Testicle Pain

WHEN TO SEE YOUR DOCTOR

* Pain in the testicle or scrotum is accompanied by any of the following: swelling, nausea, vomiting, abdominal pain, redness, penile discharge or difficulty in urinating.

What Your Symptom Is Telling You

There's a good reason why instructors in self-defense classes show women where to aim their knees. For a man, there are few pains that match the numbing agony of a direct hit in the family jewels. But not all testicular pain has an external source. Sometimes the body itself is doing the dirty work.

The likely cause of testicular pain depends on how old you are, according to Bruce H. Blank, M.D., a clinical associate professor of urology at Oregon Health Sciences University School of Medicine in Portland. When adult males develop pain in the testicles, Dr. Blank says, they're likely to have epididymitis, a bacterial infection of the epididymis—a spaghetti-like tube coiled up behind the testicle inside the scrotum. Not only will the scrotum hurt but you probably will also feel a swelling of or lump on the epididymis.

Children and teens with testicular pain are probably suffering from torsion, a condition that develops when the testicle virtually strangles itself by spinning, somehow, on the spermatic cord to which it is attached. Almost as frequently in kids, but much less serious (though maybe no less painful), is a similar twist that develops in a body part called the appendix of the testicles or the epididymis.

Whatever spins, the cruel twist of fate usually happens spontaneously, Dr. Blank says. The child could be physically active when it occurs, or he could just awaken with it in the middle of the night.

Testicular pain can also be caused by mumps. In addition, it can have indirect causes, such as pinched nerves in the back, kidney stones or varicose-type veins in the spermatic cord.

Symptom Relief

There's no time to lose when you're doubled up with excruciating scrotal pain, for if torsion's twisting at your testicles, you have breathing room of maybe four to six hours before the organ dies from lack of blood. And until you get to the hospital, knowing whether it's torsion of a testicle, torsion of a testicular appendage, epididymitis or a hernia doesn't help at all. They all hurt just the same, Dr. Blank says, and diagnosis can be difficult even for physicians. "Having acute scrotal pain requires you to see the doctor right away, because you could lose the testicle if it's not corrected in just a few hours."

See if a lift alleviates. A simple, though never foolproof, test may determine the cause. Elevating the swollen scrotum, either by lying down with a pillow under your rump or wearing an athletic supporter, or changing position might temporarily ease the pain of epididymitis but will worsen torsion's torture. Males with torsion also may feel nauseated or vomit.

Let the doctor give it a whirl. A physician may try to untwist the spermatic cord without surgery, Dr. Blank says, but that often is too painful. Normally, surgery is necessary. The doctor unwinds the testicle, then stitches it and its partner to the inside of the scrotum to prevent future torsion. If it's untangled without surgery, the doctor still may want to operate to affix the testes to the inside of the scrotum, Dr. Blank says.

Take some cold comfort. No surgery is necessary if the doctor finds torsion of an appendix of the testicle or epididymitis, Dr. Blank says. While still as painful, torsion of an appendage is not dangerous. Doctors usually recommend ice compresses, elevation of the scrotum and pain medication for a few weeks, although most of the pain will naturally subside over two to three days, he says. You can raise the scrotum with the lift of an athletic supporter or by lying down with a pillow tucked under your tush. If the ache lingers, surgery may be necessary.

The Germs of Pain

You'll be saved a visit to the operating room—but not the doctor's office—if epididymitis pains your privates. The bacterial or sexually transmitted infection—usually from an unknown bacteria but sometimes from chlamydia or gonorrhea—causes pain to increase gradually over hours or maybe even days. While most of the men who get the infection are sexually active, sexual intercourse isn't the only way to catch it. "Any bacteria, possibly one responsible for a urinary infection, can cause testicular pain," says E. Douglas Whitehead, M.D., a urologist, co-director of the Association for Male Sexual Dysfunction in New York City and an associate clinical professor of urology at Mount Sinai School of Medicine of the City University of New York.

Once infected, a lump will emerge inside the scrotum, which may be red and feel hot to the touch. You may have trouble urinating or you may notice a discharge from your penis.

Epididymitis isn't the medical emergency that torsion is, Dr. Blank says, but the pain probably could be enough to drive you to the doctor's office as quickly as you can get there. In addition to taking any antibiotics that are prescribed, here's what the physician may tell you to do.

Take a load off. Bed rest is just what the doctor ordered for epididymitis, Dr. Whitehead says. Raising the scrotum eases the pain.

Take a bath. Reclining in a tub of warm water "soothes the swelling and pain and stimulates blood flow," Dr. Whitehead says.

Glide some ice on the ache. Ice compresses also will help reduce the swelling and inflammation, Dr. Blank says.

Get some support. Wearing a jock strap, along with staying off your feet for a few days and applying ice, will be prescribed if mumps is causing your testicle pain, Dr. Blank adds.