Testicular Pain
It is a common condition in our speciality: testicular pain causes anguish, worries the patient and is often a serious situation.
It must be studied carefully and in an orderly fashion, as there are many processes that can cause it. The testicles are very sensitive, and even a minor injury can cause pain or discomfort. Pain may come from the testicle itself or from the coiled tube and supporting tissue behind the testicle (epididymis).
Sometimes the apparent testicular pain is caused by a problem that starts in the groin, abdomen or elsewhere: such as prostatitis, or a contracture of the abdominal or pelvic floor muscles.
What are the testicular causes of testicular pain?
It is a condition that requires urgent consultation and may be due to several causes:
- Orchitis: Inflammation of the testicle. It may be related to a urine infection that reaches the testicle from the seminal tract (vas deferens or epididymis). It can also reach the testicle via the bloodstream from another infectious source (infectious metastasis): the most frequent is orchitis urliana, which has its origin in an acute process of the parotid gland, popularly known as "mumps".
- Epididymitis: This is the most common condition. It is also usually related to infectious processes of urine or prostate. The inflamed epididymis is very large and painful to the touch.
- Focal epididymitis of the vasectomised patient: This is caused by rupture of the epididymal tubule, which is dilated in the classic vasectomy, and which ruptures during compression, when crossing a leg with tight trousers or when playing with a child on the lap.
- Torsion of the testicle: The cord from which the testicle hangs turns on itself, causing a strangulation of the blood supply. It causes acute pain due to testicular infarction (lack of blood supply to the testicle). It is a urological emergency and the patient must be operated on within 4 hours of the torsion.
- Genital trauma: Although it is a frequent accident, with many degrees of intensity depending on its severity, from an inflammation secondary to the trauma to an intratesticular haemorrhage, a very painful condition, to the most serious condition of testicular rupture, which requires urgent intervention.
- Testicular tumour: Although subacute or chronic pain is more common, a testicular tumour can cause acute pain, especially in connection with intratesticular haemorrhages.
What are the extratesticular causes of testicular pain?
These causes are those described as non-testis-dependent:
- Nephritic colic: This is a picture of generally very acute pain, caused by an obstruction of the urinary tract, often due to stones descending from the kidney into the bladder. The pain, which may start in the kidney, travels down the flank to the abdomen and testicle. Sometimes testicular pain is the first symptom.
- Acute prostatitis: Acute inflammation of the prostate (see prostatitis) may have testicular pain as the main symptom.
- Acute hernial process: usually after an effort, fibres of the muscles that form the inguinal canal are broken as a result of a hernia, causing pain due to fibrillar rupture, which can affect the cord and the testicle due to its proximity.
- Neuropathic pain: Inflammation or compressive processes of the sensory nerves leaving the spinal cord.
- Muscle contracture: of the abdomen, very typical in athletes, or of the pelvic floor due to bad posture. These problems are dealt with at GUA in our Pelvic Floor Unit.
How is testicular pain studied?
The physical examination is fundamental and will give us the first major division between testicular and extratesticular pain. Whether or not the testicle hurts, if it is the epididymis, if the inguinal ring hurts, or if there is no pain on palpation of the area will lead us to other tests or examinations (rectal examination, etc.).
Blood and urine tests, sometimes semen culture, will help us to distinguish between an inflammatory, tumour, infectious, urinary, seminal or other process. Testicular ultrasound is mandatory and essential.
What is the approach to testicular pain?
Treatment depends on the multiple causes described above, each of which has a corresponding therapy in the different clinical pictures described.
Infiltration of the spermatic cord or the affected area of the inguinal orifice may be indicated to resolve the painful condition.
What is chronic testicular pain?
It is a type of intermittent or constant pain. It can be unilateral or bilateral and the duration has to be longer than 3 or 6 months. It is more frequent in men between 15 and 50 years of age. It can have different causes, sometimes complicated to diagnose. It is typical to receive patients who have been to several specialists before coming to us.
A detailed history of the history and possible causes, diseases and a physical examination is required to assess whether the pain is coming directly from the testicle or from another organ. In addition, imaging tests such as ultrasound or CT scan to rule out any causes within the abdomen.
Laboratory tests are also essential and provide information about the cause of the pain. In general, if the cause of the pain is not found, optimal treatment cannot be given. It is therefore very important to study patients well with the different teams of our centre located in Las Palmas de Gran Canaria and within a protocol to rule out other non-urological causes that are very common.
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