Sexual Health

Testicular Pain: 8 Causes And When To See A Doctor

Testicle pain is perhaps one of the most disturbing symptoms a man can have, especially after a direct hit.

But there are many causes of testicular pain, and trauma is not always the most common. In this article, we’re gathering the top 8 causes of testicular pain. After explaining each one briefly, we’re also telling you what to do.

If you’re feeling testicular pain, it is maybe due to one of these causes:

1) Hernias

Hernias are common causes of testicular pain, especially a type called an inguinal hernia. They are basically a defect in the abdominal wall where abdominal content bulges out.

There are many organs in the abdomen, but the most abundant and convoluted is the gut. When there’s a defect in the abdominal wall and too much abdominal pressure, the intestines bulge out in hernias. 

An inguinal hernia is caused by a defect in the inguinal canal, on the pelvic floor. This canal is located near the groin, and it is the passageway of the spermatic cord. But when it is widened from its original size, part of the intestines can also go through.

The canal communicates to the scrotal sac, where the testicles are located. So, in high-grade hernias, you will probably feel something bulging out in your scrotum. 

Inguinal hernias are often described as a weight sensation in the testicles. It is a dull type of pain, often associated with exercising. Lifting weight and straining yourself physically increases abdominal pressure, pushing your gut against the defect. That’s why your doctor will probably ask you to cough and trigger abdominal pressure when examining your scrotal sac.

Hernias are not solved with medications. What they can do for you is only silence the symptoms for a while. Thus, if your testicle pain is worse after working out, consider testicular hernias as a possibility. Talk to your doctor as soon as possible and follow his instructions. Surgery is the most appropriate treatment, and it is a minor and relatively simple procedure.

2) Kidney stones

Men with kidney stones are somewhat close to knowing how a woman feels during labor. It causes very severe pain. Other symptoms include fever, sweat, and agitation due to the intensity of pain.

People do not always know they are kidney stones because pain can be felt in different places. You can feel pain on your back, abdominal pain, pelvic pain, leg pain, or testicular pain. They can also cause urinary tract infections and urinary symptoms.

You feel kidney stone pain in your testes because your testes’ nerves travel along the nerves of your urinary tract. When they arrive at the brain, it is recognized as pain, but not easily distinguished. Therefore, the brain interprets this impulse as testicular pain. This is also known as referred pain. It is a common symptom when abdominal organs are hurt.

This type of pain is usually very severe, and patients run to the emergency room to find relief. However, in some cases, you won’t feel such unbearable pain. It depends on the extent of the damage, the location and size of the kidney stone, and more. 

If you know you have kidney stones, we recommend following instructions by your doctor. The majority can be broken down and eliminated with medications. Others are very large and require surgery to solve the problem.

3) Orchitis

This is another common cause of scrotal pain. Orchitis is the inflammation of the testicles, usually due to infectious causes.

The most common cause of orchitis is an infection with the mump virus. This infection often appears early in the course of childhood, and it is not usually dangerous. But in adult life, mumps infection can cause severe complications.

The main symptom is pain and tenderness in the testicles and scrotum. However, you may also have urinary symptoms, such as painful urination. The lymph nodes located in the groin can become swollen because they are trying to fight the infection. The scrotum is also swollen, and you’re probably experiencing painful ejaculation. It is an infection, so you’re very likely to experience a fever as well.

Urinary tract infections and sexually transmitted diseases can also cause orchitis. They’re also after acute epididymitis, the inflammation of the epididymis. Epididymitis has similar symptoms to orchitis and requires similar tests and examination methods.

As an adult, you will have a higher risk of orchitis if you have sex without protection, have a history of sexually transmitted diseases, or a sexual partner with sexually transmitted diseases. If that’s the case, and you’re feeling testicular pain, talk to your doctor to rule out orchitis.

4) Testicular torsion

We should always rule out testicular torsion before thinking about orchitis. It is another cause of testicular pain, with almost the same symptoms. Testicular torsion is a medical emergency.

It requires urgent treatment and causes severe pain. As the name implies, the testicles twist painfully during testicular torsion. This twist affects the spermatic cord and compromises the blood flow.

Testicular torsion is not very common, and only 1 in 4,000 men experience the symptoms. They are usually very young patients, most of them under the age of 25 years. The most common cause of testicular torsion has a congenital defect. Due to the defect, the testicles move too much. They don’t have enough support, and this excessive movement can ultimately cause a twist.

In some cases, it happens right after trauma or during strenuous exercise. Sometimes, you may have a testicular appendage. Twisting of this appendage can also cause similar symptoms.

If you have a twisted testicle, chances are you will run to the emergency room. It is a very intense pain and a medical emergency. You can also feel nausea and dizziness. Your doctor will examine your testicles and may also consider an ultrasound.

5) Testicular tumor

A testicle lump may also cause pain and should be evaluated promptly. One of the possibilities is testicular cancer. But we have to see the ultrasound scan and other diagnostic tools to make sure.

Testicular tumors cause chronic pain. This is a pain for a very long time. It is usually mild at first until the tumor grows bigger. In most cases, it is detected as a testicle lump. In other cases, it is not detected until it causes complications.

Besides pain, you can also have tenderness and hydrocele. This is fluid accumulation in the scrotum. The tumor impairs the normal draining of blood and lymph out of the testicle. So, it builds up, causing severe swelling in some patients.

A testicular tumor is not necessarily testicular cancer. It could be a benign teratoma, which is a tumor of germ cells. Another possibility is a benign sex cord-stromal tumor. These arise from Sertoli cells or Leydig cells in the testicles. They can be benign or malignant, so it is very important to run the appropriate tests.

Testicular cancer is dangerous, but if you get early treatment, survival is very likely. It has a 95% survival rate after 5 years if you treat the condition appropriately. We recommend informing your doctor if you ever find a lump or suspicious pain in your testicles.

6) Trauma

A direct hit to the groin is probably the worse type of testicular pain. It causes acute and very intense pain and swelling.

In very severe cases, it may also cause a testicular rupture. The event is usually a blunt trauma. It can happen accidentally, during a fight, in a car crash, or a similar event.

Most cases of scrotal trauma are mild and go away after a short while. Most of them do not require any particular treatment. However, you might want to use non-steroidal anti-inflammatory drugs to reduce swelling. In other cases, pain symptoms are held for a long time. These patients should be readily examined by a doctor.

In a case of testicular rupture, the outer lining of the testicles gets broken. The tunica albuginea is ruptured, and the seminiferous tubules are extruded.

Sometimes the damage is extremely severe, and the testicle is no longer viable. That is why it is recommended to explore patients after scrotal trauma. Certain signs may indicate doctors that something bad is going on. They can also perform a rapid ultrasound scan to confirm the diagnosis.

Testicular trauma often affects the right testis because it is closer to the pubis, and it easily gets trapped and pressed against other structures. If you have ongoing pain or swelling after scrotal trauma, or if you consider it a considerable hit, talk to your doctor.

In most cases, the pain will be severe. In other cases, it won’t be so bad. That’s why the American Urologic Association recommends using ultrasound scans after blunt scrotal trauma, regardless of the signs and symptoms.

7) Varicoceles

Varicocele is perhaps the most common cause of chronic testicular pain. It is characterized by mild testicle pain and a sensation of heaviness and a dull ache. It happens due to incorrect blood circulation.

Similar to what happens in varicose veins in the legs, the vas deferens in the scrotum become wider and more pronounced. At first, you won’t notice, and it won’t likely hurt. If you don’t have treatment, you might encounter a lump that feels like a bag of worms, only visible when you’re lying down. Then, it will be visible even if you’re standing up.

As the disease advances, it will be more likely to give out signs and symptoms. The ones that usually lead patients to the operating room to fix the problem are testicular pain and infertility. The affected testicle is usually the left testicle due to the anatomical disposition of the veins that bring back blood to the heart.

Our recommendation is to get examined as soon as possible if you encounter a “bag of worms”. It is quite easy to procrastinate and neglect varicocele, but you should not. In severe cases, it can cause infertility, testicular atrophy, and other problems.

8) Varicoceles may cause more pain during physical activity

As the last cause of pain, we want to list varicocele again, but a specific type often goes unnoticed.

Even if varicocele does not feel like a bag of worms and only in the starting phase, it can cause pain. Thus, even if you don’t feel any lump at all, be cautious if you start having pain during physical activity. Varicocele is affecting your testicular blood flow, even if you don’t feel it.

Having scrotal heaviness or aches after exercise also counts as chronic testicle pain when it always happens. So, talk to your doctor if that’s the case and look for a definite solution (7).

Conclusion

Chronic scrotal pain is not only due to a direct hit in the groin. Several conditions can cause this symptom, including infections, hernias, kidney stones, varicocele, tumors, and testicular torsion.

Some people do not have any of the above and still experience ongoing pain. They have what’s known as chronic orchialgia. It is very important to rule out any other possibility before making that diagnosis (8). Only your doctor can do that by using the correct examination methods and diagnostic imaging tests.

Sources

  1. Jenkins, J. T., & O’dwyer, P. J. (2008). Inguinal hernias. Bmj, 336(7638), 269-272.
  2. Parmar, M. S. (2004). Kidney stones. Bmj, 328(7453), 1420-1424.
  3. Stewart, A., Ubee, S. S., & Davies, H. (2011). Epididymo-orchitis. Bmj, 342, d1543.
  4. Somani, B. K., Watson, G., & Townell, N. (2010). Testicular torsion. Bmj, 341, c3213.
  5. Coursey Moreno, C., Small, W. C., Camacho, J. C., Master, V., Kokabi, N., Lewis, M., … & Mittal, P. K. (2015). Testicular tumors: what radiologists need to know—differential diagnosis, staging, and management. Radiographics, 35(2), 400-415.
  6. Blok, D., Flannigan, M., & Jones, J. (2019). Testicular rupture following blunt scrotal trauma. Case Reports in Emergency Medicine, 2019.
  7. Sandlow, J. (2004). Pathogenesis and treatment of varicoceles.
  8. Leslie, S. W., Sajjad, H., & Siref, L. E. (2019). Chronic Testicular Pain (Orchialgia). In StatPearls [Internet]. StatPearls Publishing.

 

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