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Kerry, Nurse (RN)
Category: Health
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Experience:  35 years in Nursing: OB/GYN, Peds, Oncology, hospice, Ortho, Neuro, Addiction, Recovery, Geriatrics,
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What could this be.

Customer Question

what could this be.
Submitted: 11 years ago.
Category: Health
Expert:  Kerry replied 11 years ago.
Common causes of testicular pain

There are many possible causes of testicular pain, some of which are more common and some more serious than others. There are eight main types that all men should know something about.

    1. Direct injury

    Direct blows to the scrotum will cause that familiar nauseating dull ache that is characteristic of the condition. Any man who has ever suffered a knock in this area will remember the pain for a long time afterwards. Because the sensitive testicles are so vulnerable to injury, all contact sports should be played wearing supporting underwear or a jock strap. In cricket, a box should be used, especially when fielding near to the stumps or when batting. A hard cricket ball travelling at speed can otherwise cause considerable damage.

    Usually, bruising or swelling are the worst consequences of a direct blow. However alarming it looks, it will tend to settle within a few days with the help of supportive underwear, painkillers and warm baths. The bruising and swelling resulting from a normal vasectomy operation will also repair itself in the same way in a similar amount of time.

    Cycling injuries are not uncommon, not only from long-distance cycling in restrictive shorts on poorly padded saddles, but in stunt riders slipping off the peddles and falling heavily astride the cross bar.

    2. Infection

    Both the testicle itself and the epididymis are prone to infection with microorganisms. Inflammation of the testicle is known as orchitis, and that of the epididymis as epididymitis. When both occur together, as they often do, the term is epididymo-orchitis. All cause pain in the area of the testicle, which is tender, swollen and hot to touch.

    Bacterial infection often descends from the urinary system leading to a typical infection that will normally respond to a course of broad-spectrum antibiotics. The viral infection mumps is not an uncommon cause of orchitis in adult men who are not immune, usually affecting one side, but sometimes both.

    Mumps orchitis is usually preceded by facial swelling due to an inflamed salivary gland just below and in front of one or both ears, and because viruses do not respond to antibiotics, the mainstay of treatment is pain relief and rest. In a small proportion of cases, mumps orchitis can lead to infertility if both testicles are involved, although some authorities prescribe corticosteroid medication to minimise inflammation.

    3. Varicocele and hydrocele

    Varicocele and hydrocele can both lead to discomfort around the testicle, rather than actual pain in the testicle itself. Just like the veins in the leg, the veins that drain blood away from the testicles in the scrotum can become varicose, in which case a varicocele is formed. This feels like a bag of worms at the top of the testicle on the affected side and the veins themselves may be tender to the touch. The discomfort is of a dragging, aching nature, and wearing a supportive pair of pants or a jock strap will help.

    A doctor can distinguish between swollen veins and the normal underlying testicle through an examination. In moderate to severe cases, an operation to remove the varicose veins is curative.

    A hydrocele is a bag of clear fluid that collects in a sac around the testicle and may be the result of a direct injury. Alternatively, it can occur spontaneously in the remnants of an embryonic sac that remains formed around the testicle from birth.

    Small hydroceles may hardly be noticed and often resolve without treatment. Larger ones, however, can be drained and the remaining sac removed surgically so it does not reoccur.

    4. Hernia

    A hernia occurs when a weakness in the muscular wall of the abdomen allows a loop of intestine to push through it causing a lump to form on the outside. In the groin area, a large hernia can descend downwards into the scrotum making it appear more bulky. The pain, which is usually abdominal rather than scrotal, is usually made worse by movement, coughing or sneezing. An operation called a herniorrhaphy is required to correct the underlying muscle weakness.

    5. Torsion of the testicles

    The testicles are fairly mobile structures but they are tethered to the scrotum to prevent them twisting too far in any direction. Testicular torsion occurs when excessive twisting does happen and the blood supply is cut off from above. The testicle then swells and becomes acutely painful. While sometimes the swelling can allow the torsion to correct itself, permanent torsion can be serious in that the testicle will die after six hours without a blood supply.

    An operation carried out quickly enough can resolve the situation, but if gangrene has occurred the testicle on the affected side will need to be removed. Having said that, men still function perfectly normally with only one testicle and their future ability to perform sexually and to father children is unaffected.

    6. ‘Blue balls’ of love

    Sexual arousal that does not terminate in ejaculation can cause congestion in the sperm carrying tubes, resulting in a dull aching sensation in the testicle. This is sometimes referred to as ‘blue balls’, which is inconvenient but entirely harmless. The pain disappears within a few hours anyway, although some men relieve the discomfort through masturbation.

    7. Kidney stones

    A kidney stone on the move from the kidney area downwards to the bladder and out through the penis will usually cause intense sharp pains in the abdomen. However, the pain is commonly referred downwards into the testicle region but the intense suddenness and severity of the pain is very suggestive of a kidney stone. Also, blood may sometimes appear in the urine.

    When the doctor finds no abnormality in the scrotum in the presence of these symptoms, investigations and treatment for kidney stones are commenced.

    8. Testicular cancer

    This rarely causes pain and discomfort. Typically, testicular cancer produces a painless swelling of one testicle, a swelling which cannot be distinguished from the testicle itself by examination and therefore does not appear to be located in the epididymis or surrounding structures. Because testicular cancer is the commonest cancer in young men aged between 18 and 35, and because it can prove serious if neglected and left untreated, any lump in the scrotum that is new and abnormal should always be reported urgently to the doctor.

    Nowadays, testicular cancer is curable in more than 99 per cent of cases, so there is very little to fear and everything to gain by undergoing prompt investigation and treatment.

    I hope this helps!
    Please let me know if you have more questions.