decisions depend on whether the cyst causes symptoms and how those symptoms affect your quality of life. Many men with small, asymptomatic cysts require no treatment at all. Healthcare providers may recommend surgery when cysts cause significant pain, discomfort, or psychological distress.

How long is the recovery after epididymal cyst surgery?

Recovery from spermatocelectomy is generally straightforward. Many men go home the same day as surgery. You’ll need to rest for several days and wear supportive underwear to minimise swelling. Light activities can usually resume within a week, while strenuous exercise and heavy lifting should be avoided for two to four weeks. Many men return to work within one to two weeks, depending on their job requirements.

Can epididymal cysts come back after surgery?

Recurrence after surgical excision is uncommon but possible. When the urologist completely removes the cyst along with its wall, the chance of recurrence is low. Recurrence is more common after aspiration or sclerotherapy, as these procedures do not remove the cyst wall.

What does the consultation process involve?

During your consultation, the urologist will ask about your symptoms, medical history, and any concerns you have. The urologist will perform a physical examination of your scrotum to assess the lump. In most cases, healthcare providers will arrange a scrotal ultrasound to confirm the diagnosis and characterise the cyst. Based on these findings, your urologist will discuss the diagnosis, explain your treatment options, and answer any questions.

Are there any activities I should avoid with an epididymal cyst?

Many men with epididymal cysts can continue their normal activities without restriction. If your cyst causes discomfort during certain activities, you may choose to modify them accordingly. Wearing supportive underwear during exercise can help reduce discomfort. There are no specific activities that will worsen the cyst or cause it to rupture.

General Disclaimer: Individual experiences with epididymal cysts and their treatment vary based on personal health factors, cyst characteristics, and other circumstances. The information provided in this article is for general educational purposes only and should not replace professional medical advice. Always consult qualified healthcare professionals for individualised diagnosis, treatment recommendations, and medical guidance tailored to your specific situation.

 

Conclusion

Epididymal cysts are common, benign scrotal masses that affect many men, particularly those in middle age. Understanding that epididymal cysts are not cancerous and often require no treatment can provide significant reassurance.

The key to managing an epididymal cyst is accurate diagnosis. Once healthcare providers confirm the benign nature of the cyst, you and your urologist can decide on the most appropriate management approach. For many men, this means simply monitoring the cyst. For those with bothersome symptoms, treatment options are available.

If you’ve noticed a lump in your scrotum or have been diagnosed with an epididymal cyst, speak with Dr Azhari about your concerns.

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Dr. Nor Azhari Bin Mohd Zam

Dr. Nor Azhari Bin Mohd Zam

MBBS (NUS)|MRCS (Edin.)|MMed Surgery (NUS)|FAMS (Urology)

Former Director of Endourology (Urinary stone service) Singapore General Hospital 2016 to 2023

With more than 20 years experience as a certified Urologist, Dr Nor Azhari specializes in treating a wide range of kidney, bladder and prostate conditions as well as disorders of the male reproductive organs. He offers minimally invasive treatment options and provides same-day appointments for convenience.

  • Skilled urologist and kidney stone surgeon
  • Recognized with the College of Surgeons Gold Medal and Singapore Urological Association Book prize
  • Minimally invasive treatment options available (non-invasive and endoscopic/key-hole techniques)
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