Testicular Pain (Pain in the Testicles)

  • Medical Author:
    Steven Doerr, MD

    Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What causes testicular pain?

There are several medical conditions that can lead to testicular pain, and the pain can be acute or chronic in nature. As already described, some of these conditions require urgent evaluation and management in order to preserve testicular function.

Testicular torsion

  • This condition occurs when the testicle twists spontaneously within the scrotum, leading to a decrease in blood flow to the affected testicle (from the twisting of the vessels within the spermatic cord). If the blood supply is cut off for too long, the testicle will be permanently damaged. This condition is a medical emergency and requires immediate medical attention.
  • Testicular torsion typically occurs because of an anomaly affecting the normal attachment of the testicle within the scrotum, often referred to as the "bell clapper" deformity. This abnormality allows the testicle to be freely suspended and twist spontaneously. Often times, this anomaly is present in both testicles. Trauma to the testicle is a rare cause of testicular torsion.
  • Testicular torsion is most common in males younger than 30 years of age, with a peak incidence between 12-18 years of age. It can also occur more frequently during the neonatal period. Testicular torsion most often affects the left testicle, and it is the most common cause of testicle loss in adolescent males.

Epididymitis

  • This condition occurs when there is inflammation of the epididymis, generally as a result of an infection. Epididymitis primarily affects adults, and is most common between 19 to 40 years of age, though it can occur in the prepubertal and elderly age groups.
  • In sexually active men, the most common cause of infection is from a sexually transmitted disease (STD), most notably the bacterial organisms Chlamydia trachomatis and Neisseria gonorrhoeae. In younger and older individuals, infection is usually caused by bacteria that are found in the urinary tract, such as Escherichia coli. Infection in these age groups is typically the result of an abnormality within the genitourinary system.

Torsion of a testicular appendage causes

  • This condition occurs with torsion (twisting) of the testicular appendage or the epididymal appendage, functionless structures that are remnants of tissue from human development. The testicular appendage lies between the testicle and the epididymis, while the epididymal appendage typically projects from the epididymis. As with testicular torsion, twisting of these structures leads to a decrease in blood flow and subsequent testicular pain. This is a common condition in younger boys, with most cases occurring between 7 to 14 years of age. Though this condition is benign and self-limiting, it must be distinguished from the more serious testicular torsion.

Kidney stones

  • Occasionally, the pain associated with kidney stones can radiate into the groin area and cause testicular pain.

Testicular tumor

  • Though generally painless, tumors of the testicle can sometimes cause pain and discomfort of the testicle or scrotum.

Trauma and injuries

  • Any type of trauma or injury to the testicles can cause severe pain and discomfort. The most common mechanism of testicular trauma occurs from blunt trauma (~85%), which can occur from sports injuries, a direct kick to the area, car accidents, and straddle injuries. In most instances, the pain will improve with the passage of time. However, in a few instances, trauma to the testicles can cause more severe injuries requiring immediate medical attention.

Testicular rupture

  • Testicle rupture: This serious injury to the testicle results from a disruption to the connective tissue enveloping the testicle (tunica albuginea), leading to the extrusion of testicular tissue. This injury is often accompanied by a blood collection (hematocele) that surrounds the testicle.
  • Other types of injuries to the testicles include penetrating trauma and testicular dislocation. These types of testicular injuries typically require surgical management.

Inguinal hernia causes

  • An inguinal hernia is a bulge or protrusion of intestine through a defect in the abdominal wall musculature of the groin area. This protrusion can sometimes cause swelling of the scrotum and subsequent testicular pain.

Orchitis

  • This condition is characterized by inflammation of the testicle, typically as a result of an infection. Most cases of orchitis arise from a viral infection, with mumps being the most common causative illness. Mumps orchitis most commonly occurs in prepubertal males, though there has been an increase in cases in adolescent and postpubertal males secondary to the decreased use of the mumps vaccine. Less commonly, orchitis can occur from a bacterial infection, most often as the result of progression of epididymitis (epididymo-orchitis).

How are the causes of testicular pain diagnosed?

In order to diagnose the underlying condition causing testicular pain, a complete history and physical exam will be performed by a health-care professional. Laboratory testing and imaging studies may also be ordered depending on the health-care professional's initial impression and evaluation.

Laboratory testing may include:

  • Blood work
  • Urinalysis
  • A swab of the urethra (if the patient has penile discharge suggestive of a sexually transmitted disease)

Imaging studies may be ordered by your health-care professional to further delineate the underlying cause of the testicular pain. In certain patients with testicular pain whose symptoms are strongly suggestive of testicular torsion, immediate urologic consultation prior to testing should be obtained in order to prevent potential delays in definitive surgical management.

Imaging tests

Ultrasonography

A color Doppler testicular ultrasound is a non-invasive imaging study that can evaluate the blood flow to the testicles, as well as the presence of testicular tumors, fluid collections, testicular rupture, and hernias. A kidney ultrasound can be helpful in the evaluation of kidney stones.

Radionuclide imaging

This is an imaging study requiring the intravenous administration of a radionuclide, useful for the evaluation of testicular torsion, as well as other causes of testicular pain. It is used must less commonly than ultrasound.

CT scan or a kidney/ureter/bladder (KUB) X-ray

These particular imaging studies are sometimes ordered if there is a suspicion that the testicular pain is being caused by kidney stones or other conditions in the abdomen or pelvis.

Medically Reviewed by a Doctor on 12/14/2016

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