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Symptoms and Signs of Testicular Pain (Discomfort, Swelling)

Doctor's Notes on Testicular Pain, Discomfort, and Swelling Symptoms, Causes, and Medical Treatments

Testicular pain is any pain or discomfort felt in the testicles (testes) or scrotum. Some causes of testicular pain, such as torsion of a testicle, are medical emergencies. Torsion occurs when the blood supply to a testicle is cut off. Other causes of testicular pain can include bacterial or viral infections of the testes or scrotum, sexually-transmitted diseases, kidney stones, and tumors of the testicles.

Signs and symptoms associated with testicular pain depend on the exact cause. Associated symptoms can include swelling or tenderness, redness, or a mass or lump felt in the scrotum. In some cases, additional symptoms such as fever, chills, nausea, fatigue, vomiting, back pain, painful urination, or discharge from the penis, may be present.

Medical Author:
Medically Reviewed on 3/11/2019

Testicular Pain, Discomfort, and Swelling Symptoms, Causes, and Medical Treatments Symptoms

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

Testicular Pain, Discomfort, and Swelling Symptoms, Causes, and Medical Treatments Causes

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.

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.

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.

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.

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.

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.

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REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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