Testicular pain
Testicular pain occurs in inflammatory diseases, traumatic injuries, fluid accumulation, emergency conditions, neoplasms, purulent processes, pathologies of neighboring organs. It can be provoked by sexual arousal or prolonged abstinence. It can be constant, increasing, paroxysmal, sharp, dull, pulling, aching, bursting. The cause of pathology is established on the basis of complaints, the results of physical examination, data from hardware and laboratory tests. As part of the treatment, analgesics, antibiotics, NSAIDs, physiotherapy procedures are prescribed, operations are performed.
Why does the testicle hurt
Physiological causes
Inflammatory diseases
Accumulation of liquid
Traumatic injuries
Urgent conditions
Tumors
Other reasons
Diagnostics
Treatment
Conservative therapy
Surgical treatment
Prices for treatment
Why does the testicle hurt
Physiological causes
In the absence of pathologies of the testicle and neighboring structures, pain is usually associated with sexual arousal. Short-term soreness occurs during sexual intercourse against the background of blood flow, disappears after orgasm. Painful sensations of a nagging and bursting nature lasting up to several hours are observed with unrealized sexual arousal and prolonged abstinence. Caused by increased blood flow and accumulation of the contents of the genital glands.
Inflammatory diseases
For nonspecific acute orchitis, sharp pains are characteristic, which decrease somewhat in a horizontal position. The testicle is enlarged, the scrotum is dense, hyperemic. Possible violations of urination, inguinal lymphadenitis. One third of patients have dysuric disorders. General symptoms include weakness, headaches, hyperthermia, chills, muscle aches.
With chronic orchitis, non-intense, aching, pulling pains can spread to the groin and perineum outside of exacerbation. They increase during defecation, sexual intercourse, physical exertion. The general condition is not disturbed. During the period of exacerbation, the manifestations become more pronounced, it is possible to increase the body temperature to subfebrile figures.
Orchitis can develop as a complication of mumps. Inflammation occurs against the background of chills, hyperthermia, swelling of the submandibular zone and lower parts of the face due to an increase in salivary glands. The testicles are involved in the pathological process a few days after the onset of the disease. In 70% of cases, one testicle is first affected, after 1-9 days – the other.
Nonspecific acute epididymoorchitis is manifested by severe pain in the testicle, radiating to the lower abdomen and lumbar region. There is pronounced hyperthermia, chills, bruising, muscle pain. The scrotum is edematous, hyperemic. In the subacute course of pathology, the manifestations are somewhat smoothed out. The chronic form is characterized by moderate pain and increased testicular density, increased soreness during movements and palpation. There is a decrease in libido, the composition of sperm changes.
Acute and chronic orchitis and epididymoorchitis are also provoked by pathogens of specific infections. Testicular lesion can be observed in the following STIs:
gonorrhea;
chlamydia;
trichomoniasis;
mycoplasmosis and ureaplasmosis.
The occurrence of pain in the testicle is preceded by the phenomena of urethritis. Along with typical clinical manifestations, there is abundant discharge from the urethra with an unpleasant odor of yellowish-green or whitish hue.
Accumulation of liquid
There are no pains in the initial stages of varicocele. The symptom appears during the transition to the 2nd stage of the disease, at first it has a periodic character. The severity of pain varies from insignificant, inconspicuous to extremely intense, sharp, shooting or burning. Patients with stage 3 complain of constant pain, including at night. Seminal cysts are characterized by an asymptomatic course. Discomfort, dull and bursting pains appear with a spermatocele of considerable size, they disturb during sexual contacts, walking, movements, being in a sitting position.
Testicular pain
Testicular pain
Traumatic injuries
Acute, extremely intense, unbearable pain occurs when the scrotum is injured. An external examination reveals significant swelling, tension of soft tissues, hemorrhages. The scrotum acquires a rich purplish-bluish hue. Possible development of hematocele. With open injuries, the pain is so severe that testicular injuries are almost always accompanied by the development of traumatic shock. There is a drop in blood pressure, tachycardia, pallor, fainting.
Urgent conditions
The torsion of the testicle is manifested by a sudden acute pain, giving in the groin and perineum. The painful sensations are very intense, causing a drop in blood pressure, collapse and vomiting. Objectively, a slight or moderate increase, redness, cyanosis or pallor of the affected half of the scrotum is detected. Dysuric disorders and acute urinary retention may be detected.
Edematous scrotum syndrome (SOM) is a complication of other pathologies, traumatic injuries, allergic reactions and neoplasms. Against the background of rapid accumulation of fluid, the scrotum increases in size, extremely acute unbearable pains occur, accompanied by cold sweat, sharp hypotension and vomiting.
With segmental testicular infarction, the pain syndrome increases within a few days. With a total infarction, a clinical picture is formed, similar to acute epididymoorchitis or testicular torsion. Pain shock develops. There is a rapid heartbeat, a decrease in blood pressure, pallor, sticky cold sweat, sometimes confusion.
Tumors
With benign neoplasms, pain rarely appears, it becomes a consequence of secondary infection and the occurrence of an inflammatory process. Malignant neoplasia in the early stages is also asymptomatic. With the progression of the disease, 25% of patients have increasing painful sensations in the scrotum, perineum and lower abdomen. Germinogenic tumors may accompany: germinoma, spermatocyte seminoma, malignant testicular teratoma. Observed in testicular cancer.
Other reasons
Pains caused by the spread of the pathological process from nearby anatomical formations or caused by irradiation are detected in the following diseases:
Purulent processes: scrotal abscess, Fournier gangrene.
Prostate diseases: prostatitis, cyst, prostate sclerosis.
Defeat of the lymphatic system: elephantiasis of the scrotum in inguinal lymphogranulomatosis, lymphadenitis, Kaposi’s sarcoma, squamous cell carcinoma, etc.
Pathologies of the urinary tract: renal colic, cancer of the upper urinary tract with occlusion of the ureter.
Diseases of the digestive system: proctitis, infringement of inguinal hernia.
Other conditions: varicose veins of the pelvis, chronic pelvic pain syndrome.
Diagnostics
Determining the nature of the pathology is the responsibility of the urologist-andrologist. During the survey, the specialist clarifies when and under what circumstances there were pains in the scrotum, what symptoms were accompanied, how the disease developed over time. The examination program may include the following diagnostic procedures:
External inspection. It provides an assessment of the condition of the external genitals, detection of edema, hyperemia, cyanosis, local hyperthermia, dilated veins and other changes. During palpation, the condition of the testicle and other structures of the scrotum is assessed, enlarged inguinal lymph nodes are detected.
Diaphanoscopy. It is carried out within the framework of the initial admission. It makes it possible to differentiate the accumulation of fluid from other pathologies accompanied by an increase in the volume of the scrotum.
Ultrasonography. Informative and safe basic research. During ultrasound of the scrotum, inflammatory changes, tumors, hematomas, hemorrhages, testicular torsion are detected. To assess the condition of the vessels, dopplerography is additionally performed.
Scintigraphy. It can be static and dynamic. In the first case, structural disorders are determined, in the second, blood flow is assessed. The technique is used for traumatic injuries, inflammatory processes, vascular lesions, neoplasms.
Puncture of the scrotum. Performed to detect fluid. Allows to confirm the presence of spermatocele and hydrocele, to distinguish these conditions with hemorrhages, neoplasia and hernial protrusions.
Laboratory tests. According to the results of a general blood test, inflammation is confirmed, the severity of anemia in tumors and injuries is assessed. For STIs, ELISA and PCR are performed. With dysuria, suspected diseases of the urinary system, general and biochemical urine tests can be shown. The material obtained during punctures and biopsies is studied by histological or morphological examination.
Consultation of a urologist-andrologist
Consultation of a urologist-andrologist
Treatment
Conservative therapy
In many diseases of the testicle, suspensions are effective. The list of therapeutic measures is determined by the nature of the pathology:
Inflammatory processes. NSAIDs and broad-spectrum antibiotics are used as part of drug therapy. With specific orchitis, drugs are selected taking into account the nature of the pathogen. When an acute process manifests, cold is applied. After reducing inflammation, UHF, laser therapy, magnetotherapy, and drug electrophoresis are performed.
Twist the testicles. Manual detorsion is possible in the first hours. The testicle is unwound through the scrotum without incisions, turning outward and slightly pulling down. Upon successful completion of the manipulation, the pain decreases, the testicle becomes mobile. Patients are prescribed medications to improve blood circulation.
com. Analgesics are used to reduce the intensity of pain. The remaining medications are selected depending on the causal disease. In case of inflammation, antibiotic therapy is indicated, in case of allergies – antihistamines, etc.
Testicular infarction. Non-surgical management is possible only with a limited lesion, confirmed by the data of additional studies. Antispasmodics, blood-thinning and vascular medications are recommended. Patients are observed in dynamics, with deterioration of the condition, surgical intervention is indicated.
Injuries. Cooling of the scrotum, analgesics, hemostatics, antibacterial and anti-inflammatory agents are required. From 3-4 days – UHF, sollux, paraffin treatment to accelerate the resorption of hemorrhages.
Tumors. Conservative measures are carried out as part of a comprehensive treatment. Depending on the type of neoplasm, chemotherapy or radiation therapy is prescribed. After bilateral radical operations, hormone replacement therapy is performed.
Surgical treatment
In conditions accompanied by testicular pain, the following interventions are performed:
Fluid accumulation: Bergman, Winkelman, Lord, Ross surgeries, sclerotherapy, laser techniques, ultrasound dissection, hydrocele puncture, spermatocelectomy, spermatocele aspiration.
Urgent conditions: surgery for twisting the spermatic cord, opening and drainage of purulent foci, partial orchiectomy.
Neoplasms: orchiectomy, orchifuniculectomy, according to indications – with retroperitoneal lymphadenectomy.
Injuries: drainage of a hematoma, reposition, resection or reduction of a testicle, suturing of a scrotum wound.
