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Help! I Have Pain In The Testicles

Hey there Guys,

Today I wanted to cover a very important topic for men, pain in the testicles. Testicular pain is important to understand as pain in the testicles can represent an emergency needing medical attention straight away.

By far the most dangerous cause of pain in the testicles is testicular torsion. This is when the testicle has spun around on it’s axis cutting off the blood flow. Without immediate treatment the testicle can die and will need to be removed.

Other causes of testicular pain include infection by bacteria such as chlamydia and gonorrhoea, trauma and injury and hernias. Testicular cancer can sometimes cause pain though more often it is first noticed due to a lump or change in shape of the testicle.

Today I will cover each of these topics however before we get started let’s learn a bit about our testicles.

What are the testicles?

The testicles are a paired set of sex organs that in most cases are found in the scrotum, the sack that hangs below the penis. They have two important roles: production of sperm for reproduction and the production of the sex hormone testosterone.

In early development while in the womb the testicles form from the same tissue as the kidneys. During development they track down the back wall of the abdomen to the groin where they pass though the front abdominal wall and down into the scrotum. In about 3% of full term babies and 30% of babies born pre-term one or both testicles may not fully descend into the scrotum. This is called cryptorchidism. In most cases the undescended testicle will drop into the scrotum by the age of one.

Cryptorchidism can lead to decreased fertility and an increased risk of testicular cancer so if the testicle has not fully descended by the age of 1 it may need to be surgically corrected.

The testicle is an oval shaped organ ranging in size from a small egg to the size of an olive. Across the back of the testicle is a tubular structure called the epididymis that carries sperm away from the testicle to the penis during ejaculation. The epididymis joins to the vas deferens that is wrapped inside the spermatic chord as it travels upwards in the scrotum though the abdominal wall and inside the abdomen.

The spermatic chord also includes the arteries and veins that carry blood to the testicle, nerves and a passage way for lymphatic drainage.

When examining your testicles you can feel that the testicle is firm with a smooth outer coating. You should be able to feel the tube like structures on the back of the testicle as well as the spermatic chord as it travels up towards the top of the scrotum. Understanding the feel of your testicles is important as it will enable you to notice any changes that may be associated with testicular cancer. I’ll talk about testicular examination a bit later in this article.

What is testicular torsion?

Testicular torsion is when the testicle spins inside the scrotum leading to twisting of the spermatic chord cutting off the blood supply to the testicle.

Testicular torsion is a medical emergency and if not treated in as few as 4 hours the testicle can be starved of oxygen and die.

Testicular torsion normally presents as extreme pain in one side of the scrotum. Because of the twisting the testicle may also rise towards the top of the scrotum. Because of the intensity of the pain there can also be nausea, vomiting and abdominal pain.

Because of the extreme risk of loss of a testicle it’s important to present straight to the emergency department of your local hospital if you have any sudden or severe pain in the testicle. Every minute makes a difference.

Good news is with rapid diagnosis treatment can be done in surgical theatre to restore blood flow and to anchor the testicle to the scrotum to prevent twisting again in the future.

Some men have a small growth at the top of the testicle called the appendix testis. Due to it’s long shape it can also twist causing a similar pain. Again this can also be treated surgically though sometimes it may be able to to be treated in other ways.

To emphasis again:
any sudden or extreme pain in the testicles is a medical emergency and you need to present to your closest emergency department or local doctor straight away!

Other causes of testicular pain

Trauma to the testicles:

Any form of trauma such as a punch, kick or fall onto the groin can lead to damage to the testicle. If you have ever had the misfortune of a blow to the groin you would be well aware of the extreme pain that can be caused. Because of the risk of rupture, tearing or damage to the testicle it’s best to see your local doctor if the pain does not settle rapidly after the incident.

Infections of the testicles or epididymis:

By far the most common cause of testicular infections are the sexual infections Chlamydia and Gonorrhoea. Infections of the testicles can range from a dull ache in the testicles and discomfort passing urine, right through to extreme infections requiring admission to hospital.

The most common symptoms of testicular infections include swelling, pain and fevers. Discussion and examination with your doctor can enable treatment to be initiated. Because the testicle and epididymus can be a difficult area to get antibiotics to you may require to take an antibiotic for a number of weeks to ensure all traces of the bug are gone.

Though very rare mumps can lead to extreme swelling and pain in the testicles. Occasionally mumps can also lead to decreased fertility and low testosterone production.

Testicular cancer:

While majority of testicular cancers are pain free, 30-40% of people with testicular cancer will have a dull ache or a feeling of heaviness in the testicle or scrotum. 10% of men with testicular cancer will present with sharp or severe pain.

What is testicular cancer?

Testicular cancer is the most common form of cancer affecting men from the age of 15 to 35. Approximately 675 men are diagnosed with testicular cancer in Australia each year.

Early detection and treatment means that over 95% of men who have had testicular cancer survive, living normal lives including many fathering children.

The most common presentation for testicular cancer is the man or his partner noticing a lump or change in size of the testicle.

Because early detection is the key to survival it’s important you see your doctor as soon as you can if you notice a lump on your testicles. As part of the examination your doctor will need to assess your testicles in addition to checking your abdomen for any changes that may happen there as well.

He or she most likely will organise an blood test to check for particular hormones that can rise with testicular cancer and an ultrasound of your testicles to define the location, shape and size of the lump. If there are any changes of concern your doctor will organise urgent review with a urologist or surgeon for review and treatment as needed.

Click for a great handout about testicular cancer from the fantastic doctors at Andrology Australia

As I have mentioned, testicular cancer is survivable when treated early. The key to early detection is understanding the feel of your own testicles so you can notice if there are any changes. As the guys at “Single Jingles” say: “Man Up, Check’em”!

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How to examine your testicles

Testicular exam is a very simple process. Best done every month it’s suggested all guys give your testicles a check after a shower. Some suggest doing on the same day each month with the first being a simple way to remember.

Perhaps the easiest way to teach how to do a check of your testicles is by demonstration. Below is a great video from the UK show “Embarrassing Illnesses”.

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So guys, hit the showers, get your balls and scrotum warm and check them today!

Guys I hope you have found this post valuable. If you have any questions please do not hesitate to drop a comment in the boxes below or send me an email. I will do my best to get you an answer straight away.

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Have a great day.

Dr George

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