Testicular Ultrasound: Purpose, Procedure, and What to Expect

At Independent Physicians Medical Center (IPMC) in Northeast Philadelphia, we provide testicular ultrasound exams with professionalism and privacy in our comfortable outpatient facility.

What Is a Testicular Ultrasound?

A testicular ultrasound (also called a scrotal ultrasound) uses high-frequency sound waves to create detailed images of the testicles, epididymis (the coiled tube behind each testicle that stores and transports sperm), spermatic cord, and the surrounding scrotal structures. The exam also routinely includes Doppler imaging, which assesses blood flow to and within the testicles.

This combination of structural and blood flow imaging is particularly important for differentiating between conditions that may look similar on physical exam but require very different treatments — such as testicular torsion (which is a surgical emergency) versus epididymitis (which is typically treated with antibiotics).

Why Would Your Doctor Order a Testicular Ultrasound?

Your doctor may recommend this test to investigate:

• A lump or mass felt in the testicle or scrotum. Ultrasound is the best test for determining whether a lump is within the testicle itself (which raises concern for testicular cancer) or outside the testicle (which is more likely benign, such as a spermatocele or epididymal cyst)
• Testicular pain or swelling. Ultrasound helps identify the cause, which may include infection (epididymitis, orchitis), torsion, trauma, or other conditions
• Suspected testicular torsion. This is a time-sensitive emergency where the testicle twists on its blood supply, cutting off blood flow. Doppler ultrasound can rapidly confirm or exclude torsion by showing whether blood flow to the affected testicle is normal or absent
• A fluid collection surrounding the testicle that causes painless swelling. Ultrasound confirms the diagnosis and rules out other causes
• Enlarged veins in the scrotum (similar to varicose veins) that can cause discomfort and may affect fertility. Doppler ultrasound detects abnormal venous flow
• Undescended testicle (cryptorchidism). Ultrasound can help locate a testicle that hasn’t descended into the scrotum
• Testicular trauma. After an injury, ultrasound assesses for testicular rupture, hematoma, and blood flow compromise
• Infertility evaluation. Evaluating testicular size, identifying varicoceles, and assessing for structural abnormalities
• Monitoring a known abnormality. Follow-up imaging for previously identified cysts, masses, or other findings
• Scrotal skin changes or thickening. Evaluating the scrotal wall for edema, infection, or other conditions

Testicular ultrasound is especially critical for evaluating lumps, because it can reliably distinguish between benign conditions (like cysts, which are very common and harmless) and potentially serious conditions (like testicular cancer, which most commonly affects men ages 15-35 and is highly curable when caught early).

How to Prepare

No preparation is needed. You can eat, drink, and take your medications normally. Wear comfortable clothing. You’ll be asked to undress from the waist down and will be given a gown and draping for privacy.

What Happens During the Exam?

1. Positioning. You’ll lie on your back on an exam table. A towel is draped over your thighs to support the scrotum, and the penis is gently covered or moved aside.
2. Gel application. The sonographer applies warm gel to the scrotal skin.
3. Scanning. The sonographer gently moves the transducer across the scrotum, capturing images of both testicles and surrounding structures from multiple angles. Both testicles are always imaged for comparison, even if symptoms are only on one side.
4. Doppler assessment. Color and spectral Doppler imaging is used to evaluate blood flow to both testicles. This is particularly important when torsion or varicocele is suspected.
5. Duration. The exam takes approximately 20 to 30 minutes.
6. Comfort. The exam is generally painless. If there is already swelling, inflammation, or tenderness, you may feel some discomfort when the transducer presses on the affected area. Let the sonographer know if you need a break.

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Understanding Your Results and Follow-Up

A board-certified radiologist will review all images and Doppler findings. The report documents testicle size (both sides for comparison), any masses or cysts (including their location, size, and characteristics), the status of the epididymis, blood flow patterns, and any fluid collections or other abnormalities.

Intratesticular masses (masses within the testicle) are treated with a high level of concern and typically require referral to a urologist for further evaluation, which may include blood tests for tumor markers and surgical consultation.

Extratesticular masses (outside the testicle) are usually benign — common examples include epididymal cysts, spermatoceles, and hydroceles.

You can resume normal activities immediately after the exam. Results are typically available within 24 to 48 hours.