Testicle Pain - Symptom Evaluation

About

Testicle pain or testicular pain is pain in a part or complete testicle of either one or both sides. Pain may start elsewhere in the groin or abdomen, and then radiate to the testicles. Testicles, which sit inside the scrotum, are very sensitive organs; even a minor injury can cause pain or discomfort. A sudden, severe pain in the testis may require urgent medical care; conditions such as testicular torsion require immediate interventions. Cancer of the testes may not always be painful.

Symptoms of testicular pain may be characteristic for the underlying condition. For example,

• A testicular torsion produces a sudden and severe pain
• Pain due to epididymitis often begins gradually.
• Fournier's gangrene may produce fever and intense pain.

Testicular pain may be accompanied by symptoms like nausea, vomiting, abdominal pain, swelling, tenderness or redness of the testes and scrotum, and fever. Some may have painful urination; abnormal discharge from the penis may also be seen in others. Pain with sexual intercourse or ejaculation can occur. Some complain of observing blood in the urine or semen.

Diagnosis of the cause of testicular pain is made after a thorough physical examination, laboratory tests and imaging. Your doctor may look for findings like the cremaster reflex or Prehn's sign (elevating the testis relieves pain). Laboratory tests search for infections. Ultrasound imaging is a very helpful aid in early diagnosis of serious conditions like testicular torsion.

Treatment of the underlying cause is the primary aim in treating testicular pain. Pain killers like ibuprofen or paracetamol (acetaminophen) may provide temporary relief. Testicular torsion requires immediate surgery to prevent permanent damage to the testes. Infections require antimicrobial medications.

Timely management of the underlying cause of testicular pain can prevent complications such as loss or permanent damage of the testes and infertility. Infections, if left untreated, may lead to abscesses (collection of pus) and may spread widely (sepsis). Fournier's gangrene is fatal if untreated.

Causes of Testicular Pain

Injury, infection or inflammation, and testicular torsion are the commonest causes of testicular pain.

• Injury to the testes may produce severe pain. Most of the testicular injuries are caused by blunt trauma. Sports injuries, direct blows (kick or punch), vehicle accidents are common. A bruise or swelling of the testis and scrotum occurs. Some injuries are severe and warrant emergency surgical interventions.
• Epididymitis and orchitis are infections that cause pain in the testicles.

Epididymis is a curved structure at the back of the testes that plays a role in the storage and transport of sperms. Infection of the epididymis is called epididymitis. This is usually caused by a sexually transmitted disease such as chlamydia or gonorrhoea. A urinary tract infection associated with an enlarged prostate (obstruction leads to inability to completely empty the bladder) can also lead to epididymitis. The pain is usually gradual in onset.

Orchitis is inflammation of one or both testicles. It is usually caused by bacteria or a virus (esp. Mumps). Orchitis may occur together with epididymitis or prostatitis (inflammation of the prostate gland).

• Testicular torsion is a surgical emergency which requires an emergency treatment within hours. Failure to treat may lead to permanent damage. Twisting of the testicle compromises the blood supply to the testis, leading to death of the tissues. This causes sudden and severe pain. The condition can occur at any age, but is commonest between ages 12 and 16.
• Fournier's gangrene is an aggressive and rapidly spreading infection that affects the perineum. It is characterized by fever and intense pain. An early diagnosis and management is mandatory since the condition is fatal.
• Other conditions such as inguinal hernia, kidney stones, infection or bleeding in the abdomen may also be associated with testicular pain.

Frequently Asked Questions

1. Can testicular pain be prevented?

While most causes are not preventable, some measures are advisable:

• Wear protective pads while engaging in sporting activities
• Practise safe sex to prevent sexually transmitted diseases (STD)
• Mumps vaccination may protect you from orchitis
• Regular self-examination of the testicles and scrotum can help in an early diagnosis of testicular cancer

2. Does cancer of the testicles cause pain?

Testicular cancer may not be associated with pain. However, any lump or abnormality felt during self-examination warrants consultation with your doctor.

References:

1. Keoghane SR, et al. Investigating and managing chronic scrotal pain. BMJ. 2010;341:c6716.
2. Wampler SM, et al. Common scrotal and testicular problems. Primary Care: Clinics in Office Practice. 2010;37:613.

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