Pain that occurs in one or both testicles is called Scrotal Pain or Testicular Pain. In some cases, the pain emanates somewhere in the abdomen or groin area and then radiates into scrotum and testicles. Whenever there is any pain in this area, men will become anxious and extra cautious and feel sensation of pain in testicles.
In order to better understand the etiology and symptoms of pain, one should have knowledge about basic anatomy and developmental stages of testicles are important. The testicles are situated in the belly (abdomen) before birth and then they gradually descend down into the scrotum (scrotal sac). In this process, they don’t lose connection with the abdomen and connected by spermatic cord. Spermatic cord contains lymphatic, blood vessels, the vas deferens, and nerves. This cord plays a vital role in suspension of testicles within the scrotum.
Epididymis: The structure which is attached to the outer, upper, back position of the testis. Spermatozoa are stored in the coiled segments. Spermatozoa gets matured here and then transports between vas deferens (tube connecting testes with urethra) and testis.
STD (sexually transmitted disease) such as chlamydia or gonorrhea may lead to epididymitis, often seen in sexually active men.
Due to abnormal condition of genitourinary system, younger and older men may get epididymitis. Enlargement of prostate gland is the usual cause in older men.
Classification And Types of Scrotal Pain or Testicular Pain
Testicular pain has different causes, but some warrant surgical treatment on an urgent basis and through medical attention affected testicle is salvaged.
- Injury or Trauma: Injury to the testicles usually produces severe pain and discomfort in the scrotal area. There will be temporary pain due to sudden blow to the scrotal area or testicles, though very painful, relieves in short period of time. In majority of the cases (around 85%), scrotal pain is caused due to testicular injuries occurred due to blunt trauma such as direct punch or kick, motor vehicle accidents, straddle trauma, or sports injuries. Inflammation or bruising may be the result of this injury. In most traumatic cases where testicles are involved surgical treatment would be warranted.
- Testicular Twisting or Torsion: Due to direct or sudden trauma to the testicles, they tend to twist within the scrotum. In the testicles are in twisted state, blood supply will not be there to the affected area or testicles. This is due twisting of blood vessels present in the spermatic cord. In severe cases death of testicle may occur due to loss of oxygen supply to the testicles due to the trauma. Torsion is mostly seen in newborns and children between 12 to 18 years of age.
- Testicular Appendage Torsion: Appendage is a functionless or useless remnant tissue of embryonic development in human being. This condition is mostly seen in age group 7-14, especially younger boys.
Causes of Scrotal Pain or Testicular Pain
Some Rare Common Causes Of Scrotal Pain or Testicular Pain Are:
- Inflammation of Testicle (Orchitis): Inflammation caused due to infection is called Orchitis. Sometimes it is associated with epididymitis, specifically if epididymitis is left untreated for a long period. Usually orchitis occurs due to viral mumps infection; other bacterial organisms and viruses too cause inflammation though rarely.
- Tumor of Testicles: Usually testicular tumor does not cause pain, but one should self-examine the testicles now and then and to seek medical advice if there are any masses or lumps present. Early diagnosis will be very helpful in treating the cancerous conditions.
- Renal Calculi: Pain emanating from renal calculi (kidney stones) sometimes tend to radiate down into scrotum causing testicular pain. In such cases, should contact the Urologist immediately and seek medical attention.
- Inguinal Protrusion (Hernia): When some part of large or small intestine protrudes through the muscle or muscular defect in the groin area and skips into scrotal sac. This could cause testicular discomfort or scrotal inflammation.
Etiology And Risk Factors of Scrotal Pain or Testicular Pain
- Scrotal or testicular pain has different causes. In most of the cases, a small injury can lead to discomfort or testicular pain. This is because testicles are very delicate and sensitive. The pain starts within the testicle and sometimes in the coiled tube situated at the back of the testicles. In some cases, the testicular pain starts because of pains related to abdomen, groin or other areas like hernias or renal stones. It is not so easy to understand the pain of the testicles.
- When a patient approaches the doctor, then the doctor’s main goal will be to find out the cause of the pain and whether the pain is related to testicular torsion. If the pain is related to torsion, then surgical treatment will be warranted with proper medical care and attention.
- The below mentioned information might be helpful in identifying the symptoms, but it is always suggested not to delay in seeking medical advice in case of testicular pain.
- In case of scrotal pain which may arise from any source, the patient will experience symptoms such as vomiting, fever, swelling, redness of testicles or scrotum, penile discharge or painful urination, and pain with sexual intercourse, tenderness, blood in the semen or urine or pain with ejaculation.
- Gradual onset of pain in case of epididymitis. In most cases, initially the pain will be localized to a particular area or epididymis. This pain is usually caused due to epididymitis.
- Sudden onset of due to testicular torsion.
Causes of Scrotal Pain or Testicular Pain Can Include:
- Kidney stones.
- Diabetic neuropathy.
- Blood vessel inflammation.
- Swelling of the scrotum.
- Idiopathic testicular pain (unknown cause).
- Inguinal hernia.
- Inflamed testicle (Orchitis).
- Scrotal masses.
- Enlarged veins in the scrotal area (Varicocele).
- Retractile testicle.
- Buildup of fluid buildup in the testicle (Spermatocele).
- Cryptorchidism (Undescended testicle)
- Testicular cancer.
- UTI (Urinary tract infection).
Medical Attention for Scrotal Pain or Testicular Pain
It is always advisable to treat this scrotal or testicular pain as medical emergency unless it is cleared by the doctor. One should approach the doctor on an emergent basis in case of this pain. It is not advisable to do self-treatment or call any doctor as the doctor cannot suggest anything over phone; should go to the hospital directly without any delay and seek medical treatment.
Pathophysiology of Scrotal Pain or Testicular Pain
To diagnose the underlying etiology of scrotal or testicular pain, a complete history and physical examination will be conducted on the patient by the doctor (Urologist). Physical examination is often focused up on testicles, scrotum, abdomen, penis, and groin areas.
Treatment for Scrotal Pain or Testicular Pain
- Self-Care treatment is strictly not advised. In case of testicular pain, one should seek medical attention on an emergent basis.
- Follow up Evaluation: Once discharged after medical treatment, patient should follow up with the doctor on a regular basis. This will help both the patient as well as the medical practitioner to evaluate the condition and to plan further treatment. If in between the scheduled follow up visits, the pain increases or worse, patient should seek medical attention immediately.
Prevention of Scrotal Pain or Testicular Pain
We cannot prevent all causes of testicular pain, but still we can adopt measures to decrease the risk by making sure to wear protective equipment to prevent injury, and not to engage in strenuous sports activities. In case of engaging in sports activities, one should be sure to take measures to avoid trauma.
In case of epididymitis caused by STDs, use of condoms and safe sex methods are always advisable to reduce the risk of testicular pain.
Regular and consistent self-checks of the testicles will be very helpful in detecting the testicular pain early.
Synonyms of Testicular Pain:
- Testicular torsion.
- Acute scrotal pain.
- Testicular pain.
- Testicular trauma.
- Scrotum pain
- Inflammation of the testes.
Investigations of Scrotal Pain or Testicular Pain
Certain lab tests that are helpful in detecting the testicular pain include: UA (urinalysis), blood tests, check for STDs with the help of urethral swab especially if there is penile discharge
In most of the cases, imaging studies are obtained to help detect the cause of pain. In some cases testicular ultrasound can be done as a non-invasive test to evaluate blood flow to the testicles. Some health care centers perform nuclear scan which is also a non-invasive test to evaluate testicular pain.