Scrotal pain: Causes, Symptoms, tests, complications, treatment & Prevention

Scrotal pain (Testicular Pain) : Causes, Symptoms, tests, complications, treatment and  Prevention

Over the next few words, I would be talking about an uncommonly discussed topic that would be of benefit primarily to men, and also of equally much gain to women who have men (and male children) that they really care about.

For the purposes of this thread, and to make things simple a little, I would interchangeably use the words “testicular pain” and “scrotum pain” even though technically, the scrotum is like the bag, and the testes is the balls in the bag.

It may interest you to know that pain or discomfort that comes from the testes or the scrotum can be a sign of something very sinister, which if ignored or improperly handled, can ultimately lead to a man being unable to have children. This is no joke, guys.

What is the testes?

These are the egg-like structures located in the scrotum of men and young male children.

What is Testicular/Scrotum Pain?

This refers to a sensation of discomfort or pain that is felt in the testes or scrotum or both.

Before birth, the testicles are in the tummy, but then later migrate down into the scrotum (the pouch that contains the testes outside the body). However, they remain connected to the abdomen by the spermatic cord which suspends the testicles within the scrotum.

Now on the upper, back part of the testicle lies a connected but separate noodle-like structure called the epididymis, which helps to store and transport sperm from the testis. Normally, this epididymis has a direct connection to the wall of the scrotum.

Before you get too bored with all of this story about the development of the testis from birth as well as the structures around it like the epididymis, the reason I’ve mentioned it is because that knowledge really helps to understand the source of Scrotal Pain in a patient.

And it’s because sometimes the actual cause of Scrotum Pain can be from a problem in the tummy which is now felt in the testis/scrotum, or it may be from a problem in the testis itself or a problem in the epididymis (that is attached to the testis). I hope this makes sense?

How serious can Scrotal Pain get?

Now it is important to quickly state here that there are two common causes of Scrotum Pain which can either immediately or eventually lead to losing the testis or being unable to have children as a man.

These two common Scrotum Pain causes are Testicular Torsion and Epididymitis. 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.

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 to the scrotum like if a man is kicked in the scrotum during a fight or sports.

Testicular Torsion is an emergency because the person needs to go to the theatre immediately before that testicle becomes useless. The testes require oxygen transported by the blood to remain functional, and the sudden twisting may result in the “death” of a testicle.

When the testicle twists, the blood vessels to it also twist leading to an interruption of blood/oxygen flow to the affected testicle which IF not quickly corrected with an urgent surgery can lead to loss of the testis and eventually make the man infertile.

Who can have Testicular Torsion?

Torsion can happen at any age actually, but it is most common in the first few months of life (newborns) and then it’s quite common in boys between the ages of 12-18 years. So you need to report at the hospital any #ScrotumPain in this ages.

What is Epididymitis?

Epididymitis (it’s an inflammation of the epididymis) mostly due to an infection like an STI. And it’s the most common cause of testicular pain in men older than 18 years, though it can happen in boys before puberty and even in elderly men.

Scrotal pain
A man holding on to his painful scrotum
Credit: Buoy Health

So if someone has scrotal pain, the doctor’s first concern is to determine whether or not the pain is caused by testicular torsion, because this is a surgical emergency requiring prompt medical attention and urgent operation to salvage the testis.

NEVER IGNORE #ScrotumPain!

What are the other possible causes of Scrotal Pain?

-Hernia (protrusion of tummy contents through the groin and scrotum)

-Orchitis (inflammation of the testis itself, usually occurs with Epididymitis)

-Trauma to the scrotum

-Kidney Stones

-Testis Cancer

-Diabetes

-Hydrocele

Apart from Scrotal Pain, other symptoms to note are

-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

All of the above symptoms, taken together with having #ScrotumPain are very important things to never take lightly.

Especially if you are a young man who has not had children.

Or who wants to live a long life.

A quick visit to the doctor can save you from many tears later.

When Should You Call Your Doctor?

Call your doctor immediately to book an appointment if:

-there’s a lump on your scrotum

-you have high temperature

-your scrotum is red, warm when you touch, or is quite painful

-you’ve recently had sex without condoms.

Please call an ambulance immediately if your testicular pain is:

-sudden or severe.

-occurs with nausea or vomiting.

-is caused by an injury that’s painful or if swelling starts to develop.

You may be bleeding or have a twisted testicle. Don’t delay. This may be a Torsion!

How Is the Cause of #ScrotumPain Diagnosed?

In order to make a diagnosis, the doctor will ask a few questions and do a physical exam. The physical exam will focus on checking the following areas for important signs:

Abdomen/groin

Penis

Testicles

Scrotum

Are there any tests needed?

Some tests that may be useful in helping make the diagnosis include:

-Blood tests

-Urine tests

-Swab tests from the penis can be sent to the lab (to check for sexually transmitted diseases)

-Testicular ultrasound (can help especially in Torsion)

What if my Scrotum Pain is nothing serious?

All men and male children should ALWAYS 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 to clarify doubts.

What are the treatment options?

Depending on the cause, treatment options include:

-antibiotics to treat an infection

-surgery to untwist the testicle if it is testicular torsion

-painkiller medications

-surgery for hydrocele

-ice packs

-scrotal support/elevation

-bed rest

Should I regularly examine my testis?

A regular testicular self-examination helps men to detect testicular cancer at an early stage.

Often, an abnormal lump or swelling, or a change in the size or consistency of the testicle may be the first sign of a testicular tumor.

As a matter of fact, doctors recommend that men perform a monthly testicular self

-check if they have the following risk factors:

-A past history of testicular tumor

-An undescended or late-descending testicle

-A family member with testicular cancer

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

While standing, gently roll each testicle between your thumb and fingers, making sure to feel the entire surface of the testicle.

Please note that it is NORMAL for one testicle to be larger than the other, and for one testicle to hang lower than the other.

But if you notice any lumps or changes in the size, shape or consistency of the testicle, seek prompt medical attention for further evaluation.

What Are the Complications of Testicular Pain? Never ignore any case of Scrotum Pain. Talk to a doctor. An untreated STD such as chlamydia/gonorrhoea or a serious condition such as testicular torsion can result in permanent damage to your testicles and make you infertile.

How To Prevent Scrotum Pain?

Simple tips are:

-wearing an athletic supporter to prevent injury to the testicles during sports

-practicing safe sex, including using a condoms -check your testicles once a month to note changes/lumps

-get the mumps vaccine if you don’t have it.

Thanks for your amazing patience for reading through this to the very end.

I hope you find this quite helpful.

Yours sincerely,  

Dr Olufunmilayo 

(Medical doctor based in the UK)

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