Ultrasound imaging of the scrotum is a safe and painless examination used to diagnose scrotal swelling, testicular lumps, and pain.

Ultrasound is considered to be the “gold standard” for imaging the scrotum and testicles. It uses sound waves to produce images of the structures. Since there is very little fat in the scrotum and the structures within are very close to the skin, high-frequency ultrasound can be used to obtain detailed images.

Scrotal, or testicular ultrasounds, are recommended when there is pain, swelling, or a lump. Men who have groin pain may also have an ultrasound to rule out any scrotal abnormalities that could cause the pain to radiate into the groin.

Scrotal Swelling, Lumps, and Pain

Cancer is often the first thought that comes to people’s minds, but most scrotal lumps and swelling are completely unrelated to testicular cancer. Caucasian men between the ages of 15 and 34 are at an increased risk for testicular cancer. Some men find a spongy lump on the upper outer portion of the scrotum that turns out to be the epididymis, a perfectly normal structure.

Varicoceles are likened to varicose veins in the scrotum and are often the cause of pain. Scrotal swelling is often attributed to a hydrocele, a collection of fluid around the testicle that is usually of no significance. These conditions may be treated if they cause discomfort, but often go unnoticed.

Preparing for the Testicular Ultrasound

Most ultrasonographers are women who have experience performing testicular ultrasounds. While protocol may vary among hospitals and clinics, the patient is asked to prepare for the exam while the sonographer steps out of the room for reasons of privacy. The patient is asked to undress only from the waist down.

In many places, the patient will be asked to lie down and to place a rolled-up towel between his legs. The scrotum must be placed on top of the towel. Some people may be able to place the towel below the scrotum (below meaning toward the feet) and simply push it up against the scrotum. The idea is to make the front surface of the scrotum as flat as possible to accommodate the flat surface of the camera. The penis should be held up against the abdomen with a second towel. After doing so, the patient may cover everything up with another towel.

The Testicular Ultrasound Examination

The sonographer applies a warm gel to the scrotum. Gel is used to eliminate any air between the surface of the camera and the skin. If air is present, an adequate image cannot be obtained.

Both testicles are examined. The sonographer takes a series of images from the top to the bottom of each testicle, and from side to side. Each epididymis is also examined. If a varicocele is expected, the patient may be asked to perform the Valsalva maneuver. This is done by closing the mouth and the nose and trying to breathe out. The patient will be asked to Valsalva, and then will be instructed to relax.

After the examination, the sonographer will leave the room while the patient cleans off the gel and dresses. Some people are difficult to image using ultrasound, even if nothing is wrong, so the sonographer may need to ask a physician to look at the ultrasound before concluding the exam.

Generally, the examination is sent to a radiologist who issues a report to the patient’s primary care physician. This may take several days. The physician may discuss the results with the patient at a follow-up appointment or over the phone.

Ultrasound is a safe examination. Unlike x-rays, sound waves do not put the patient at risk for sterility or other fertility issues. Ultrasound produces clear, detailed images and is a painless examination, although some pressure may be felt.

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