Testicular pain is a medical condition that can affect men and boys. The testicles (testes) are two egg-shaped organs located in a pouch of skin called the scrotum. They produce sperm and testosterone (male sex hormone) in mature males.
Testicular pain refers to the pain or discomfort that is felt in one or both testicles. The pain may be acute or chronic. The sensation may be dull, sharp, or a vague discomfort. The cause can originate from many diseases and other health conditions. Some causes of the pain can be a medical emergency.
Testicular pain is a pain that occurs in or around one or both testicles. In some cases, a pain in the testicles can originate from elsewhere in the groin or abdomen (referred pain).
The pain may be acute, meaning that its onset is sudden and does not remain for an extended amount of time. Chronic testicular pain is a constant or intermittent pain that lasts three months or longer. Pain may occur in one testicle or both testicles.
What Causes Testicular Pain?
Because of the nerves of the scrotum, the testicles are very sensitive making the cause of testicular pain difficult to determine. Sometimes, what seems to be testicle pain is caused by a problem that begins in the groin, abdomen or elsewhere.
Testicular pain can have several causes, from infections to traumatic injuries. Even a minor injury can cause major testicular pain or discomfort. Sometimes, testicular pain can be a medical emergency.
Some common causes of testicular pain include:
Cancer. Some tumors might cause a dull ache or pain in the testicles, or heaviness and aching in the lower abdomen or scrotum.
Drug side effect. Certain antibiotics and chemotherapy drugs can be the origination of the pain.
Epididymitis. Inflammation occurs in the epididymis, the tightly coiled mass of thin tubes that carries sperm from the testes to the sperm duct.
Gangrene. A specific type of gangrene called Fournier’s gangrene typically seen in elderly, diabetic, or otherwise immune-compromised individuals.
Henoch-Schonlein purpura. A disease causing an inflammation of the blood vessels.
Hernias. Tissue that pushes through a weak part of the abdominal muscles. An inguinal hernia is one type of hernia that can push into the scrotum, causing testicular pain and swelling.
Hydrocele. A build-up of fluid that causes swelling of the scrotum.
Injury or trauma. An injury to the testicles can occur during physical activity, a fight, or an accident.
Kidney stones. These may cause referred pain that radiates to the scrotum and testicles.
Orchitis. An infection and inflammation of the testicle that can be caused by a bacterial or a viral infection. Some of the bacteria that may cause orchitis include Escherichia coli, Streptococcus, and Staphylococcus. Up to one-third of boys who have the mumps will develop orchitis.
Prostatitis. The swelling and inflammation of the prostate gland.
Scrotal mass. An abnormal bulge or lump inside the scrotum.
Spermatocele. The build-up of fluid in a cyst near the testicle.
Testicular torsion (twisted testicle). A serious medical condition that occurs when one or both testicles twist around the spermatic cord, causing the blood supply to the testicle(s) to be cut off. Torsion may occur during exercise, but it can also happen when standing, sitting, or during sleep.
Undescended testicle (cryptorchidism). A condition in which the testicle has not moved into its proper position in the scrotum.
Urinary tract infection (UTI). Bacteria that infects any part of the urinary system.
Varicoceles. Abnormally large or twisted veins in the testicles.
Vasectomy. Minor surgery that blocks sperm from reaching the semen.
What are the Symptoms of Testicular Pain?
Testicular pain is the pain or discomfort that is felt in one or both testicles. The signs and symptoms of testicular pain vary depending on the underlying cause. The pain may originate from the testicle itself, or it may be the result of other conditions affecting the scrotum, groin, or abdomen.
The testicular pain may be constant or intermittent. The signs and symptoms of testicular pain can include:
Pain in one or both testicles.
Swelling of the testicles.
Redness of the scrotum.
Tenderness of the testicle and/or scrotum.
You may also experience nausea, vomiting, and fever.
Though there are numerous medical conditions that can cause testicular pain. A few conditions constitute medical emergencies that require immediate medical attention in order to prevent impairment or loss of testicular function.
It is best to see a health care provider, or go to a hospital emergency room, if any of the following symptoms accompany testicular pain:
Pain is severe, sudden, or radiates into the abdomen.
Pain is accompanied by nausea, vomiting, and fever.
You experience urinary frequency, or urgency, or there is painful urination.
There is swelling or bruising of the scrotum, or the scrotum or testicle is punctured.
How is Testicular Pain Diagnosed?
In order to diagnose the condition causing testicular pain, a health care professional will perform a complete history and physical exam. The medical history includes questions concerning lower urinary tract and bowel symptoms. The onset and nature of the pain can give important clues to diagnosis. The doctor will ask about the patient’s sexual and medical history, including any surgeries.
The patient should tell his doctor what activities cause the pain to lessen or worsen, such as urination, physical or sexual activity, or sitting for long periods.
It is impossible to measure the sensation of pain directly. However, a doctor will perform a physical exam with the patient standing and lying down. The doctor will try to identify the exact location of the pain, when the pain began, how severe it is, and how long it has lasted.
Blood or urine tests may be performed to rule out infections as a possible cause. Typically, the patient will undergo an ultrasound of the scrotum. Other imaging tests include:
Radionuclide imaging. This imaging study requires the intravenous administration of a radioactive solution. It is useful for the evaluation of testicular torsion, as well as other causes of testicular pain. Its use is much less common than ultrasound.
CT scan or a kidney/ureter/bladder (KUB) X-ray. These studies are sometimes ordered if there is a suspicion that the testicular pain is being caused by kidney stones or another condition in the abdomen or pelvis.
How is Testicular Pain Treated?
The treatment for testicular pain varies depending on the underlying cause. Typical treatment includes pain medication and antibiotics. In more serious cases, surgery may be necessary.
Typical medications include:
Pain relievers. Acetaminophen (Tylenol®, for example) or non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, and similar drugs may help to relieve pain in cases due to injury or trauma.
Antibiotics or anti-infective medications. Orchitis or epididymitis that is caused by a bacterial infection should be treated with antibiotics, usually for at least 10 days. Doxycycline and ciprofloxacin are usually preferred and may be given up to four weeks.
Tricyclic antidepressants. Oral medications such as amitriptyline or nortriptyline may be prescribed.
The treatment for cases involving swelling is for symptom relief. Doctors typically advise:
Taking pain medication and anti-inflammatory agents.
Avoid strenuous activity.
Scrotal support and elevation (typically by wearing supportive underwear).
Ice pack to reduce swelling.
In certain situations, such as testicular torsion or testicular cancer, surgery may be necessary. Testicular torsion is an urgent condition that must be treated promptly to avoid the loss of a testicle from loss of blood supply. Damage can occur after six hours if the blood flow is cut off. Almost 75% of patients must have a testicle removed if surgery is not performed within 12 hours.
For cases where the cause cannot be determined, a nerve block (the injection of a local anesthetic and steroid into the ilioinguinal nerve) or microsurgical denervation may relieve the pain.
Is It Possible to Prevent Testicular Pain?
There are a few measures that you can take to prevent certain causes of testicular pain. However, many of the causes of testicular pain are not entirely preventable.
For epididymitis or bacterial orchitis, the use of a condom can reduce the risk of transmission of sexually transmitted diseases (STDs).
The use of appropriate protective gear during sporting activities can help prevent testicular trauma.
Mumps immunization can decrease the incidence of viral orchitis.
When a man experiences swelling or pain in one or both testicles, it is best to see a doctor. If the pain is causing nausea and vomiting, it is vital the patient seek immediate medical attention. In cases of testicular torsion, the sooner a person seeks help, the more likely they can receive prompt attention to restore blood flow.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating testicular pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.