Pain In Testicles : Causes, Symptoms, Diagnosis & Treatment

• Why Does The Testicle Hurt
• Physiological Causes
• Inflammatory Diseases
• Fluid Accumulation
• Traumatic Injuries
• Emergency Conditions
• Tumors
• Other Reasons
• Diagnostics
• Treatment
• Conservative Therapy
• Surgery

Pain in the testicles occurs with inflammatory diseases, traumatic injuries, fluid accumulation, emergency conditions, neoplasms, purulent processes, pathologies of neighboring organs. May be provoked by sexual arousal or prolonged abstinence. It happens constant, growing, paroxysmal, sharp, dull, pulling, aching, bursting. The cause of the pathology is established on the basis of complaints, the results of a physical examination, data from hardware and laboratory studies. As part of the treatment, analgesics, antibiotics, NSAIDs, physiotherapy procedures, and operations are prescribed.

Why does the testicle hurt

Physiological causes

In the absence of pathologies of the testis and neighboring structures, pain is usually associated with sexual arousal. Short-term soreness occurs during sexual intercourse against the background of blood flow, disappears after orgasm. Painful sensations of aching and bursting nature lasting up to several hours are observed with unrealized sexual arousal and prolonged abstinence. Due to increased blood flow and accumulation of the contents of the gonads.

Inflammatory diseases

For nonspecific acute orchitis, sharp pains are characteristic, which are somewhat reduced in a horizontal position. The testicle is enlarged, the scrotum is dense, hyperemic. Possible urination disorders, inguinal lymphadenitis. A third of patients have dysuric disorders. General symptoms include weakness, headaches, hyperthermia, chills, and muscle aches.

In chronic orchitis, without exacerbation, pain is not intense, aching, pulling, and can spread to the groin and perineum. Increased with defecation, sexual intercourse, physical activity. The general condition is not broken. During the period of exacerbation, the manifestations become more pronounced, an increase in body temperature to subfebrile numbers is possible.

Orchitis can develop as a complication of mumps. Inflammation occurs against the background of chills, hyperthermia, swelling of the submandibular zone and lower parts of the face due to an increase in the salivary glands. The testicles are involved in the pathological process a few days after the onset of the disease. In 70% of cases, one testicle is first affected, after 1-9 days - the other.

Nonspecific acute epididymo-orchitis is manifested by severe pain in the testicle, radiating to the lower abdomen and lumbar region. Pronounced hyperthermia, chills, fatigue, muscle pain are noted. The scrotum is edematous, hyperemic. In the subacute course of the pathology, the manifestations are somewhat smoothed. The chronic form is characterized by moderate pain and increased testicular density, increased pain during movement and palpation. There is a decrease in libido, the composition of sperm changes.

Acute and chronic orchitis and epididymo-orchitis are also provoked by pathogens of specific infections. Testicular involvement can occur with the following STIs:

• gonorrhea;
• chlamydia;
• trichomoniasis;
• mycoplasmosis and ureaplasmosis.

The occurrence of pain in the testicle is preceded by the phenomena of urethritis. Along with typical clinical manifestations, abundant discharge from the urethra with an unpleasant odor of a yellowish-green or whitish hue is observed.

fluid accumulation

At the initial stages of varicocele, there is no pain. The symptom appears during the transition to stage 2 of the disease, at first it has a periodic character. The severity of pain ranges from slight, barely noticeable to extremely intense, sharp, shooting or burning. Patients with stage 3 complain of constant pain, including at night. Seminal cysts are usually asymptomatic. Discomfort, dull and arching pains appear with a spermatocele of a significant size, they are disturbed during sexual intercourse, walking, movements, staying in a sitting position.

Pain in testicles

Traumatic injuries

Acute, extremely intense, unbearable pain occurs with injuries of the scrotum. An external examination reveals significant edema, soft tissue tension, and hemorrhages. The scrotum acquires a rich purple-bluish hue. Hematocele may develop. With open injuries, the pain is so severe that testicular injuries are almost always accompanied by the development of traumatic shock. There is a drop in blood pressure, tachycardia, pallor, fainting.

Emergency conditions

Testicular torsion is manifested by sudden acute pain radiating to the groin and perineum. Painful sensations are very intense, cause a drop in blood pressure, collapse and vomiting. Objectively, a slight or moderate increase, redness, cyanosis or pallor of the affected half of the scrotum is detected. Dysuric disorders and acute urinary retention may be present.

The edematous scrotum syndrome (SMS) is a complication of other pathologies, traumatic injuries, allergic reactions, and neoplasms. Against the background of the rapid accumulation of fluid, the scrotum increases in size, extremely acute unbearable pain occurs, accompanied by cold sweat, severe hypotension and vomiting.

With segmental testicular infarction, the pain syndrome increases over several days. With a total infarction, a clinical picture is formed, similar to acute epididymo-orchitis or testicular torsion. Pain shock develops. Palpitations, decreased blood pressure, pallor, clammy cold sweat, and sometimes confusion are noted.

Tumors

With benign neoplasms, pain rarely appears, becomes the result of secondary infection and the onset of an inflammatory process. Malignant neoplasias in the early stages are also asymptomatic. As the disease progresses, 25% of patients experience increasing pain in the scrotum, perineum, and lower abdomen. Can accompany germ cell tumors: germinoma, spermatocyte seminoma, malignant testicular teratoma. Seen in testicular cancer.

Other reasons

Pain caused by the spread of the pathological process from nearby anatomical formations or resulting from irradiation is detected in the following diseases:

• Purulent processes: abscess of the scrotum, Fournier's gangrene.
• Diseases of the prostate gland: prostatitis, cyst, prostate sclerosis.
• Damage to the lymphatic system: elephantiasis of the scrotum with inguinal lymphogranulomatosis, lymphadenitis, Kaposi's sarcoma, squamous cell carcinoma, etc.
• Pathologies of the urinary tract: renal colic, cancer of the upper urinary system with ureteral occlusion.
• Diseases of the digestive system: proctitis, infringement of the inguinal hernia.
• Other conditions: varicose veins of the small pelvis, chronic pelvic pain syndrome.

Diagnostics

Determining the nature of the pathology is the responsibility of the urologist-andrologist. During the interview, the specialist clarifies when and under what circumstances pain in the scrotum occurred, what symptoms were accompanied, how the disease developed over time. The examination program may include the following diagnostic procedures:

• Visual inspection. Provides an assessment of the condition of the external genital organs, the detection of edema, hyperemia, cyanosis, local hyperthermia, dilated veins and other changes. During palpation, the condition of the testicle, other structures of the scrotum is assessed, enlarged inguinal lymph nodes are detected.
• Diaphanoscopy. It is carried out within the framework of the initial reception. It makes it possible to differentiate the accumulation of fluid from other pathologies accompanied by an increase in the volume of the scrotum.
• Ultrasonography. Informative and safe baseline research. During the ultrasound of the scrotum, inflammatory changes, tumors, hematomas, hemorrhages, testicular torsion are detected. Dopplerography is additionally performed to assess the state of the vessels.
• Scintigraphy. Can be static and dynamic. In the first case, violations of the structure are determined, in the second, the blood flow is assessed. The technique is used for traumatic injuries, inflammatory processes, vascular damage, neoplasms.
• Puncture of the scrotum. Performed to detect fluid. Allows you to confirm the presence of spermatocele and hydrocele, to distinguish between these conditions with hemorrhages, neoplasia and hernial protrusions.
• Laboratory tests. According to the results of a general blood test, inflammation is confirmed, the severity of anemia in tumors and injuries is assessed. With STIs, ELISA, PCR are performed. With dysuria, suspected diseases of the urinary system, general and biochemical urinalysis may be indicated. The material obtained during punctures and biopsies is studied by histological or morphological examination.

Consultation of a urologist-andrologist

Treatment

Conservative therapy

In many diseases of the testicles, suspensions are effective. The list of therapeutic measures is determined by the nature of the pathology:

• inflammatory processes. As part of drug therapy, NSAIDs and broad-spectrum antibiotics are used. With specific orchitis, drugs are chosen taking into account the nature of the pathogen. With the manifestation of an acute process, cold is applied. After inflammation is reduced, UHF, laser therapy, magnetotherapy, drug electrophoresis are performed.
• Testicular torsion. In the first hours, manual detorsion is possible. The testicle is untwisted through the scrotum without incisions, turning outwards and slightly pulling downwards. Upon successful completion of the manipulation, the pain decreases, the testicle becomes mobile. Patients are prescribed drugs to improve blood circulation.
• COM. Analgesics are used to reduce the intensity of pain. The remaining drugs are selected depending on the causative disease. With inflammation, antibiotic therapy is indicated, with allergies - antihistamines, etc.
• Testicular infarction. Non-surgical management is possible only with a limited lesion, confirmed by data from additional studies. Antispasmodics, blood-thinning and vascular medicines are recommended. Patients are monitored in dynamics, with a deterioration in the condition, surgical intervention is indicated.
• Injuries. Cooling of the scrotum, analgesics, hemostatics, antibacterial and anti-inflammatory drugs are required. From 3-4 days - UHF, sollux, paraffin treatment to accelerate the resorption of hemorrhages.
• Tumors. Conservative measures are carried out as part of complex treatment. Depending on the type of tumor, chemotherapy or radiation therapy is prescribed. After bilateral radical operations, hormone replacement therapy is performed.

Surgery

In conditions accompanied by pain in the testicle, the following interventions are performed:

• Fluid accumulation: Bergmann, Winckelmann, Lord, Ross operations, sclerotherapy, laser techniques, ultrasound dissection, hydrocele puncture, spermatocelectomy, spermatocele aspiration.
• Urgent conditions: surgery for torsion of the spermatic cord, opening and drainage of purulent foci, partial orchiectomy.
• Neoplasms: orchiectomy, orchifuniculectomy, according to indications - with retroperitoneal lymphadenectomy.
• Injuries: drainage of a hematoma, reposition, resection or relegation of the testicle, suturing of the wound of the scrotum.