Any pain or discomfort in a testicle is abnormal, and although most swellings or lumps are harmless, it is essential to have them checked out as soon as possible, particularly if they are painless.
It’s the painless lump in the testicle that’s more likely to be a malignant tumour, so, ironically, the presence of pain can be a positive sign.
Whatever your testicular concern here at Somerset Urology Associates we can assist all ages and address almost all testicular concerns using the latest diagnosis techniques, technology, medicines and surgery procedures.
Common Causes of Testicular Pain
Bruising and swelling are the main consequences of a direct blow. This sort of pain will tend to decrease over a few days. Supportive underwear, painkillers and warm baths can help.
Because the testicles are so vulnerable to injury, all contact sports should be played wearing supporting underwear, a jock strap or a box. Cycling injuries are also to blame for painful testicles, and even padded shorts won’t help if a long day is spent in an uncomfortable saddle.
Surgery, such as a vasectomy operation, also involves bruising and swelling, which will repair itself like any other direct injury.
Both the testicle itself and the epididymis are prone to infection with microorganisms, mainly spreading from the urethra (the tube that takes urine through the penis) or from the bladder. The epididymis is a tightly coiled, thread-like tube that collects sperm from the testicle and passes it on to the vas deferens, from where it goes into the urethra during ejaculation.
Inflammation of the testicle is known as orchitis, and that of the epididymis as epididymitis, and there are two forms of this infection, acute and chronic.
Acute epididymo-orchitis is a clinical syndrome consisting of sudden, severe pain, swelling and inflammation of the epididymis, with or without inflammation of the testes, which is hot to touch. It usually responds to medication.
Chronic epididymitis usually starts gradually with pain and inflammation but not scrotal swelling, tenderness, redness or hot skin. The pain occurs only in the scrotum and is less severe than acute epididymitis, and there is usually no urine infection. Chronic epididymitis can be improved with treatment but may not be completely cured.
In children who haven’t reached puberty, the infection usually starts in the bladder or kidney and then spreads to the testicle; in men it can also be sexually transmitted.
Symptoms of Testicle Infections
Symptoms from the original source of the infection may be present, including urethral discharge and urethral pain or itching (from urethritis); pelvic pain and a frequent or urgent need to urinate, plus painful or burning urination (from cystitis); fever, low abdominal pain, urinary frequency or urgency, or painful/burning urination (from prostatitis); fever and pain in the side (from a kidney infection, or pyelonephritis).
In some cases, pain in the scrotum from one of these infections is the first symptom, starting at the back of one testicle but soon spreading to the entire testicle, the scrotum and occasionally the groin.
Epididymitis occasionally has a non-infectious cause, such as heavy lifting or straining, or can be without a known cause.
Mumps orchitis, a viral infection, occurs in approximately one-in-three males who contract mumps after puberty, usually affecting one testicle, but sometimes both: if both testicles are involved mumps orchitis can lead to infertility, so an anti-inflammatory painkiller and rest are required.
In the scrotum, the veins that drain blood away from the testicles can become varicose and form a varicocele, which feels like a bag of worms at the top of the testicle. The veins can be tender to touch and there may be a dragging, aching feeling. Wearing a supportive pair of pants or a jock strap will help, but in severe cases, an operation to remove the varicose veins may be needed.
The epididymis may be enlarged by one or more cysts, which can be painful. Sometimes small cysts may drain away without treatment. Larger ones can feel like painful lumps within the testicle itself, and surgical removal can give relief.
A hydrocele is a bag of clear fluid that collects in a sac around the testicle and may be the result of a direct injury. Larger hydroceles can be drained and the remaining sac removed surgically so it does not reoccur.
In this case, the pain is more abdominal and is usually made worse by coughing, sneezing or twisting the body. An operation called a herniorrhaphy is required to push back the intestine and sew up the weak muscle.
Testicular torsion occurs when the testicles are twisted so much that the blood supply is cut off, the testicle swells and acute pain is the result.
Sometimes the torsion corrects itself, but after six hours without a blood supply a testicle will die, so an emergency operation may be vital, and occasionally the affected testicle will need to be removed.
Testicular Pain Treatments
Torsion requires immediate surgery by an urologist, and severe pain that cannot be relieved due to a hernia may also require surgery. On occasions surgery needs to be performed on an abscess, or other rare event.
Self care at home
Applying an ice pack or a bag of frozen peas (wrapped in a cloth) to your scrotum will help relieve pain and swelling.
Ice packs increase the time that a testicle can survive with decreased blood flow, such as in the case of torsion. Pain medicines such as ibuprofen and paracetamol may also help.
Treatment for epididymitis includes a few days of bed rest, propped up for much of the time so that the inflamed epididymis above the level of the heart. This improves the blood flow out of the testicle, helping to reduce the swelling and discomfort. Well wrapped ice packs on the scrotum, anti-inflammatory pain killers such as ibuprofen, and drinking plenty of fluids will also help.
If the infection is thought to be bacterial, at least two weeks of antibiotics may be prescribed.
The primary treatment for chronic epididymitis is medication and local application of heat to reduce the discomfort, whilst referral to a specialist in pain management may be useful. Treatment will not provide a cure and, unless the symptoms resolve spontaneously, medication will need to be taken for years.
In the long run the epididymis can be surgically removed (epididymectomy) while leaving the testicle in place, with relief of symptoms occurring in three out of four patients after a few weeks.