Benign scrotal & foreskin conditions
Many testicular lumps and foreskin problems are benign and can be managed conservatively. Accurate assessment helps avoid unnecessary surgery while ensuring important conditions are not missed.
Overview
Common, non-dangerous conditions affecting the scrotum, testicles and foreskin
Benign scrotal/testicular conditions and foreskin problems are common across all age groups. Most are not dangerous and do not require surgery. The focus of assessment is reassurance, exclusion of serious pathology, and treatment where appropriate.
Benign scrotal and testicular conditions
Common causes of scrotal lumps and swelling
Hydrocele
A collection of fluid around the testicle causing scrotal swelling. Often painless and commonly managed with observation. Surgery when large.
Epididymal cyst / spermatocele
Benign cysts arising near the epididymis. Treatment is usually unnecessary unless painful or enlarging.
Varicocele
Dilated scrotal veins, often left-sided. Frequently asymptomatic and managed conservatively. Surgery for pain.
When to investigate
New, persistent, or firm testicular lumps should be assessed, usually with testicular ultrasound.
Foreskin conditions
Emphasis on conservative management
Many foreskin conditions improve with simple, non-surgical measures. Surgery is rarely first-line.
Phimosis
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Phimosis refers to a foreskin that does not retract comfortably.
- Gentle daily foreskin stretching by the child (never forceful)
- Short courses of topical steroid cream where appropriate
- Good hygiene and avoidance of irritants
- Gentle washing with water only
- Avoidance of soaps, antiseptics, and fragranced products
- Targeted topical treatment if infection or inflammation is identified
- Do not forcibly separate adhesions
- Gentle retraction only as it becomes naturally possible
- Reassurance is often all that is required
At birth, the foreskin is normally attached to the head of the penis and separates gradually over several years.
As a result, all boys have a degree of non-retractability in early childhood, and this usually resolves naturally with time.
The foreskin may become retractable at any age during childhood or adolescence.
Ballooning of the foreskin during urination is not concerning provided the urine stream is normal and there is no pain or infection.
Only the individual should attempt foreskin retraction. Forced retraction can cause small tears, leading to scarring and increasing the risk of infection.
Foreskin infections, when they occur, are usually mild and respond well to simple treatment, such as topical antibiotic ointment (for example, mupirocin).
An intact penis with a foreskin requires no special cleaning. Until the foreskin becomes naturally retractable, routine external washing is sufficient.
Once retraction is possible, gentle retraction during washing and replacement of the foreskin afterward is all that is required.
Many adults with phimosis can be managed with division of the frenulum (band behind the glans) and/or preputioplasty (small incisions to loosen the foreskin) and can avoid circumcision
In many cases, phimosis improves or resolves completely over time and can be managed conservatively without surgery.
Surgery is usually reserved for scarring, recurrent infections, or failure of conservative treatment.
Balanitis
Balanitis is inflammation of the glans and foreskin, commonly due to irritation, yeast infection, or local skin conditions.
Preputial adhesions
Adhesions between the foreskin and glans are common in children and often persist into adolescence. They will normally resolve naturally over time. Rarely they need to be divided under anaesthesia
When to seek urgent care
Important safety information
- Sudden severe testicular pain
- Rapidly increasing scrotal swelling with fever
- Paraphimosis (foreskin stuck retracted)
- A new firm lump within the testicle
This page provides general information only and does not replace medical advice.
Appointments & referrals
Assessment and advice available with GP referral
Suite 311, Level 3
North Lakes Specialist Centre
6 North Lakes Drive
North Lakes QLD 4509