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Testicular pain

SYMPTOMS

What is testicular pain?

Testicular pain refers to pain in the testicles or the surrounding area.

Testicular pain may originate from the testicles themselves or from nearby structures such as the epididymis behind the testicles or other surrounding tissues. Pain can also be referred from distant areas, such as renal colic caused by ureteral stones. Since the nerves transmitting pain signals from these areas enter the same central nervous system region as those from the testicles, they can also produce a sensation of testicular pain. This type of pain is called "referred pain"[1,2].

Common causes of testicular pain include infections, inflammation, and injury. The testicles in healthy individuals are highly sensitive, and even minor trauma can cause pain or discomfort. Conditions affecting surrounding tissues, such as varicocele or epididymitis, may also lead to testicular pain[1,3].

Testicular pain can be classified as acute or chronic. Acute testicular pain occurs suddenly, is severe, and may persist and worsen over time or gradually subside after a certain period. Chronic testicular pain is usually milder, often presenting as a dull or lingering ache that may persist intermittently or continuously for an extended duration.

TREATMENT

How to relieve testicular pain?

  1. When testicular pain occurs, over-the-counter nonsteroidal anti-inflammatory and analgesic drugs such as aspirin, ibuprofen, or acetaminophen can be taken to alleviate the pain[4];

  2. If experiencing testicular pain or discomfort, ensure bed rest, support or elevate the scrotum, and apply local heat to relieve symptoms[1].

It is important to note that these measures only provide temporary relief for testicular pain and are effective for pain caused by inflammation. However, even if the pain subsides, be alert to the possibility of testicular torsion. It is recommended to promptly visit a hospital for a scrotal ultrasound to confirm the condition and receive appropriate treatment to avoid worsening the situation.

DIAGNOSIS

How to Self-Examine the Scrotum When Experiencing Testicular Pain?

  1. Visual Inspection: Use a mirror or lift the scrotum to check for visible skin abnormalities, swelling, lumps, or other unusual signs. A mirror can help inspect the back and underside of the scrotum[1].
  2. Touch: Feel the scrotum and testicles for any hard lumps, and note the size, position, firmness, and shape of the testicles. Compare both testicles for differences. A normal testicle should feel like a smooth, oval-shaped structure, with an inverted teardrop-shaped protrusion (the epididymis) attached at the back. The epididymis is where sperm mature and gain motility after leaving the testicle, and its tail connects to the vas deferens[3].

When Should You Seek Immediate Medical Attention for Testicular Pain?

Go to the hospital immediately if testicular pain is accompanied by the following symptoms:

  1. Sudden, severe testicular pain, whether persistent or intermittent[5];
  2. Sudden pain in one side of the scrotum during sleep or after intense exercise[5];
  3. Redness, swelling, warmth, or tenderness in the scrotum[5];
  4. Progressive enlargement of the testicle[6];
  5. A lump in the testicle[1];
  6. Testicular trauma;
  7. Swelling or pain in the lower limbs, or an abdominal mass[7];
  8. Other accompanying symptoms, such as blood in urine or semen; frequent, urgent, or painful urination; nausea, vomiting, or abdominal pain; fever (axillary temperature > 37.3°C), chills, etc.[5,8].

What Tests Are Usually Required for Testicular Pain?

Scrotal ultrasound is one of the most common tests for testicular pain, necessary for both acute and chronic cases. For pain caused by inflammation, blood tests and urinalysis may also be required[1-3].

Which Department Should You Visit for Testicular Pain?

Generally, visit the urology department. In emergencies, such as severe testicular pain or blood in urine, go to the emergency department.

POTENTIAL DISEASES

What Are the Possible Causes of Testicular Pain?

Testicular pain may result from, but is not limited to, the following causes:

  1. Acute Testicular Pain:

    • Testicular Torsion: This occurs when the spermatic cord twists, cutting off blood supply to the testicle, leading to sudden, severe pain often accompanied by swelling. The pain may radiate to the groin and lower abdomen[5]. It is more common in adolescents.

    • Testicular Trauma: Injuries to the pelvis, perineum, or genitals can damage blood vessels or cause secondary inflammation or infection, resulting in testicular pain[8].

    • Kidney or Ureteral Stones: When kidney stones pass into the ureter or form within it, they can cause renal colic. The pain may radiate to the lower abdomen (below the navel), groin (inner thigh), and scrotum, leading to testicular pain. Symptoms may also include frequent urination, urgency, painful urination, and blood in the urine[9].

  2. Chronic Testicular Pain:

    • Chronic Epididymitis: A common cause of chronic testicular pain, often resulting from incomplete treatment of acute epididymitis. Symptoms include long-term mild discomfort or a dull ache in the scrotum, which may improve with rest[1].

    • Chronic Prostatitis: A common condition in young and middle-aged men. Since the testicles are connected to the prostate via the vas deferens, prostatitis can affect the testicles and cause pain. Patients may also experience constipation or painful bowel movements, frequent urination, urgency, difficulty urinating, painful ejaculation, or discomfort during intercourse[1].

  3. Other Causes: Testicular pain may also occur due to various forms of orchitis (caused by common bacteria, tuberculosis, gonorrhea, mycoplasma, chlamydia, brucellosis, or mumps virus), inguinal hernia, testicular or epididymal tumors, scrotal inflammation, testicular ischemia, spermatic cord inflammation, seminal vesiculitis, varicocele, hydrocele, testicular microlithiasis, benign prostatic hyperplasia, or seminal vesicle cancer[5-10].