Men become very concerned and anxious when they feel pain in their testicles. To better understand the various causes of this symptom, an understanding of basic anatomy and the development of the testicles is necessary.
Testicular pain, discomfort, swelling, and soreness have many causes, some of which constitute surgical emergencies that require immediate medical attention in order to salvage the affected testicle.
Trauma: Trauma to the testes often produces extreme pain. A direct blow to the scrotum, while very painful, usually causes only temporary pain. Most cases of testicular injuries (85%) are caused by blunt trauma (sports injuries, a direct kick or punch, car accidents, or straddle injuries).
Testicular torsion: Testicular torsion is a surgical emergency. This problem occurs when the testicle twists inside the scrotum, either spontaneously or less commonly, as a result of direct trauma. When the testicle twists, the blood vessels contained within the spermatic cord also twist leading to an interruption of blood flow to the affected testicle.
Epididymitis: Epididymitis (inflammation of the epididymis) is most often due to an infection. It's the most common cause of testicular pain in men older than 18 years of age, though it can also occur in prepubertal boys and in elderly men.
Torsion of a testicular appendage: This self-limiting condition is a common cause of testicular pain in younger boys, with most cases occurring between the ages of 7 and 14 years.
Other, less common causes of testicular pain include:
Inguinal hernia: This condition occurs when part of the intestine protrudes through a muscular defect in the groin area and slides into the scrotum. This may cause scrotal swelling and testicular discomfort.
Orchitis (inflammation of the testicle): This inflammatory condition of the testicle generally occurs because of an infectious process. It is sometimes found along with epididymitis (epididymo-orchitis), especially when epididymitis has gone untreated for several days. Most cases of orchitis are caused by a viral mumps infection, though other viruses and bacterial organisms can also cause it.
Testicular tumor: A tumor rarely causes testicular pain. It is important to conduct regular self-examinations of the testicles to locate any lumps or masses, as early detection improves the prognosis for testicular cancer.
Kidney stone: The pain from kidney stones may sometimes radiate into the testicular area.
If you have testicular or scrotal pain, the doctor or other health care professional's first goal is to determine whether or not the pain is caused by testicular torsion, because this is a surgical emergency requiring prompt medical attention. Though the following information may be used to help differentiate the symptoms of testicular torsion and epididymitis, any male with testicular pain should not delay and see a doctor or other health care professional right away because trying to distinguish between the two conditions often can be difficult.
Certain uncomplicated conditions leading to testicular pain can be managed by your primary care doctor or internist. However, depending on the underlying cause, a specialist may need to become involved in the management of your condition. The specialists may include the following:
In order to diagnose the underlying cause of testicular pain, the healthcare professional will conduct a complete history and physical exam. The physical exam will focus on examining the following areas:
Laboratory tests that may be useful in helping make the diagnosis include:
In many cases, in order to help determine the cause of the testicular pain, an imaging study also may be ordered at the discretion of the healthcare professional. In some cases after examining the patient, the healthcare professional may have such a high degree of suspicion that testicular torsion is present, that no imaging tests will be ordered and the individual will be taken straight to the operating room.
Testicular ultrasound: This non-invasive test can evaluate the blood flow to the testicle (if testicular torsion is suspected), in addition to helping diagnose other anatomical abnormalities within the scrotum that can cause testicular pain, including the following:
In cases of epididymitis, testicular ultrasound may reveal an inflamed epididymis with increased blood flow to this structure.
Nuclear scan: Some hospitals may perform this test to help evaluate the cause of testicular pain. It is non-invasive, although it does require the injection of radioactive dye through an IV line.
A testicular self-examination may allow men to detect testicular cancer at an earlier stage of the disease. Often, an abnormal lump or mass, or a change in the size or consistency of the testicle may be the first sign of a testicular tumor. Many doctors and healthcare professionals recommend that young men perform a monthly testicular self-examination if they have the following risk factors:
A testicular self-examination should be performed during or shortly after a bath or shower when the scrotum is relaxed and the testicles descended.
The medical treatment and/or surgical treatment for testicular pain depends entirely upon the underlying cause:
Trauma: After careful evaluation, if no serious underlying testicular injury has been identified, most cases of testicular trauma can be managed and treated at home. Treatment consists of the following measures:
More severe cases of testicular trauma such as testicular rupture, blunt trauma with an associated hematocele (a collection of blood), and penetrating traumatic injuries to the testicle often require surgical intervention.
Testicular torsion: This condition requires immediate consultation by a urologist (specialist in genital and urinary organs) for surgical management. Prior to surgery, a doctor may attempt to untwist the testicle manually to relieve the problem temporarily, though definitive surgery will ultimately still be required. Surgery will consist of untwisting the affected testicle, assessing its viability, and finally securing the testicle to the scrotal wall (orchiopexy) to prevent subsequent episodes of torsion. The other testicle also is often secured to the scrotal wall in order to prevent testicular torsion of that testicle.
Epididymitis: The treatment for this condition is generally managed on an outpatient basis, although patients with severe cases of epididymitis accompanied by complications may require hospitalization. Generally speaking, treatment consists of the following:
Rarely, individuals with epididymitis may develop a complication requiring surgical management, such as a scrotal abscess. Also, some cases of chronic epididymitis refractory to the above measures may require the administration of nerve blocks for pain control, or rarely surgical removal of the epididymis (epididymectomy).
Torsion of a testicular appendage: The treatment for this self-limiting condition primarily consists of pain control with anti-inflammatory medication, scrotal support and elevation, and ice packs. The pain should generally go away within about one week.
Inguinal hernia: The definitive treatment for inguinal hernias requires surgery, which is generally accomplished electively as an outpatient. However, individuals with inguinal hernias that cannot be pushed back in (incarcerated hernia) require emergent surgical management.
Orchitis: The treatment measures for orchitis include pain medication, ice packs, scrotal support, and rest. Antibiotics are reserved only for those cases of bacterial orchitis (not viral orchitis). Rarely, a complication from orchitis (such as an abscess) may require surgical drainage.
Testicular tumor: A testicular mass requires prompt evaluation by a urologist in order to establish a definitive diagnosis. If the patient has testicular cancer, he will be referred to a specialist for further treatment options.
Kidney stone: The treatment for an uncomplicated kidney stone generally involves pain medication, anti-nausea medication, and medication that facilitates the passage of the kidney stone (for example, tamsulosin [Flomax]). Certain individuals with kidney stones will require urologic intervention to remove the kidney stone. If the kidney stone is complicated by an infection, emergent urologic consultation is required.
There is no home treatment for testicular pain until a doctor can find what's causing the pain. In general, you should seek medical care immediately if you or your child experiences testicular pain. For temporary relief pain medication like ibuprofen (Motrin, Advil) and acetaminophen (Tylenol) may help provide temporary relief. Remember not to give your child aspirin because of the risk of Reye's syndrome.
Medical treatment will depend upon the cause of the pain, and it may include:
If you are experiencing pain in the scrotum or testes, contact a doctor or other medical healthcare professional as soon as possible.
If you or your child has been admitted to the hospital, you'll need to follow up per the instructions given at the hospital with your child's pediatrician or primary care doctor. Generally speaking, patients who have undergone surgery for any reason will require outpatient follow-up with the surgeon to monitor progress and manage any potential complications. If your symptoms worsen or fail to improve after treatment, contact your doctor or other health care professional.
The prognosis for a child or man with testicular pain is dependent entirely upon the underlying cause leading to the symptoms.
Trauma: The prognosis for patients with testicular trauma depends on the severity and extent of the initial injury. Though most patients with this type of injury will recover without long-term problems; however, others may experience loss of the testicle or permanent damage to the testicle.
Testicular torsion: the prognosis and recovery depend on the time elapsed between the time of symptom onset and the time to successful manual detorsion or surgical intervention. The chance of salvaging the testicle decreases as more time passes.
Complications associated with testicular torsion include loss of the testicle, permanent damage to the testicle, infertility, and infection.
Epididymitis: Patients with epididymitis and bacterial orchitis generally will recover without complications if treated with antibiotics in a timely manner. Potential complications include abscess formation, impaired fertility, and rarely, a systemic blood infection (sepsis).
Torsion of a testicular appendage: Testicular appendage has an excellent prognosis.
Testicular tumor: The prognosis depends upon the type of tumor and the extent of the disease at the time of diagnosis.
Many causes of testicular pain are not entirely preventable; however, some measures may be taken to decrease the risk:
The symptoms associated with orchitis may range from mild to severe, and the inflammation may involve one or both testicles. Patients may experience the rapid onset of pain and swelling, or the symptoms may appear more gradually. Symptoms of orchitis may include the following:
