Testicular Pain (Discomfort, Swelling)

Facts and Definition of Testicular Pain and Swelling

  • Testicular pain is a discomfort felt in the testicles (testes) or scrotum.
  • Causes of testicular pain, discomfort or swelling may be very serious and require prompt medical treatment, like testicular torsion, which is a medical emergency. that requires surgery.
  • Causes of the pain can range from common to rare, for example:
  • Symptoms associated with the pain include:
    • Testicle tenderness
    • Swelling
    • Redness
  • You may have other signs like:
  • A doctor or other medical professional can diagnose the cause of yours or a child's testicular pain with tests and a physical exam.
  • Treatment of depends on the underlying cause, and may include pain medication, antibiotics or surgery.
  • Certain causes of testicular pain, discomfort or swelling can be prevented. A testicular self-exam may help detect testicular cancer at an earlier stage.
  • The prognosis depends entirely on the underlying cause. Certain causes of testicular pain carry an excellent prognosis, while others may lead to infertility, or even death.

How Do the Testicles Develop, and What's Their Purpose?

Anatomy and Development of the Testicles

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.

  • Before birth, the testicles are located in the abdomen (belly). Eventually, the testicles migrate down through the abdomen into the scrotum (the outside pouch that contains the testicles). However, they remain connected to the abdomen by the spermatic cord, which contains vital blood vessels, nerves, lymphatic vessels, and the vas deferens. The spermatic cord also functions to suspend the testicles within the scrotum.
  • On the upper, outer, back position of the testicle lies a connected but separate structure called the epididymis, which serves to store and transport sperm. Normally, the epididymis has a direct connection to the wall of the scrotum.

Picture of the Male Urinary and Reproductive Structures
Picture of the Male Urinary and Reproductive Structures

How Bad Can the Pain Get? What Other Signs and Symptoms Accompany the Pain?

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 distinguishing between the two conditions often can be difficult.

  • Pain from testicular torsion usually comes on suddenly.
  • Pain from a viral or bacterial infection of the testes or scrotal area (epididymitis) usually begins gradually. Early on, the pain due to the infection frequently is localized to the area of the infection itself.
  • With testicular pain from any source, you or your male child may have any of the these symptoms:
    • Swelling, tenderness, or redness of the testicles and scrotum
    • Nausea and vomiting
    • Fever
    • Painful urination or penile discharge
    • Pain with sexual intercourse
    • Pain with ejaculation
    • Blood in the urine
    • Blood in the semen

What Are the Common Causes Testicular Pain, Discomfort, Swelling, and Soreness?

Testicular pain, discomfort, swelling, and soreness 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 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).

  • The injury may result in a bruise or swelling of the scrotal area and testes.
  • Occasionally, trauma to the testes may cause a more significant injury that may require emergency surgery.

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.

  • The testes and the scrotal area require oxygen transported by the blood to remain functional and viable, and the twisting may result in the "death" of a testicle.
  • Torsion can 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'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.

  • 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.

What Are the Less Common Causes of This Condition?

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.

Inflammation of the Testicle (Orchitis)

Orchitis Symptoms

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:

  • Testicular swelling
  • Testicular redness
  • Testicular pain and tenderness

How Is the Cause of Testicular Pain, Discomfort, and Swelling Diagnosed?

In order to diagnose the underlying cause of testicular pain, the health-care professional will conduct a complete history and physical exam. The physical exam will focus on examining the following areas:

  • Abdomen/groin
  • Penis
  • Testicles
  • Scrotum

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 health-care professional. In some cases after examining the patient, the health-care 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:

  • Testicular rupture
  • Hematocele (a collection of blood)
  • Abscess (a collection of pus)
  • Testicular tumor
  • Inguinal hernia

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 nuclear scan will diagnose testicular torsion by showing decreased accumulation of dye in the affected testicle compared to the normal testicle.
  • In many hospitals, the time required to prepare the materials and perform a nuclear scan is so lengthy that it is not practical when testicular torsion is suspected.

Which Types of Doctors Treat the Condition?

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:

  • Urologists
  • General Surgeons
  • Oncologists

When Should I Call the Doctor?

  • Males should view testicular pain as an emergency until proven otherwise.
  • Promptly call your doctor or other health care professional if you or your child develops testicular pain.
  • If you cannot contact a doctor or health care professional, go directly to a hospital's emergency department.

Can I Treat Testicular Pain At Home, or Will I Need Medical Treatment?

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:

  • Pain medicine
  • Antibiotics
  • Ice
  • Rest
  • Scrotal support
  • Surgery

If you are experiencing pain in the scrotum or testes, contact a doctor or other medical health-care professional as soon as possible.

What's the Medical Treatment for the Cause of the Pain?

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:

  • Pain medications, including anti-inflammatory agents
  • Scrotal support and elevation
  • Ice packs
  • Rest

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:

  • Antibiotics for 10 to 14 days with the choice of antibiotic prescribed varying depending on the age and sexual history of the individual
  • Pain medications, including anti-inflammatory drugs
  • Scrotal support and elevation
  • Ice packs
  • Rest

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.

  • Individuals with hernias should be instructed to avoid straining and to avoid lifting heavy objects. Also, there are various medical devices used to provide support for those individuals with hernias. Consult with your health care professional for more information.

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.

Do I Need to Examine My Testicles and Scrotal Area?

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 health-care professionals recommend that young men perform a monthly testicular self-examination if they have the following risk factors:

  • A history of testicular tumor
  • An undescended or late-descending testicle
  • A family history of testicular cancer

A testicular self-examination should be performed during or shortly after a bath or shower when the scrotum is relaxed and the testicles descended.

  • While standing, hold the penis out of the way and gently roll each testicle between your thumb and fingers, making sure to feel the entire surface of the testicle.
  • It is normal for one testicle to be larger than the other, and for one testicle to hang lower than the other.
  • If you notice any lumps or changes in the size, shape or consistency of the testicle, seek prompt medical attention for further evaluation.

What Is the Aftercare for the Problem?

Individuals with testicular pain who are discharged home after undergoing a medical evaluation will need to follow-up as per the instructions set forth by the health care professional. Generally speaking, patients who have undergone surgery for any reason will require outpatient follow-up with the physician to monitor progress and manage any potential complications. If your symptoms worsen, or fail to improve after treatment, contact your health care professional.

How Can I Prevent Testicular Pain, Discomfort, and Swelling?

Many causes of testicular pain are not entirely preventable; however, some measures may be taken to decrease the risk:

  • When engaging in sporting activities, make sure to wear the appropriate protective equipment to prevent testicular trauma.
  • For those cases of epididymitis caused by sexually transmitted diseases, safe sexual behavior using condoms greatly reduces the risk of acquiring sexually transmitted diseases.
  • The mumps vaccination can reduce the incidence of viral orchitis.
  • Though testicular tumors cannot be prevented, regular self-examinations of the testicles can improve the chance of early detection.

What Is the Outlook for a Male with This Problem?

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 depends 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.

  • If detorsion occurs within 6 hours from the time of symptom onset, the rate of salvaging the testicle is between 90% and 100%.
  • After 12 hours, the salvage rate is between 20% and 50%.
  • After 24 hours, the salvage rate is between 0% and 10%.

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 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.

Reviewed on 9/11/2017
Sources: References

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