Pain in the testicle is a symptom that usually causes much apprehension in men. The testicles are very sensitive organs and any minor trauma is enough to cause pain.
In most cases the testicular pain brings no greater concern, however there are some serious diseases of the testes that are considered medical emergencies, as immediate treatment is indicated. In this paper we discuss the main causes of testicle pain.
To better understand the causes of pain in the testicles and scrotum it is necessary to know the anatomical structures that comprise them.
The testicles are formed within the abdomen down into the scrotum before birth, in most cases. About 10% of babies are born with at least one of the testicles still inside the abdomen (a situation called cryptorchidism), however, until the first year of life the other one usually descends toward the scrotum.
So the correct location of testicles is in the scrotum outside the abdomen. By being "outside", testes have a temperature about 2°C below body temperature, allowing their better operation.
The testicles are not loose inside the scrotum, but suspended by the spermatic cord, a kind of cord that comes inside the abdomen and contains nerves, blood vessels, the vas deferens (the structure that carries sperm) and cremaster muscle responsible for involuntary movement of the testes (see the image on the left).
On top of the testes, like a big wig, lies the epididymis, the organ responsible for the storage of sperm produced by the testicles. The spermatic cord is easily palpable, so is the epididymis.
It is normal for one testicle to be more outstanding than the other, causing asymmetry in the scrotum. The size also tends to be a little different, one of them may be slightly higher than the other. However, we must emphasize that a very large difference in size between the two testes is not normal.
It is also usual that testes move unintentionally moving up or down, being more or less close to the body to regulate its own temperature. These movements are performed by the cremaster muscle.
There are several causes for pain in the testicles, some of little clinical importance, while others are more serious and need emergency care. There is also pain in testicles that does not refer to testicular problems such as pain radiated from kidney stones that migrated to the lower urinary tract, some cases of urinary tract infection and inguinal hernia (hernia in the groin area).
In young adults and adolescents it is common to have mild testicular pain without other symptoms. Generally this picture is nonspecific and usually disappears with time, often without unable to identify a cause.
Tables of testicular pain should always be investigated by a urologist; those of most concern are those that present intense pain associated with other symptoms like fever or swollen scrotum.
We will describe below the main diseases that cause pain in the testicles:
Varicocele
A varicocele is a disease caused by dilation of the veins that drain blood from the testicles. We can say that are testicular varicose veins. A varicocele affects up to 15% of the young adult population, with a peak incidence between 15 and 25 years. In most cases a varicocele occurs on the left side of the scrotum, affecting the left testicle.
One of the common symptoms of varicocele is pain, discomfort or heaviness in the scrotum that worsens throughout the day and when a person sits or stands for a long time.
Trauma testicular
The testicles are very sensitive organs and any trauma causes great discomfort. In most cases the pain is very strong, but is temporary, which improves after a few minutes. In cases of serious traumas, such as car accidents or assaults, like kicks in the scrotum swelling and ecchymosis (bruising) may arise. The most severe cases occur when the impact is so strong that causes testicular rupture, which requires surgical repair.
Testicular torsion
Torsion of the testis occurs when there is a defect in fixing the testicle to the scrotum, allowing it to be "hanging" without fixing, can rotate and twist the spermatic cord, causing compression of the inside structures. Testicular torsion is a medical emergency as it can lead to necrosis of the testicle if not reversed in time.
The symptom of testicular torsion is an excruciating testicular pain that arises suddenly, usually after prolonged exercise or trauma. Torsion of the testis may also occur during deep sleep, when there is great involuntary movement of cremaster muscle, waking the patient due to the intense pain.
Epididymitis
Epididymitis is the name given to the inflammation of the epididymis (explained at the beginning of the text). In sexually active men epididymitis is usually caused by the bacteria Chlamydia or Gonococcus, sexually transmitted infections. Epididymitis can also be caused by the bacterium E. coli, the same that causes urinary tract infection.
Patients with epididymitis may have acute or subacute onset of pain and swelling of the scrotum. There may also be frequent dysuria (pain passing urine), purulent discharge from the urethra and / or fever. In some cases there may be hematospermia (blood in semen).
Treatment of epididymitis is done with antibiotics.
Orchitis
Orchitis is inflammation of the testicle, usually caused by a viral infection. The most common cases of orchitis are caused by mumps. Orchitis can also be caused by bacteria, which is usually a complication of epididymitis.
Symptoms of bacterial orchitis are very similar to epididymitis. The viral orchitis, as in mumps, usually causes testicular pain, redness and swelling of the scrotum associated with high fever.
Cancer of testes
Testicular cancer is always a concern for patients with pain in the testicle, however, the testicle pain is uncommon for cancer. The clinical presentation of testicular cancer is usually an asymptomatic palpable mass in the testicle. Eventually there may be pain or discomfort in the scrotum, but it is not the most usual.
Vasectomy
Some patients after surgical vasectomy may have testicular pain due to accumulation of spermatozoa in the epididymis without their ejaculation. Over time, the testicles stop producing new sperm and the body absorbs the already stored one, with gradual improvement.
