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8 Causes of Testicular Pain Explained by a Urologist

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Human

January 22nd, 2020· 5 min read

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Testicular pain is a sensitive topic, as not all men are open to talk about such a personal issue.

However, as there has been an increase in sexual awareness when it comes to urological diseases, more men are willing to come forward when they have these issues.

The testicles, commonly referred to as the "family jewels", are important and delicate organs that should not be ignored when one feels any pain or discomfort down south.

There are many different conditions that cause testicular pain. Worryingly, the symptoms are so similar that it is crucial for one to head to the doctor.

In this article, I will discuss the 8 different types of conditions that may cause pain in the testicles.

What are testicles?

Almost all men will have a pair of these reproductive organs situated in the scrotum under the penis. Each testicle is shaped like an egg. Collectively, the testes, or "balls", are in charge of producing sperm.

Apart from that, the testes also produce a hormone called testosterone. The function of this hormone includes the development of physical sexual characteristics, bone growth and bone health, sex drive, sexual function and growth of muscle bulk [1].

The testicle has a fibrous outer covering called the tunica albuginea, which encases the seminiferous tubules, tightly packed into this relatively small and neat package.

The testicles are found hanging loose in the scrotum so that they have an ambient temperature of 2°C lower than the body core temperature of 36.9°C [2]. Lower temperatures are more conducive for the manufacture of good numbers of premium-quality sperm.

There are many causes of pain in the balls

man-holding-hands-at-crotch-area

Testicular pain refers to any discomfort that is felt in either one or both testicles. The pain may start in the groin or abdomen.

It is important to note that the left testicle tends to hang lower than the other. Having said that, any change in the way either testicle lies warrants a trip down to the urologist.

When you see a doctor for testicular pain, the first condition that we would want to exclude is testicular torsion. It is the twisting of the spermatic cord (which contains the blood vessels that keep the testes alive).

Other common causes of testicular pain include:

Rarer causes of testicular pain include:

In some cases, the pain may be caused by a problem that started elsewhere. This includes, but is not limited to:

  • Urinary tract stones (e.g stones in the ureter)
  • Inguinal hernia
  • Chronic prostatitis

Testicular torsion

testicular-torsion-pain-causes

This is a urological emergency. It happens when the testicle twists around the spermatic cord.

The spermatic cord contains blood vessels that allow nutrients to be delivered to the testicle to keep it alive. The spermatic cord also contains the vas deferens — the tube within which sperms produced in the testicle swim towards the prostate and seminal vesicles. There, they are mixed with seminal fluid before being ejaculated out of the body.

When torsion or twisting of the cord occurs, blood supply is cut off and the patient will experience pain in the affected testicle. Sometimes, the pain can travel up towards the lower abdomen. If severe enough, it is not uncommon for the sufferer to also experience nausea and vomiting.

Testicular torsion is more common in male patients younger than 30 [3]. Most of those affected are aged between 12 and 18. Peak incidence occurs from age 13 to 14.

Having said that, torsion can occur at any age. The impact of testicular torsion would be even greater in prepubescent boys since both their puberty and fertility would be affected.

Orchitis

testicular-orchitis-pain-causes

Orchitis is an inflammation of the testicles. It can be caused by bacteria, a virus or may even be unknown. Often, it is a result of a bacterial infection, such as sexually transmitted infections (STIs).

Orchitis can affect fertility, as the infection can cause the sperm-producing parts of the testicle to die off and have a poorer reproductive function, or even lose that function altogether.

This condition will cause pain, swelling and make the scrotum feel more tender or firm than normal. It will also turn warm and the skin may turn reddish.

Orchitis and testicular torsion present in quite similar ways, hence do not take their symptoms lightly.

Epididymitis

epididymitis

The epididymis is the organ where the sperms mature before they swim along the vas deferens to the prostate and seminal vesicles.

Epididymitis is the infection of this organ. Most sufferers will present with symptoms and signs similar to orchitis. Doctors will prescribe antibiotics to treat this infection.

Other conditions that may also lead to epididymitis are:

  • STIs
  • Urinary tract infections (UTI)

Epididymitis can also occur together with orchitis, and when that happens the patient has epididymo-orchitis (EO).

Varicocele

varicocele-testicular-pain-causes

Varicocele refers to a group of enlarged veins in the testicles. 80% to 90% of the time, this condition occurs in the left testicle [4]. 20% to 30% of men have varicoceles.

Sometimes, this condition does not have any symptoms. However, when the symptoms do present themselves, one may notice the pain worsening over the day or during physical activity. The scrotum feels heavy and there is a dull ache in the affected testicle. Some men will also notice that there are visible veins on the scrotum.

30% of men who have subfertility issues have varicoceles [5]. Microsurgical surgery to tie off these enlarged veins show the best results in the hands of a trained urologist.

Trauma

trauma-testicular-pain-causes

The testicles are covered only by the scrotum and a thin layer of cremasteric muscle.

In addition, the fact that they are hanging loose makes them prone to injuries if the man does not take extra care. Situations where they are vulnerable include:

  • Contact sports
  • Accidents involving blunt trauma to the scrotum
  • Accidents involving penetrating trauma to the scrotum

Rupture of the testis will result in the spillage of the tightly packed seminiferous tubules into the scrotum, and the bleeding would continue till it is stopped surgically.

Trauma to the testis can also result in torsion due to cremasteric reflex (a protective primitive reflex) that results in the affected testes being pulled up towards the body, causing twisting of the cord.

Spermatocele

spermatocele

Spermatocele refers to the formation of cysts in the epididymis. These cysts are often filled with fluid and benign. They also may contain dead sperm.

The quality and quantity of the patient's sperm may be affected if the cyst gets too large and blocks the transport of the sperm.

Sufferers may feel discomfort or pain in the testicle. Apart from that, when the cyst gets too big, one may experience heaviness as well as a feeling of fullness in the testicle.

Hydrocele

hydrocele-testicular-pain-causes

This is a type of swelling that occurs in the scrotum. It happens when there is a fluid build-up in the thin sheath that surrounds a testicle. The condition is usually painless, although the size of the hydrocele can cause discomfort that is usually not acute.

Testicular tumour

tescular-tumour

Most testicular tumours are painless. A testicular tumour can cause pain when parts of the tumour undergo necrosis, or in simpler words, die.

Takeaways

No man should take pain/discomfort in the testicles lightly. There are many different causes of testicular pain, with similar symptoms.

Hence, if you experience any discomfort or pain in the groin area, you should consult a doctor to get it checked out.


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Dr Ronny Tan is a consultant urologist and andrologist who is practising at Advanced Urology. Dr Tan is also a Fellow of the Academy of Medicine, Singapore. He received his fellowship training in his area of specialty in the USA, as well as an SMSNA (Sexual Medicine Society of North America)-accredited clinical fellowship in Tulane University, New Orleans.

Read more of Dr Ronny Tan's Q&A here.

I hope that you've found this guide useful, and perhaps gained more insight into the application process. Most of the admissions-related information (admin and logistics wise) can be found on the official NUS Faculty of Dentistry website.

To help yourself out, you should take note of what people look for when they look for a dentist.

This article was written by Human and published on Wednesday, 25 January 2017. Human medically reviewed the article on Wednesday, 25 January 2017. The last update was made on Friday, 18 September 2020.

Disclaimer: Opinions belong to the author and not to the platform.

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