Testicular Pain

Testicular pain is a symptom involving the testes, a part of the male reproductive system, which produce sperms and hormones for the proper functioning of the reproductive system. This pain could be due to an underlying cause and may arise from the scrotum, testis, or the adjoining organs.

The testes also synthesise testosterone, which is an important hormone for the optimal functioning of the male reproductive system. Testicular pain, also known as Orchialgia in medical terms, is pain felt in the inguinal or the scrotal region. Testicular pain may also arise due to abdominal pain radiating to the scrotum or scrotal pain radiating to the groin and the back. Pain can be one-sided or in both the testes. Testicular pain can occur at any age, from children to adults, but is most common in the age group of the mid-30s.

If you feel pain in the testes, you should visit your doctor immediately to rule out any serious underlying cause, and get appropriate treatment.

Testicular pain is usually a symptom of an underlying condition. Depending upon the cause, it may be accompanied by other symptoms such as:

• Nausea and Vomiting
  Nausea and vomiting may be experienced due to twisting of the testes and abdominal discomfort.
• Fever
  Fever along with pain may occur due to infection.
• Abdominal pain
  This may be a referred pain (pain experienced at a location other than the source of the pain) from the testis and the groin and may present as an initial symptom prior to the onset of testicular pain. (Read more - Stomach pain causes and treatment)
• Redness and increase in local temperature
  Infection or inflammation of the testis can lead to redness of the scrotum and an increase in the temperature may be felt on touch.
• Swelling or lump
  Swelling in the scrotal region can arise from a cyst, a tumour or a hernia.

Causes

Detecting the underlying cause of the testicular pain can be helpful to establish a diagnosis and start the treatment. Causes of testicular pain can be divided into more common and less common causes.

• More common causes
  These  include:

  • Trauma or injury to the testes
    You may have testicular pain due to any sports injury or trauma received during any previous surgery such as vasectomy (permanent sterilization method by surgical closure of the duct carrying sperms). Trauma or injury can also lead to torsion of the testes.
  • Torsion of testes
    Twisting of the testes along with the nerves and vessels supplying it is called as torsion of the testes. It is an extremely painful condition and requires immediate treatment.
  • Infection
    Sexually transmitted infections are also responsible for tenderness, redness, and pain in the scrotum.
  • Referred pain
    The testicular pain may be referred from a painful ureter or hip, intervertebral disc prolapse, or following an inguinal hernia repair.
  • Hernia
    A hernia is bulging of the abdominal or inguinal content through weakened muscles resulting from a sports injury or lifting heavy weights. A hernia leads to the development of tension in the groin area which pulls the testes and hence, pain is felt by the person.

• Less common causes
  These include:

  • Cancer
    A cancerous tumour of the testis or the adjoining structure can be a less common cause of testicular pain.
  • Diabetic neuropathy
    Testicular pain can be a complication in people with diabetic neuropathy in which pain is felt due to the involvement of the nerves supplying the testis and the groin area.
  • Idiopathic
    Sometimes testicular pain maybe without any exact known cause. This is known as idiopathic testicular pain. In these people, conservative treatment is tried to relieve the pain.

Risk Factors

You can be at a higher risk of testicular pain in case of the following:

• Exposure to high temperature
  In case, your occupation involves exposure to intense heat or high temperature, you are at an increased risk of having a tumour.
• Exposure to chemicals
  Chemical exposure, in case you are working in chemical industries, can also lead to inflammation or a tumour of the testis.
• Unsafe sex
  This is the most common factor for causing infection of the testicles by the spread of sexually transmitted diseases.

Prevention is possible mainly in case of pain due to injury and infection. Testicular injury and infection can be avoided by:

• Self-examination of the testicles once every month
  Self-examination for any swelling or pain via palpation can be helpful for early detection of injury or swelling.
• Safe sex 
  Practising safe sex by using condoms can protect from sexually transmitted infections and hence prevent testicular pain.
• Support to testes
  Use of scrotal support is advised when participating in any type of sports or when performing a heavy exercise like lifting heavy weights as it may lead to the weakening of muscles which causes hernia.
• Use of protective gear 
  If you are working in chemical industries or at a workplace where there are chances of intense heat or temperature exposure like coal mines, protective shields and instruments should be used.

Diagnosis of testicular pain should be established promptly and for that, your doctor will ask you a detailed medical history and advise some tests.

• Detailed Medical History 
  Medical history is very important as it may possibly indicate the cause of pain such as recurrent injury or a previous operation, such as a vasectomy (a sterilization method for males in which tubes carrying sperms are sealed by surgery).
• Physical examination 
  Your doctor will examine you for any redness, tenderness, swelling or pain on touch which can help to rule out cancer or any inflammation. Physical examination may also help the doctor to find out an obvious source of pain, such as a hernia, hydrocele, spermatocele, varicocele or testicular torsion. These all are conditions related to the scrotum and testes.
• Urine routine and culture 
  Urine examination and culture can help rule out any infection that is viral or bacterial in origin.
• Scrotal USG (Ultrasonography)
  If your doctor suspects any swelling or tenderness during the physical examination, he may advise ultrasound of the scrotum to find out the cause.

Treatment depends upon the underlying cause. So, finding the cause and managing according to that cause is crucial for treatment as sometimes the cause may be unknown. Treatment modalities include:

• Rest 
  In case of pain due to some minor injuries, no treatment is required. Rest alone can help your body to heal the injury and relieve pain, but if the pain is due to any major injury or infection other remedies are required, along with, rest.
• Ice
  Ice packs can relieve your pain temporarily until you visit your doctor for treatment.
• Painkillers 
  Over the counter drugs like non-steroidal anti-inflammatory (NSAIDs) drugs like ibuprofen can be used to relieve pain.
• Antibiotics
  These drugs are used to treat infections. Depending on the type of infection suspected, your doctor will give you antibiotics which can completely cure the infection and relieve the pain.
• Anti-inflammatory agents
  Your doctor can prescribe these type of drugs if inflammation is suspected due to trauma or any type of injury.
• Scrotal support
  Various scrotal supports and instruments are available in the market for use during sports to prevent injury and also for recovery during treatment.
• Radiofrequency
  Radiological pulse therapy can also be advised by your doctor in case of chronic pain.
• Surgery
  Surgery is reserved as the last option and is advised when conservative therapy fails to treat pain or if a tumour is detected. Surgical procedures include:
  • Microsurgical denervation in which pain is relieved by surgical removal of the nerve supplying the testes.
  • Surgery for hernia repair in which bulging due to the weakness of muscle is repaired using mesh.
  • Removal of testis may be required in case of tumours.

Lifestyle management

Lifestyle changes are important in people who are at risk of testicular cancer. It cannot be prevented if it is of genetic origin. The risk of testicular pain can be reduced by taking the following measures:

• Exposure to occupational hazards like working in coal mines or industries with heavy exposure to chemicals and intense heat should be avoided to reduce the risk of a testicular tumour. This can be done by using protective shields and gears that minimize the exposure to such harmful agents
• Use of scrotal supports while participating in any type of sports can prevent injury to testes.
• Practising safe sex by using condoms can avoid sexually transmitted infections.

Prognosis

The outcome completely depends on the underlying cause of testicular pain. If it is due to infection, prompt antibiotic treatment should be given otherwise it may lead to a poor outcome. Prognosis for testicular tumours is good if surgical removal is performed in early stages. In late stages, the outcome may be poor with the spread of cancer to other parts of the body.

Complications

Whenever you feel testicular pain, immediately consult your doctor as delay in treatment can lead to serious complications such as:

• Infertility
  Permanent damage to the testis due to infection or injury leading to infertility.
• Sepsis
  Infection, if not treated, can lead to the spread of infection in the whole body which can cause sepsis and is a serious complication which requires intense treatment and may lead to other life-threatening complications.