Testicular Pain

Testicular pain refers to the pain felt in one or both testicles or scrotum, the sac that covers testis. Testicles are male reproductive organs involved in the production of sperms and male hormones.

The testes are present within an external sac-like structure called scrotum. At the back of each testis is the epididymis, the tube that stores and transports sperm. Each testicle is connected to the abdomen through spermatic cord. It also helps to suspend the testicle within the scrotum.

Testicular pain is accompanied by other symptoms including tenderness of testicles, swelling, and tenderness. In some cases, vomiting, fever, and pain while urination is also reported. The pain originates in the testes or may start from some other organ and spread to testicles.

This type of pain that originate some other organ and spread to the testes is known as referred pain. Pain may be acute or chronic. There are multiple causes for pain in the testicles, of which some are medical emergencies and require immediate medical attention.

Injury to the testes is a common cause of testicular pain. But in most of the cases, it is caused by an underlying medical condition. These include diabetic neuropathy, inflammation of testicles, gangrene, swelling of the scrotum, inguinal hernia, kidney stones, inflammation of testicles, fluid retention in testis, undescended testicles, and enlargement of veins in the testes.

Testicular torsion, a severe medical condition, is another cause of pain in the testicles. This is characterized by twisting of testicles that hinder the supply of blood to the testicles. It damages the tissue in the organ, leading to damage.

Doctor’s visit is warranted if pain in the testicles is accompanied by the following symptoms:

• Lump in scrotum
• High fever
• Tenderness and redness in scrotum

Medical attention is important if the pain was sudden and severe, and is accompanied by nausea and vomiting. If the pain is caused by an injury, and if there is a swelling in the testicles after an hour or so, it is important to report to the doctor.

Testicular pain may be harmless and can be treated with home care. Wearing an athletic supporter provides support to the scrotum and helps to reduce pain. Ice compress is of help in reducing swelling. Warm baths and over-the-counter pain medications are also of use in alleviating pain.

Diagnostic tests include ultrasound, urinalysis, urine cultures, and examination of prostate secretions. Common treatment methods include antibiotics, surgery, and pain medications.

Surgery is used to untwist the testicles in testicular torsion, and to correct an undescended testicle. Fluid retention in testicles may also be treated by surgical method. If left untreated, testicular pain may lead to permanent damage to the organ.

Torsion of testicles may lead to gangrene and to spread of infection, a potentially life-threatening condition. Prognosis of this condition depends on the underlying cause of the pain.

Testicular pain caused by injury or trauma have a good outlook if the severity and extent of the injury are mild. For those with testicular torsion, prognosis depends on the duration between onset of symptoms and successful management of the condition.

Testicles are very sensitive and even mild injury may cause pain and discomfort. The pain may originate from within the testicles or from some other organ and later spread to the testes.

Pain that originates in some other organ and then spread to the testicles is known as referred pain. The problem may originate in another organ like groin or abdomen.

Some of the causes of testicular pain are: 

Trauma – trauma or injury to the testes causes severe pain. Blunt trauma, as in sports injuries, direct kick, or straddle accidents, are the common cause of testicular trauma. It may lead to swelling and bruise of the scrotum.

In some rare cases, trauma may cause severe injury to the testicles and may require emergency surgery. Serious injury may cause disruption of connective tissue covering the testicles. This may lead to extrusion of testicular tissue.

Torsion of testis – this is caused by the twisting of the spermatic cord, restricting the flow of blood to the testes. It leads to severe pain and permanent damage to the organ. It may result from injury to the groin or due to rapid growth during puberty. It usually occurs only in one testicle and can occur anytime.

Orchitis – this condition is characterized by inflammation of testicles. This may be caused by viral or bacterial infection and may affect both testicles simultaneously. Scrotal tenderness, pain during urination, swelling in the scrotum, and an enlarged prostate is other symptoms of orchitis, apart from testicular pain.

Epididymitis – epididymitis refers to the inflammation of the epididymis, the tube that is involved in storage and transport of sperms. It is caused by gonorrhea or chlamydia. In children, this may be caused by urinary tract infection (UTI) or trauma.

Prostatitis – inflammation of prostate gland is known as prostatitis. People above 50 years and with an enlarged prostate have an increased risk of developing inflammation. Prostatitis can be acute or chronic, and the symptoms vary with the type.

Chronic prostatitis is the most common form of this condition. Pain in the lower back, difficulty or pain during urination, and testicular pain are the characteristic symptoms of this condition.

Kidney stones – also known as ‘renal calculi’, kidney stones usually develop in the kidneys. But it may develop in other parts of the urinary tract as well. Kidney stones may cause vomiting, nausea, foul-smelling urine, fever, and frequent urination, in addition to testicular pain.

Polyarteritis nodosa (PAN) – PAN leads to swelling of arteries. It usually affects small and medium arteries and is caused by abnormal functioning of the immune system. It causes abdominal pain, testicular pain, fever, muscle pain, and sudden weight loss.

An inguinal hernia – it is characterized by protrusion of intestine through a weak area in the muscular wall in the groin region. The bulge may slide into the scrotum, causing discomfort and swelling.

Diabetic neuropathy – this damages the nerves of the scrotal bag leading to pain in the scrotum and testes.

Complete medical history and physical examination are used in identifying the probable cause of the pain in the testicles. Physical examination includes examination of the abdomen, groin, penis, testicles, and scrotum.

Depending on the initial impression, further tests and investigations are recommended. Commonly suggested lab tests include blood tests, urinalysis, and urethral swab. Urethral swab helps in identifying sexually transmitted diseases, particularly if the patient has penile discharge.

Urinalysis is recommended for the diagnosis of epididymitis. Repeated blood tests are suggested to measure the antibodies and to identify causative virus of orchitis. Imaging studies are suggested in some cases.

If testicular torsion is suspected, urologic consultation is recommended prior to any other tests. This is to prevent any delays in surgical treatment of the condition. Ultrasound is suggested to evaluate the blood flow to the testes.

This aids in identifying the structural abnormalities within the scrotum that leads to pain in the testicles. Ultrasound scan helps to visualize testicular rupture, hematocoele, a collection of pus, testicular tumor, and inguinal hernia.

In some cases, the nuclear scan is suggested to evaluate the underlying cause of pain in the testicles. In this process, a radioactive dye is injected intravenously. It helps in the diagnosis of testicular torsion as the accumulation of dye in the affected testis will be less when compared to the unaffected one.

Color Doppler ultrasonography may also be suggested for identifying the testicular torsion if it is suspected. 

Identifying the underlying cause is the first step before starting treatment of testicular pain. Hence home treatments should not start unless the cause is identified. Treatment depends on the cause of pain. This includes pain medications, antibiotics, ice, rest, scrotal support, and surgery.

Most cases of testicular trauma can be treated at home. It can be treated with pain medications, scrotal support, ice packs, and rest. Surgical intervention is suggested only in case testicular rupture, blunt trauma, hematocele, and penetrating traumatic injuries.

• Testicular torsion requires immediate surgical correction, during which the affected testes is untwisted and secured the same to the wall of the scrotum. This will prevent recurrence of torsion.
• Antibiotics are the choice of treatment for epididymitis. Apart from antibiotics, pain medications, scrotal support, ice packs and rest are also suggested.
• Inguinal hernias are treated with surgery. They are advised not to lift heavy objects and to avoid strain. Certain medical devices provide support to these individuals with hernias.
• Pain medication, ice packs, scrotal support, and rest are suggested in the treatment of orchitis. Antibiotics are recommended for orchitis caused by bacteria. Surgical drainage is used in case of abscess formation, a complication of orchitis.
• Testicular tumor requires specialized treatment. They are usually referred to an oncologist for treatment.
• Uncomplicated kidney stones are treated with pain medications, anti-nausea drugs, and medications that help in the passage of stones. In some cases, urology intervention is suggested to remove the stones.

Prognosis of an individual depends on the underlying cause of the condition. Outlook of testicular trauma depends on the extent and severity of injury to testicles. For testicular torsion, prognosis depends on the duration between the onset of symptoms and management.