Lloydspharmacy.com Health - Testicular pain

Written by Dr Hilary Jones

Introduction

Men are notoriously sensitive about their testicles. After all, they are sensitive structures. But discomfort and pain in the testicles causes a disproportionate amount of concern to men, over and above their vulnerability and association with masculinity and virility, which is why they are still often referred to by many as their ‘family jewels’. So when anybody talks about a man being kicked ‘where it hurts most’, we know what they are talking about.

The testicles, those delicate production factories of spermatazoa and testosterone, are situated externally to the body for a reason. It is so that an optimum temperature for sperm production of 2°F lower than the rest of the body can prevail, a fact that unfortunately makes them more susceptible to injury.

But testicles are also sensitive in that men often find it difficult to talk about them. Any abnormality in this area is, for many, a source of embarrassment and coyness resulting in an inability to make appointments with doctors, a reticence to discuss the issue with friends, partners or relatives, and a potentially life threatening delay in the diagnosis and treatment of more serious problems.

A recent spate of high profile awareness campaigns has highlighted the issue of testicular cancer, based on the fact that it is the most common cancer affecting young men in the 15 to 35 age group.

The fact that this cancer is relatively rare and has a successful cure rate of 99 per cent if it is captured early seems to have escaped them. More importantly, so has the fact that testicular pain itself is a very uncommon sign of cancer. It is a painless lump in the testicle that is more suggestive of a tumour.

So, ironically, the presence of pain, excruciating though it may be, is in some ways a very positive sign.

Men may have the balls, but women have the brains

On the whole, women are better informed about anatomy and how the body works. If only men paid as much attention to looking after themselves and undergoing medical screening examinations as women did.

Women realise that a man's testicles are just as sensitive as tender breasts may be before a period and they also know (since they have had more opportunity for comparison) that men's testicles are often asymmetrical with one bigger than the other, one hanging higher or lower than the other, and at times lying in a more horizontal rather than vertical position in the scrotum.

Women also know that there are two basic functions performed by the testicles, firstly that of male hormone production (which finds its way directly into the bloodstream) and, secondly, that of sperm production (which finds its way via the fine system of tubes at each end of the testicle, called the epididymis, into the vas deferens, the tube which transports sperm to the outside). In fact, the female's superior knowledge of the contents of a man's scrotum has often been known to save men's lives.

Very frequently, a male attends the doctor's surgery simply because his female partner has noticed a new and abnormal swelling on a testicle that otherwise he might not have bothered about.

The bottom line is that any pain or discomfort in a testicle is abnormal and although many lumps that may be felt are benign, it is always essential to have them checked by a doctor, especially if they are painless.

Common causes of testicular pain

There are many possible causes of testicular pain, some of which are more common and some more serious than others. There are eight main types that all men should know something about.

1. Direct injury

Direct blows to the scrotum will cause that familiar nauseating dull ache that is characteristic of the condition. Any man who has ever suffered a knock in this area will remember the pain for a long time afterwards. Because the sensitive testicles are so vulnerable to injury, all contact sports should be played wearing supporting underwear or a jock strap. In cricket, a box should be used, especially when fielding near to the stumps or when batting. A hard cricket ball travelling at speed can otherwise cause considerable damage.

Usually, bruising or swelling are the worst consequences of a direct blow. However alarming it looks, it will tend to settle within a few days with the help of supportive underwear, painkillers and warm baths. The bruising and swelling resulting from a normal vasectomy operation will also repair itself in the same way in a similar amount of time.

Cycling injuries are not uncommon, not only from long-distance cycling in restrictive shorts on poorly padded saddles, but in stunt riders slipping off the peddles and falling heavily astride the cross bar.

2. Infection

Both the testicle itself and the epididymis are prone to infection with microorganisms. Inflammation of the testicle is known as orchitis, and that of the epididymis as epididymitis. When both occur together, as they often do, the term is epididymo-orchitis. All cause pain in the area of the testicle, which is tender, swollen and hot to touch.

Bacterial infection often descends from the urinary system leading to a typical infection that will normally respond to a course of broad-spectrum antibiotics. The viral infection mumps is not an uncommon cause of orchitis in adult men who are not immune, usually affecting one side, but sometimes both.

Mumps orchitis is usually preceded by facial swelling due to an inflamed salivary gland just below and in front of one or both ears, and because viruses do not respond to antibiotics, the mainstay of treatment is pain relief and rest. In a small proportion of cases, mumps orchitis can lead to infertility if both testicles are involved, although some authorities prescribe corticosteroid medication to minimise inflammation.

3. Varicocele and hydrocele

Varicocele and hydrocele can both lead to discomfort around the testicle, rather than actual pain in the testicle itself. Just like the veins in the leg, the veins that drain blood away from the testicles in the scrotum can become varicose, in which case a varicocele is formed. This feels like a bag of worms at the top of the testicle on the affected side and the veins themselves may be tender to the touch. The discomfort is of a dragging, aching nature, and wearing a supportive pair of pants or a jock strap will help.

A doctor can distinguish between swollen veins and the normal underlying testicle through an examination. In moderate to severe cases, an operation to remove the varicose veins is curative.

A hydrocele is a bag of clear fluid that collects in a sac around the testicle and may be the result of a direct injury. Alternatively, it can occur spontaneously in the remnants of an embryonic sac that remains formed around the testicle from birth.

Small hydroceles may hardly be noticed and often resolve without treatment. Larger ones, however, can be drained and the remaining sac removed surgically so it does not reoccur.

4. Hernia

A hernia occurs when a weakness in the muscular wall of the abdomen allows a loop of intestine to push through it causing a lump to form on the outside. In the groin area, a large hernia can descend downwards into the scrotum making it appear more bulky. The pain, which is usually abdominal rather than scrotal, is usually made worse by movement, coughing or sneezing. An operation called a herniorrhaphy is required to correct the underlying muscle weakness.

5. Torsion of the testicles

The testicles are fairly mobile structures but they are tethered to the scrotum to prevent them twisting too far in any direction. Testicular torsion occurs when excessive twisting does happen and the blood supply is cut off from above. The testicle then swells and becomes acutely painful. While sometimes the swelling can allow the torsion to correct itself, permanent torsion can be serious in that the testicle will die after six hours without a blood supply.

An operation carried out quickly enough can resolve the situation, but if gangrene has occurred the testicle on the affected side will need to be removed. Having said that, men still function perfectly normally with only one testicle and their future ability to perform sexually and to father children is unaffected.

6. ‘Blue balls’ of love

Sexual arousal that does not terminate in ejaculation can cause congestion in the sperm carrying tubes, resulting in a dull aching sensation in the testicle. This is sometimes referred to as ‘blue balls’, which is inconvenient but entirely harmless. The pain disappears within a few hours anyway, although some men relieve the discomfort through masturbation.

7. Kidney stones

A kidney stone on the move from the kidney area downwards to the bladder and out through the penis will usually cause intense sharp pains in the abdomen. However, the pain is commonly referred downwards into the testicle region but the intense suddenness and severity of the pain is very suggestive of a kidney stone. Also, blood may sometimes appear in the urine.

When the doctor finds no abnormality in the scrotum in the presence of these symptoms, investigations and treatment for kidney stones are commenced.

8. Testicular cancer

This rarely causes pain and discomfort. Typically, testicular cancer produces a painless swelling of one testicle, a swelling which cannot be distinguished from the testicle itself by examination and therefore does not appear to be located in the epididymis or surrounding structures. Because testicular cancer is the commonest cancer in young men aged between 18 and 35, and because it can prove serious if neglected and left untreated, any lump in the scrotum that is new and abnormal should always be reported urgently to the doctor.

Nowadays, testicular cancer is curable in more than 99 per cent of cases, so there is very little to fear and everything to gain by undergoing prompt investigation and treatment.

Last updated 04.10.2005