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Testicular Pain (cont.)

Testicular Pain Causes

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Testicular pain has many causes, some of which constitute surgical emergencies that require immediate medical attention in order to salvage the affected testicle.

Trauma: Trauma to the testicles 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).

  • It may result in a bruise or swelling of the scrotum and testicles.
  • Occasionally, trauma to the testicles may cause a more significant injury that may require emergency surgery.

Testicular torsion: Testicular torsion is a surgical emergency. It 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.

  • Because blood contains oxygen, and testicles require oxygen to remain functional and viable, the twisting may result in the "death" of a testicle.
  • Torsion may occur at any age, but it is most common in the first few months of life (newborns) and in boys between the ages of 12-18 years.
  • Torsion often occurs in men who have an anomaly affecting the normal attachment of the testicle to the wall of the scrotum (referred to as the bell-clapper deformity). Many of these men have the same abnormality present in both testicles.

Epididymitis: Epididymitis (inflammation of the epididymis) is most often due to an infection. It is the most common cause of testicular pain in men older than 18 years of age, though it can also occur in prepubertal individuals and the elderly.

  • In sexually active men, the most common cause of epididymitis is a sexually transmitted disease (STD) such as gonorrhea or chlamydia.
  • Older and younger men may also get epididymitis, often because of an abnormality in the genitourinary system. In older men, enlargement of the prostate gland is a common cause.

Torsion of a testicular appendage: This is a common cause of testicular pain in younger boys, with most cases occurring between the ages of 7 and 14 years.

  • The testicular appendage and the epididymal appendage are basically functionless tissue remaining from human embryonic development. As in testicular torsion, the twisting of these structures can lead to an interruption of blood flow, leading to varying amounts of testicular pain.

Other, less common causes of testicular pain include the following:

  • 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.
  • Infection: Appendicitis, for example, is a rare cause of testicular pain.
Medically Reviewed by a Doctor on 10/7/2013

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