Pain in the scrotum

Pain in the scrotum is noted in inflammatory and volumetric processes, fluid accumulation, injuries, some infectious and parasitic pathologies. In diseases of the kidneys, ureters, prostate, rectum, it is explained by irradiation. More often dull, pulling, aching, bursting, less often sharp, jerking, pulsating. The causes of scrotal pain are determined by the results of a survey, external examination, diaphanoscopy, ultrasound and laboratory tests. Sometimes a puncture is required. Before diagnosis, immobilization using a special dressing or suspension is recommended.

Why there is pain in the scrotum
Lack of sexual discharge
Inflammatory diseases
Purulent processes
Accumulation of liquid
Varicocele
Urgent states
Neoplasms
Parasitic pathologies
Other reasons
Diagnostics
Treatment
Assistance at the pre-hospital stage
Conservative therapy
Surgical treatment
Prices for treatment
Why there is pain in the scrotum
Lack of sexual discharge
Pain in the scrotum becomes a consequence of sexual arousal without subsequent discharge. This condition is more common in adolescence and adolescence, develops against the background of a combination of high libido and the absence of a sexual partner. In adults, it is observed when circumstances arise that prevent sexual relations, voluntary refusal of sex for religious reasons.

A similar condition is observed in men who practice prevention by interrupting sexual intercourse, in patients suffering from orgasmic dysfunction. In all these cases, the cause of pain is a rush of blood to the genitals without the subsequent release of seminal fluid. The pain is dull, bursting, aching. It can persist for several hours.

Inflammatory diseases
Pain in inflammatory diseases is combined with edema, hyperemia, hyperthermia. It is caused by nonspecific bacterial infections, develops after injuries, invasive medical manipulations. In children and adolescents, it can be a consequence of a viral infection: mumps, measles, rubella. It is detected in such pathologies as:

Orchit. It proceeds acutely or chronically. In the first case, it is accompanied by a pronounced pain syndrome, symptoms of general intoxication. In the second, the condition is satisfactory, the pain is minor or moderate, dull, aching, pulling. Possible discharge from the urethra.
Epididymitis. Rarely observed in isolation. It can be combined with orchitis, urethritis. According to clinical manifestations, it resembles orchitis, it can also be acute or chronic.
Epididymoorchitis. The acute form is manifested by hyperthermia up to 40 ° C, sharp pains that increase when walking, radiating to the lower abdomen, lumbar region. In the chronic form, all symptoms are smoothed out.
Funicular. It develops with inflammatory lesions of the testicle and its appendage, less often occurs in isolation. It is characterized by pain, fever, thickening of the spermatic cord.
In case of immune disorders, massive infection, acute forms of these diseases can turn into purulent inflammation. There is a deterioration of the condition, an increase in symptoms of intoxication, an increase in pain, which become twitching, pulsating. Along with nonspecific microflora, inflammation of the testicle, spermatic cord and appendage of the testicle can be caused by the following sexually transmitted diseases:

gonorrhea;
trichomoniasis;
chlamydia;
mycoplasmosis.
The clinical manifestations of specific infections vary. A typical feature is the discharge from the urethra of an abundant yellowish, greenish or whitish secretion with an unpleasant odor.

Pain in the scrotum
Pain in the scrotum
Purulent processes
Purulent inflammation can affect organs or soft tissues of the scrotum, be local or widespread, occur primarily or develop due to the transition of infection from nearby anatomical structures:

Abscess of the scrotum. A rare pathology. A limited abscess is formed intraperitoneal or in the area of superficial soft tissues. There is an increasing swelling. The pain increases rapidly, acquires a twitching character, disrupts night sleep. Body temperature rises to febrile numbers.
Fournier’s gangrene. An extremely dangerous form of erysipelas with the formation of phlegmon, necrosis of the genitals. It begins with general symptoms: weakness, weakness, subfebrility. After a few days, a painful area of compaction and redness appears in the scrotum. Local manifestations progress simultaneously with the aggravation of general symptoms. When necrosis zones appear, the pain decreases due to the death of nerve endings.
Complication of a prostate abscess. An abscess of the prostate gland sometimes breaks into the urethra, rectum, scrotum, and nearby cellular spaces. The breakthrough occurs after a temporary improvement in the condition, when the scrotum is affected, it is accompanied by edema, hyperemia, sharp soreness.
Accumulation of liquid
Dropsy can be common or limited. The following variants of pathology are distinguished:

Hydrocele. A common condition. Fluid accumulates between the vaginal membranes of the testicle. Discomfort and pulling pains appear when the volume of exudate reaches 300 ml or more, accompanied by an asymmetric increase in the scrotum.
Spermatocele. A seminal cyst forms in the area of the testicle or appendage. It is asymptomatic for a long time. The pain is associated with the accumulation of a large amount of fluid, suppuration of the cyst.
Funicular. The cyst of the spermatic cord is also prone to asymptomatic flow. Minor pulling pains, a feeling of discomfort can be observed during sexual contacts, physical exertion.
Varicocele
Pain occurs at stage 2 of varicocele. The intensity of unpleasant sensations varies significantly, some patients note slight soreness or discomfort when walking, others complain of very sharp burning or shooting pains. There is a connection between pain and physical activity. Visually, the expansion of veins, sagging of the diseased half of the scrotum is revealed. At stage 3, the pain becomes permanent, occurs at rest, worries at night. The asymmetry of the scrotum is progressing.

Urgent states
Sudden sharp pain in the scrotum, radiating into the perineum and groin area, is the first symptom of testicular torsion. Due to unbearable pain, vomiting and collapse are possible. The scrotum is slightly enlarged, the affected testicle is located above the healthy one. The skin above the testicle is hyperemic, pale or cyanotic. There may be difficulty urinating, acute urinary retention.

The syndrome of the edematous scrotum develops acutely with the accumulation of a large amount of effusion. Complicates injuries, inflammatory and non-inflammatory diseases of the scrotum, tumors, allergic reactions. The scrotum is rapidly increasing in volume. The pain is so acute and intense that it is accompanied by vomiting, a drop in blood pressure, the appearance of cold sweat.

Segmental testicular infarction is manifested by pain sensations that increase over several days. With a total heart attack, the symptoms resemble testicular torsion or acute epididymoorchitis. According to the intensity of the sensations, they reach the degree of pain shock. Patients are pale, covered with cold sticky sweat. Tachycardia, hypotension are detected, confusion of consciousness is possible.

With closed injuries of the scrotum organs, the pain is also sharp, very intense, often accompanied by the development of pain shock. The scrotum is edematous, cyanotic with a purple or black tinge, significantly increased in size. There may be a hematocele, dislocation of the testicle, sometimes with a twist. With open injuries of the scrotum against the background of pain and bleeding, traumatic shock almost always develops.

Neoplasms
Pains in the scrotum appear some time after the onset of compaction, sometimes combined with pain in the lower abdomen, are detected in every fourth patient with a malignant testicular tumor. They are observed in germinogenic and non – germinogenic neoplasms:

seminome;
chorioncarcinome;
malignant teratoma;
embryonic testicular cancer;
sarcoma;
leidigome;
sertoliome.
The neoplasm increases in size, the scrotum becomes edematous. The subsequent symptoms are largely due to metastasis. For benign tumors of the scrotum, pain syndrome is uncharacteristic, it can appear with secondary infection due to the development of inflammation.

Parasitic pathologies
Parasitic diseases of the scrotum are characteristic of countries with tropical and subtropical climates. Filariasis is caused by helminths, provokes the development of elephantiasis due to damage to the lymphatic system of the genitals. Scrotal soreness occurs several years after infection, often combined with hydrocele, epididymitis, funiculitis. The pain is caused by dense edema due to the accumulation of fluid in the tissues. Vuhereriosis is also accompanied by damage to the lymphatic vessels, elephantiasis. The weight of the scrotum in both diseases can reach 15-20 or more kilograms.

Other reasons
Sharp pains in the scrotum and inguinal region, nausea, vomiting, deterioration of the general condition occur when the inguinal-scrotal hernia is infringed. Another possible cause of pain is irradiation in diseases of the rectum and organs of the genitourinary system. Radiating pains are observed in the following pathologies:

prostatitis (congestive, calculous, etc.);
prostate sclerosis;
renal colic, including those caused by ureteral stones;
occlusion of the ureter in kidney or ureter cancer;
proctitis.
Consultation of a urologist
Consultation of a urologist
Diagnostics
The cause of pain in the scrotum is determined by a urologist-andrologist. During the conversation with the patient, the doctor determines the circumstances and time of the symptom, monitors the dynamics of the disease. To clarify the diagnosis, the following procedures are performed:

Physical examination. The specialist examines the external genitalia, reveals an increase in volume, swelling of tissues, changes in skin color and temperature, dilated veins, and other manifestations. Palpates the scrotum and regional lymph nodes to assess the condition of the testicle, appendage and spermatic cord, detection of lymphadenitis.
Rectal examination. It is carried out to exclude bulky formations, inflammatory processes of the prostate gland.
Diaphanoscopy. Screening of the scrotum is performed during admission, allows for preliminary differentiation of hydrocele and other conditions with an increase in the scrotum (tumors, hernia, edema, inflammation, elephantiasis).
Ultrasound of the scrotum organs. A safe and painless procedure used to detect torsion, varicocele, neoplasms, inflammatory processes, and other pathologies. According to the indications, it is supplemented by Dopplerography.
Scintigraphy. It is used in the process of diagnosing injuries, tumors, vascular diseases, inflammatory diseases. Dynamic examination is assigned to assess the function and blood flow of the testicles, static – to identify structural pathologies.
Puncture of the scrotum. It is performed with hydrocele and spermatocele for differential diagnosis of these conditions with tumors, hernias, hematocele.
Laboratory tests. To determine the activity of inflammation, to detect anemia in injuries and oncological diseases, general blood tests are prescribed. Urine tests are performed to detect renal pathologies. If STIs are suspected, PCR is performed. Punctates and biopsies are sent for cytological or histological examination. According to the indications, a spermogram is made.
Treatment
Assistance at the pre-hospital stage
Patients with injuries are shown fixation with a suspension or a special bandage, cold on the scrotum. In other conditions, suspensions are often effective. With severe pain and the absence of urgent pathology, a single dose of painkillers is possible. Other methods of treatment are not indicated before diagnosis.

Conservative therapy
Medicines of the following groups are prescribed:

NSAIDs. Reduce the temperature, reduce inflammation and pain in inflammatory processes, traumatic injuries.
Antibiotics. They are indicated for purulent foci, inflammatory diseases, injuries. Initially, broad-spectrum drugs are prescribed. After receiving the results of microbiological analysis, the antibiotic therapy regimen is adjusted.
Cytostatics. Recommended for patients with non-seminoma cancer, late stages of seminoma. They are supplemented with radiation therapy.
Antiparasitic agents. They are necessary for patients with vuchereriosis and filariasis.
In many diseases of the scrotum, wearing a suspension is effective. With the secondary nature of the pathology, treatment of the underlying disease is necessary. In the case of non-tumor processes, it is possible to prescribe physiotherapy procedures.

Surgical treatment
Taking into account the nature of the pathology , the following can be performed:

Purulent processes: autopsy, drainage of phlegmon and abscesses of the scrotum.
Hydrocele: operations of Winkleman, Bergman, Lord, Ross.
Spermatocele: excision of the spermatocele.
Funiculocele: excision of the cyst of the spermatic cord.
Varicocele: operations of Marmara, Palomo, Bernardi, Ivanissevich, embolization of varicocele, laparoscopic excision of the testicular vein.
Urgent conditions: testicular torsion surgery, wound suturing, testicular reposition or resection, hematoma removal.
With malignant tumors, severe testicular lesion due to infarction, crushing, extensive necrosis against the background of Fournier gangrene, purulent complications of inflammatory processes, organ–bearing surgery is required – orchiectomy, epididymectomy, orchoepididymectomy. Subsequently, an artificial testicle is implanted to eliminate the cosmetic defect.

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