Testes or testicles are male reproductive glands which produce sperm and the hormone testosterone. Males have two testicles within the scrotum, which is the extension of the abdominal wall. The testes are covered by a membrane called tunica albuginea, and the insides are made of fine tubes called seminiferous tubules. These tubules are lined with sperm cells, and the developing sperm travels through these tubules to the efferent ducts. These sperm cells mature in the epididymis.
The testicles are very sensitive, so any minor injury can cause pain or discomfort. The pain can be acute, chronic, dull, sharp, or just a sensation of soreness and discomfort. There are also many health conditions that can cause this. Usually, problems in the testicles first cause abdominal pain or pain in the groin before testicular pain. It is never a good idea to ignore the pain in the scrotum, as it might be due to some serious underlying condition, which can cause irreversible damage to the testicles and scrotum.
The common conditions that cause testicular pain are:
Epididymitis - Inflammation of the epididymis, which is the coiled tubes at the back of the testicles that stores sperm. It makes the scrotum red and swollen and causes one-sided testicular pain that worsens gradually. The other symptoms seen are pain on urination, blood in semen, and pain in the lower abdominal and pelvic region. It is most commonly caused due to sexually transmitted diseases (STDs).
Testicular Torsion - It is a medical emergency which occurs when the testicles rotate, causing the spermatic cord (brings blood to the scrotum) to twist. This cuts off the blood supply to the testicles and causes sudden pain and swelling.
Trauma - Any injury during a fight or an accident or sports can cause testicular pain. Any blunt injury can cause bruising and swelling of the testicle.
Inguinal Hernias - It is a condition where the intestines protrude through the groin area and slide into the scrotum. It causes swelling and testicular discomfort.
Epididymal Hypertension - Or known as blue balls, which causes pain and aching in the testicles due to a prolonged erection without an orgasm. It is not a serious condition.
Orchitis - Inflammation of the testicles is called orchitis. It can be caused by either bacteria or virus and is commonly associated with mumps and STDs. It causes tenderness in the scrotum, painful urination, swollen scrotum, and enlarged prostate.
Urinary Tract Infection (UTI) - UTI in men causes painful urination, pain in the lower abdomen and near the groin, frequent urination, and blood in urine.
Spermatocele - Also called a spermatic or epididymal cyst, which is a benign cyst that occurs close to the testicle. It cannot be seen visually but can be felt. It does not cause any symptom early on, but as the cyst grows, it causes pain and discomfort.
Varicocele - It is the enlargement of the veins within the scrotum. It causes sharp to dull pain in the scrotum which gets worse with standing and physical exertion. And the pain is relieved on lying on your back.
Hydrocele - It is a swelling caused due to the collection of fluid in the scrotum. It results from injury or inflammation within the scrotum.
Prostatitis - Inflammation of the prostate. The types are chronic prostatitis, acute bacterial prostatitis, chronic bacterial prostatitis, and asymptomatic inflammatory prostatitis. The prostate becomes tender, swollen, and inflamed.
Post-vasectomy - After vasectomy (male sterilization surgery), a person can experience congestive epididymitis or sperm granuloma. Both of these conditions cause pain and discomfort.
Kidney Stones - Stones in the kidneys may cause referred pain in the scrotum.
Undescended Testicles - It is when one or both the testicles fail to drop into the normal place in the scrotum. Rarely, an undescended testicle might get twisted and stop the blood supply, causing pain.
Testicular Cancer - Usually, testicular cancer does not cause any pain. But in cases where cancer grows rapidly, it may cut off the blood flow to the testicle or might bleed, causing pain and tenderness.
Fournier’s Gangrene - It is rare, but a severe bacterial infection, which starts on the abdominal wall and spreads to the scrotum and penis causing the death of tissue (gangrene). It causes testicular pain and tenderness.
Diabetic Neuropathy - It causes damage to the nerves of the scrotum.
The symptoms that you might experience are:
Tenderness of the testicles.
Blood in urine.
Blood in semen.
Nausea and vomiting.
Pain on ejaculation.
Pain during urination.
If you have pain in your testicles, your doctor will perform a physical examination of the abdomen, groin, penis, testicles, and scrotum. This is to check for any swelling, tenderness, skin changes, and masses in these regions. He or she will also ask for the complete history to try to find the cause of the pain. If needed, you might have to undergo some or all of the following tests:
Urethral swab (for sexually transmitted diseases).
Ultrasound scan of the abdomen, pelvis, and scrotum.
Depending on the diagnosis, your doctor might suggest various treatment options. The treatment might include:
If there is an infection, antibiotics are given.
Surgery to untwist testicle (testicle torsion) or to correct undescended testicle or to reduce the fluid accumulation or to remove infected and dying tissue (gangrene) or to remove cancer.
Nerve block and cord denervation.
Avoid lifting heavy objects and doing strenuous exercises, as it might aggravate your pain.
Apply ice to reduce swelling and redness.
Applying heat with the help of a heating pad or a hot bath can soothe sore muscles.
Over-the-counter painkillers like Ibuprofen might give temporary relief from the pain.
Wearing tight-fitting underwear helps limit movement and pain.
Stretching and strengthening exercises might ease spasms.
Avoid having unprotected sexual intercourse. Use condoms and practice safe sex to prevent STDs.
To prevent injuries, wear athletic supporters.
Self-examine your testicles to look for any lump or changes every month.
Empty your bladder completely to prevent UTI.
Testicular pain should be considered a medical emergency, and the exact cause should be found out. Whenever you experience pain, consult a doctor immediately as it can be something serious and if left untreated, might cause permanent testicular damage.Last reviewed at: 07.Feb.2019