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Testicular/Scrotal Pain

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Testicular or scrotal pain of any type should be taken seriously. The testicles (testes) are the two glands that produce sperm and are therefore part of the male reproductive system. These glands are very sensitive to pain and even the most minor trauma can be very painful. Scrotal pain can occur at any age, even to newborns, and the condition typically needs medical evaluation.

What can cause scrotal pain?

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Trauma or injury

Sports injuries are one of the most common causes of testicular injury and can occur with team sports or individual activities (e.g. -bicycling)

Inflammation or infection

The most common in this category is epididymitis, an inflammation of the epididymis. These glands are located on top of and behind each testicle (testis). The epididymes are important for sperm maturation and are more prone to infection than the testicles. Some scrotal infections in adolescent and young adult males are caused by sexually-transmitted bacterial infections.

Orchitis

Orchitis is an inflammation of the testicle, which usually results from the spread of infection from the epididymis. This condition can occur at any age, and causes severe pain. It can be caused by the mumps virus, though that disease has been significantly reduced by standard childhood vaccinations.

Lump/Mass

This is a non-specific description of a physical presence that may be due to benign or malignant conditions. The most serious would be a solid testis mass due to cancer. Such tumors are most commonly seen in teenagers and young men but can occur at any age. Trauma can cause collections of blood or fluid that may mimic a mass in the scrotum. Fluid can build up around the testicle (hydrocele) or within the epididymis (spermatocele) and will feel solid on exam.

Testicular torsion

This causes acute and severe scrotal pain and swelling. It happens when the spermatic cord twists, blocking blood flow to the testicles. It most commonly occurs in newborns and adolescent males under 18, but can occur at any age. A testicular torsion is an acute surgical emergency and requires an operation to untwist the testicle within 6 hours in order to save the gonad.

What are the symptoms of scrotal pain?

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If you should experience tenderness or pain in the scrotum that is related to a lump, fever, and abnormal warmth, or redness, blood in the urine, or unusual discharge from the urethra, make an appointment to see your urologist.

You should seek immediate medical attention if you experience any of the following symptoms:

  • Sudden onset of pain
  • Severe pain
  • Pain that is associated with a puncture wound
  • Pain with swelling, after an injury
  • Pain that is accompanied by nausea or vomiting

If any of these symptoms are left unexamined, the result could be loss of the testicle and the risk of infertility.

How is scrotal pain diagnosed?

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Doctors may use the following tests to determine the cause of pain in the testicles or scrotum:

  • Physical examination
  • Ultrasound of testicles
  • Urinalysis
  • Examination of prostate secretions
  • Nuclear scan

How is scrotal pain treated?

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Overall Treatment

Your treatment for scrotal or testicular pain will depend on what the diagnosis is. Applying an ice pack to your scrotum can help reduce pain and swelling. Make sure to wrap the ice in a cloth. Never put the ice pack directly on your scrotum.

If the pain derives from a bacterial infection, antibiotics will be prescribed. Other remedies include, over-the-counter pain relievers, (e.g. – ibuprofen), and reduced activity. You can also seek relief by wearing scrotal support and by placing a rolled towel under the scrotum when lying down.

Treatment for specific diagnoses:

  • Torsion (twisted testicle): This requires immediate surgery by a urologist. Sometimes the doctor may attempt to untwist the testicle before surgery. This would relieve the problem temporarily.
  • Tumor: A cancerous tumor requires urgent removal after a proper diagnosis has been made.
  • Epididymitis: This is treated with oral antibiotics and supportive care. You may need to take the antibiotics for as long as 30 days to fully clear the infection.
  • Trauma: A urologist will assess this problem and may perform surgery if the testicle has been severely damaged. Minor trauma would only require supportive care such as ice packs and anti-inflammatories.
  • Hydrocele: These fluid collections can get quite large and uncomfortable. However, surgical excision of the fluid sac is only required if the collection become uncomfortable and/or interferes with daily activities.

How do I prevent scrotal pain?

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To help prevent some types of scrotal pain, follow these simple measures

  • Regular testicular self-exams
  • Practice safe sex
  • Wear a protective cup or athletic supporter while playing sports.
  • Limit excessive bicycling or weight-lifting.
  • Seek medical attention at once for urinary tract infections