Scrotum Pain Complications, Risk Factors and Management

Testicular pain is pain or discomfort that is felt in one or both testicles. The pain may originate from the testicle itself, or it may be the result of other conditions affecting the scrotum, groin or abdomen.

Though there are numerous medical conditions that can cause testicular pain, it is important to understand that a few of them constitute medical emergencies that require immediate medical attention in order to prevent the loss of testicular function.

What function do the testicles have?

The testicles form part of the male reproductive organs, with a primary function of producing sperm and the male hormone testosterone.

The testicles are contained within an external sac-like structure called the scrotum, which is located between the penis and the anus.

Adult testicles are similar in size to large olives, and it is common for one testicle to hang lower than the other within the scrotum.

Located near the back of each testicle lies the epididymis, a coiled tubular structure which functions to store and transport sperm.

The spermatic cord (a tubular structure containing blood vessels, nerves, lymphatic vessels and the vas deferens) courses from the abdomen and is connected to each testicle.

Apart from containing vital structures for each testicle, the spermatic cord also suspends the testicles within the scrotum.

Causes

Pain may be directly related to the testes or be caused by disorders in the scrotum, groin, or abdomen.

Common Causes

The most common causes of sudden scrotal pain include

  • Twisting of a testis (testicular torsion)
  • Twisting of the testicular appendage (a small piece of tissue attached to the testis)
  • Inflammation of the epididymis (epididymitis)

Testicular torsion (see Testicular Torsion) occurs when a testis twists on its spermatic cord. The twisting blocks blood flow to the testis, causing pain and sometimes death of the testis.

Testicular torsion is more common in newborns and after puberty. Torsion can also occur in the testicular appendage, a small piece of basically functionless tissue that is left over from development of the embryo.

Like testicular torsion, the twisting of the testicular appendage can block blood flow, causing pain.

Torsion of the testicular appendage is more common among boys aged 7 to 14.

Epididymitis (see Epididymitis and Epididymo-orchitis ) is inflammation of the coiled tube on top of the testis in which sperm mature.

Epididymitis is the most common cause of scrotal pain in adults. Epididymitis is usually caused by an infection, typically a sexually transmitted one.

However, sometimes there is no infection. In such cases, doctors believe the epididymis becomes inflamed by reverse flow of urine into the epididymis, perhaps because of straining (as when people lift something heavy).

Less Common Causes

There are a number of less common causes. Less common causes include

  • A hernia in the groin (inguinal hernia)
  • Infection of the testis (orchitis), usually caused by mumps or another virus
  • Pain from a disorder in the abdomen (such as a kidney stone or appendicitis)
  • Injury

Dangerous disorders that sometimes cause scrotal pain include a ruptured abdominal aortic aneurysm and necrotizing infection of the perineum—the area between the genitals and anus—called Fournier gangrene.

Cancer of a testis only rarely causes pain.

Evaluation

The following information can help people decide when immediate medical attention is necessary and help them know what to expect during the evaluation.

Warning Signs

In men with pain in the scrotum, certain symptoms and characteristics are cause for concern. They include

Sudden, severe pain

Swelling in the scrotum or groin area, particularly one that cannot be pushed down and that is accompanied by severe pain or vomiting

Blisters and/or red or black discoloration of the scrotum or the area between the penis and the anus

Symptoms of severe illness, such as high fever, difficulty breathing, sweating, dizziness, or confusion

When To See A Doctor

Men or boys who have warning signs or are in severe pain should see a doctor immediately because some causes of pain can lead to loss of a testis or other severe complications.

People without warning signs should see a doctor in a day or two.

What The Doctor Does

Doctors first ask questions about the person’s symptoms and medical history and then do a physical examination. What they find during the history and physical examination often suggests a cause of the scrotal pain and the tests that may need to be done (see Table, above).

Doctors ask

  • Where the pain is located
  • How long pain has been present
  • Whether there are injuries to the groin area
  • About the man’s sexual history
  • Whether there are any problems urinating (such as burning or discharge
  • Whether there are any disorders that may cause pain to travel to the groin

Although the physical examination concentrates on the genitals, the groin area, and the abdomen, doctors also look for signs of disorders elsewhere that may cause pain to be felt in the scrotum.

Doctors first look to identify disorders that require immediate treatment. The onset and nature of the pain and the age of the person can provide clues to the cause.

Testing

The need for tests depends on what doctors find during the history and physical examination. However, some testing is typically done.

Urinalysis and urine culture

Testing for sexually transmitted diseases

Color Doppler ultrasonography if testicular torsion seems possible

Timely surgery for testicular torsion is critical, so when doctors are very concerned about testicular torsion they may do surgery immediately instead of testing.

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, and these may include the following.

Imaging tests may include

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 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.

For certain cases of testicular pain, such as those that 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.

Treatment

The best treatment of scrotal pain is treatment of the cause of pain. For example, testicular torsion, strangulated hernias, and necrotizing infection require prompt surgery.

Doctors may give analgesics, such as nonsteroidal anti-inflammatory drugs or opioids, to relieve severe pain.

Essentials for Older People

Testicular torsion is uncommon in older men. When it occurs, the symptoms may be unusual, making the diagnosis more difficult. Epididymitis and orchitis are more common in older men.

Sexually transmitted diseases are less often the cause of epididymitis. Occasionally, inguinal hernia, perforation of the colon, or kidney stones (renal colic) may cause scrotal pain in older men.

What are the complications of the conditions causing testicular pain?

The complications associated with the different causes of testicular pain may include the following.

Testicular torsion complications

  • permanent damage to the testicle
  • loss of testicle
  • infertility
  • infection
  • cosmetic deformity

Epididymitis complications

  • epididymo-orchitis
  • abscess (a collection of pus) formation
  • impaired fertility
  • systemic blood infection (sepsis)

Torsion of a testicular appendage complications

  • no significant complications exist

Trauma complications

  • permanent damage to the testicle
  • atrophy (decrease in size) of the testicle
  • loss of testicle
  • infertility
  • abscess formation
  • cosmetic deformity
  • testicular torsion

Inguinal hernia complications

  • incarceration (hernia unable to be pushed back in)
  • strangulation (disruption to the blood supply of the intestine protruding through the abdominal wall defect)

Orchitis complications

  • atrophy of the testicle
  • impaired fertility
  • abscess formation

Kidney stone complications

  • permanent kidney damage
  • urosepsis (systemic blood infection arising from infected urine)

Testicular tumor complications

The complications of a testicular tumor vary depending on the underlying type of tumor and the extent of disease.

How can testicular pain be prevented?

There are a few measures that you can take to prevent certain causes of testicular pain. However, many of the causes are not entirely preventable.

For epididymitis or bacterial orchitis caused by sexually transmitted diseases (STDs), condom use can reduce the risk of transmission of STDs

The use of appropriate protective gear during sporting activities can help prevent testicular trauma.

Mumps immunization can decrease the incidence of viral orchitis.

Source & More Info: Medicine Net and Merck Manuals

>>VIDEO

Leave a Comment