Pain in testicle: Causes, Symptoms and Diagnosis
Some men may be reluctant to talk about it, but it’s quite common to have pain in your testicles or scrotum at some point in your life. It’s why many men see a urologist. Called orchialgia, long-term testicle pain can occur in men of any age, from adolescents to the elderly. It can affect one testicle or both, and the pain, which can range from mild and dull to severe and debilitating, may move toward the groin or abdomen. Causes range from trauma to inflammation to more serious concerns, and many cases occur for unknown reasons.
Though many things can give way to this kind of discomfort, experts suspect that the cause of chronic testicle pain is unknown in up to 50 percent of men. Known as chronic orchialgia, intermittent or constant testicle pain that lasts for three months or longer and is disruptive to daily life is diagnosed after other causes are ruled out. Doctors often suspect such pain is owed to irritated nerves, a pulled groin muscle, or pelvic floor spasms, but these cannot be confirmed.Cases for which a cause is able to be identified are usually due to the following.
Testicle pain is often seen in men with these concerns.
Epididymitis refers to inflammation of the epididymis, a duct located at the back of the testes. Along with testicular pain, epididymitis causes swelling and in severe, rare cases, a fever and chills. Most of the time, epididymitis results from a urinary tract infection or sexually transmitted disease, but it can also occur as a result of trauma or an autoimmune condition.
An Inguinal Hernia
Testicle pain may occur when a part of your intestines protrudes (herniates) into the scrotum with the testicles. An inguinal hernia may only be visualized as a groin bulge when a person coughs or lifts something heavy.
Acute Idiopathic Scrotal Edema
Testicular torsion is a surgical emergency that results from twisting of the spermatic cord, the structure that carries nerves to the testicles. It results in the sudden onset of one-sided, severe testicular pain and swelling, along with nausea and vomiting. While testicular torsion is more common in infants and pubescent boys, it can occur at any age.
Luckily, the more serious causes of testicle pain are rare. They do, however, highlight the importance of listening to your body and seeking the advice of a doctor.
Most testicular cancers do not cause pain, but rather present as painless nodules or lumps. However, some rapidly growing tumors may bleed or cut off blood flow to the testicle, both of which can lead to testicle pain.
Fournier’s gangrene is a severe bacterial infection that begins on the abdominal wall, spreads to the scrotum and penis, and causes gangrene (death of tissue). It is a rare, but potentially life-threatening cause of scrotal pain and swelling.Other symptoms may include skin blisters, crepitus (a crackling or popping sensation), and symptoms of septic shock like a fever, high heart rate, and low blood pressure. The most common risk factor for developing Fournier’s gangrene is diabetes mellitus.
Diagnosing the root cause of your testicle pain is the first step to getting better and feeling well. Your doctor will do a physical exam and recommend tests, as necessary.
During the physical exam, your doctor will examine and then press on the testicles to check for swelling, tenderness, skin changes, and lumps or masses. He may also perform an abdominal exam and check for enlarged lymph nodes in the groin.
Labs and Tests
In order to rule out infection, like epididymitis, your doctor will order a urine culture, as well as a urethral swab to screen for sexually transmitted infections. If a tumor is suspected, blood tests that check for the tumor markers alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) may be ordered.
The hallmark imaging test for examing testicle pain is an ultrasound, which can detect abnormalities like testicular cancer. With testicular torsion, a color Doppler ultrasound reveals decreased or absent blood flow to the testicle. Other imaging tests, like a computed tomography (CT) scan or magnetic resonance imaging (MRI), will be used for staging if testicular cancer is diagnosed.
Not all pain in the testicular area actually comes from the testicle. In fact, referred pain, or pain radiating from somewhere else, such as from a kidney stone or pinched nerve, may be the cause.If your doctor suspects a kidney stone, a urine test to look for blood and/or a CT scan to evaluate your urinary tract system may be ordered. Likewise, imaging, often an MRI of your spine, and a thorough neurological exam can be used to diagnose a pinched nerve.
Depending on the cause of your testicle pain, your doctor will recommend one of many therapies.
Many causes of testicle pain can be treated or partially treated with at-home therapies. For instance, in addition to prescribed antibiotics, epididymitis can be treated with scrotal elevation, ice, and a nonsteroidal anti-inflammatory like ibuprofen to reduce pain.For men with unexplained orchialgia, these options may bring relief, although beware that it may take three months or more for you to notice an improvement:
- Rest: Don’t lift heavy objects or do strenuous exercise. Avoid aggravating sore muscles.
- Heat: Using a heating pad or sitting in a hot bath can stimulate blood flow and soothe muscle aches.
- Anti-inflammatories: Nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen can reduce pain.
- Tight-fitting underwear: Wearing it helps restrain movement and the pain it can cause.
- Physical Therapy: Home exercises and stretching may help strengthen pelvic floor muscles and ease spasms.
Besides anti-inflammatory medications, antibiotics are used to treat infectious-related causes of testicle pain, such as epididymitis or Fournier’s gangrene.
With certain causes of testicle pain, surgery is required. For example, Fournier’s gangrene requires emergent surgical removal of the infected and dying tissue, as well as sometimes reconstructive surgery. Likewise, testicular torsion requires emergent surgery to promptly restore blood supply to the affected testicle.Surgery is also the first treatment for almost all testicular cancers.
Nerve Block and Cord Dennervation
A nerve block may be used for chronic orchialgia when at-home treatments don’t work.With a nerve block, a urologist injects an anesthetic into the spermatic cord. If the anesthetic does take away the pain, your urologist can deduce that the cause of pain is in the testicle.