Testicular Pain

Whether it begins suddenly or develops gradually, testicular pain is distressing.

Because the testicles are very sensitive organs, even minor problems can lead to acute symptoms and discomfort. In some cases, the cause is straightforward and easy to manage. Other times, pain is the body’s way of warning about a more serious condition that needs medical care.

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The testicles or testes are two oval-shaped organs located in the scrotum beneath the penis. They are responsible for producing sperm and testosterone. The spermatic cord suspends each testicle. It contains blood vessels, nerves, and the tube that transports sperm, called the vas deferens. Sitting on the back of each testicle is the epididymis, where sperm mature and are stored.

Because of their location and the way nerves travel in the body, pain in the testicles may arise from the scrotum itself or be referred from other areas. These may include the lower back, groin, or kidneys.

1. Emergencies

Some causes of testicular pain require immediate medical attention.

A serious, emergent cause is testicular torsion. Torsion happens when the spermatic cord twists and cuts off blood supply to the testicle, leading to:

• Severe pain
• Swelling
• Nausea or vomiting

Without surgery, permanent damage to the testicle can occur in just a few hours.

Testicular rupture is another cause of pain that is usually the result of severe trauma. It also requires immediate surgical repair.

2. Cancer and growths

Testicular cancer often appears as a firm lump or swelling, sometimes with a dull ache or heaviness in the scrotum. If detected early, treatment outcomes are excellent. Other harmless growths, such as cysts, can also cause discomfort if they enlarge.

3. Infections and inflammation

Inflammatory conditions are some of the most common causes of testicular pain.

• Epididymitis is inflammation of the epididymis. Bacterial infections typically cause it. It can be linked to sexually transmitted infections, and in older men, it’s often associated with urinary tract infections.
• Orchitis refers to inflammation of the testicle itself, which can occur on its own or alongside epididymitis.

Both conditions may cause swelling, warmth, and redness in the scrotum, sometimes with fever. They each require antibiotics and supportive care such as rest, scrotal elevation, and anti-inflammatory medication.

4. Hernias and abdominal conditions

Because the testicles share nerve pathways with the abdomen and kidneys, pain may sometimes come from outside the scrotum.

• An inguinal hernia occurs when part of the intestine pushes into the scrotum. It can create a bulge and cause pain or heaviness.
• Kidney stones produce sharp, cramping pain that radiates into the groin and testicle.

In both cases, a medical evaluation is important to confirm the source of pain so the right treatment plan can be put in place.

5. Nerve-related pain

Sometimes, testicular discomfort comes from nerve irritation rather than a problem with the testicle itself. Conditions that can send pain signals to the scrotum include:

• Sciatica
• Herniated spinal discs
• Pelvic nerve dysfunction

This type of pain is often dull or aching and tends to get worse with sitting or specific movements. It is not usually accompanied by swelling or redness. Treating the underlying nerve issue can offer relief.

6. Trauma and injury

The testicles are vulnerable to injury. A direct blow during sports or even minor repeated trauma can cause pain, swelling, and bruising. Most mild injuries will resolve with rest, ice, and support. More significant trauma can cause internal bleeding or rupture. Severe cases require urgent surgical care to preserve the testicle.

7. Fluid collections

Several conditions involve fluid buildup around the testicle, leading to swelling and discomfort:

• Hydrocele. A collection of fluid that typically causes painless swelling, but large hydroceles can feel heavy or uncomfortable.
• Hematocele. A blood collection, usually from trauma, can increase pressure in the scrotum and cause pain.
• Varicocele. Enlarged veins in the scrotum are often described as feeling like a bag of worms. These may cause aching pain that worsens after standing or exercising and, in some cases, may affect fertility.

8. Chronic or unexplained pain

In some men, testicular pain persists even after other causes are ruled out, a condition called chronic orchialgia. It can develop after:

• Infections
• Surgery, including vasectomy
• Nerve irritation. Stress and psychological factors can sometimes amplify the sensation of pain

Chronic pain isn’t always tied to serious conditions. Still, it’s important to evaluate it.

You should never ignore testicular pain, especially if it develops suddenly. Get an immediate medical evaluation if you notice:

• Sudden severe pain in one testicle
• Swelling, redness, or warmth of the scrotum
• Pain accompanied by nausea, vomiting, or abdominal discomfort
• A lump or firm mass in the testicle
• Fever with testicular swelling
• Blood in urine or semen

A urologist may order tests such as an ultrasound or urine studies to determine the source of pain and guide therapy. How testicular pain is treated depends on its underlying cause:

• Infections respond to antibiotics and supportive care
• Torsion, hernias, and tumors typically require surgery
• Injuries may be managed conservatively with rest or surgically if severe
• Kidney stones and nerve-related problems may need specialized treatment aimed at treating the underlying cause of the condition

1. Can lifestyle habits make testicular pain worse?

Yes. Long hours of sitting, strenuous lifting, or wearing restrictive clothing can aggravate discomfort, especially if you have a varicocele or nerve-related pain. Supportive underwear and breaks to move around can help.

2. Should I check my testicles regularly?

Yes. Performing a monthly self-exam is recommended. Gently roll each testicle between your thumb and fingers, looking for lumps, firmness, or size changes. Finding testicular cancer early makes treatment more effective. It also increases the chances of a full recovery.

3. Can untreated testicular problems affect fertility?

Yes. Infections, untreated torsion, or large varicoceles can damage sperm production over time. An early diagnosis and management plan can help protect your fertility.

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