Testicular Pain
Testicular pain can originate in the testicle itself or as referred pain from another part of the body (including the tissues and structures surrounding the testicle). Pain can be sharp and shooting or a constant dull ache. How you experience pain may point to the underlying cause of your pain.
There are a variety of causes of testicular pain, with the most common being trauma to the testicles (usually during physical activity and most commonly occurring in younger men). Minor trauma typically causes only temporary pain, with any lingering side effects diminishing quickly.
After trauma, infection is the most common cause of testicular pain. A common infection of the testicles is called epididymitis, an infection or inflammation of the epididymis (the duct through which sperm passes). This condition is frequently caused by sexually transmitted diseases, including chlamydia or gonorrhea, but epididymitis in older men may be related to an enlarged prostate. Epididymitis usually results in a gradual onset of pain, with redness and swelling of the scrotum.
Some other symptoms of epididymitis include: nausea, vomiting, fever, painful urination and/or painful intercourse. Another inflammation of the testicle caused by infection is orchitis. Orchitis may be caused by epididymitis that has gone untreated. It can be a very painful condition.
Hernias - An inguinal hernia is an example of pain that may not begin in the testicles but makes its way there. This type of hernia occurs when a loop of bowel protrudes into the scrotum through a weakened part of the abdominal muscles. Symptoms include pain (usually gradual onset) and bulging in the groin and scrotum that is worse with heavy lifting. If the intestine becomes trapped, or strangulated, in the hernia, medical attention should be sought as soon as possible.
Other causes
Other less common causes of testicular pain include:
Henoch-Schonlein purpura(blood vessel inflammation)
Undescended testicle(also referred to as cryptorchidism)
Varicocele (enlarged veins in the scrotum)
Diagnosis of the cause of testicular pain is generally achieved through a medical history and physical exam. An ultrasound may be necessary as well.
While all cases of testicular pain may feel very serious, there are a few causes that are true medical emergencies that require immediate attention. Testicular torsion is a twisting of the spermatic cord that cuts off blood flow to the testes. Pain is usually excruciating and accompanied by swelling, nausea, and vomiting. This condition can occur spontaneously in newborns and children or as a result of trauma. In either case, this is a true emergency that can result in the loss of the testicle within hours.
Another case of emergency is testicular rupture, usually caused by trauma to the testicles. This is diagnosed by ultrasound and treated with surgery to ease swelling and remove damaged tissue.
If you’re not sure if your pain is serious, visit your doctor. It’s best to have them diagnose the cause of your pain so you can find relief.
8 testicular pain treatments
The first step in treating this type of pain is proper diagnosis of the cause. The most successful treatments address the cause of the testicular pain at the same time that they manage painful symptoms. Chronic testicular pain that is present for three or more months can be more challenging to treat so early diagnosis is best.
Whether chronic or acute, there are generally eight treatments for testicular pain:
Comfort measures
Medication
Acupuncture
Biofeedback
Physical therapy
Nerve blocks
Spinal cord stimulation (SCS)
Surgery
Comfort measures
Ice (or, more frequently, frozen peas that conform to the body) can be very soothing to sore or swollen testes.
Medication
Common types of medications that can help treat pelvic pain include:
Anti-inflammatories (ibuprofen, naproxen)
Antidepressants (Cymbalta, amitriptyline)
Neuropathic medications (gabapentin, Lyrica
Opioids (hydrocodone, oxycodone)
For infections, the usual course of treatment also includes antibiotics.
Acupuncture
Acupuncture may be helpful and can be administered by a licensed acupuncturist.
Biofeedback is a technique in which a person learns to control pain through managing their bodily processes, like breath. It can be very helpful for treating testicular pain.
A licensed therapist can teach biofeedback, relaxation techniques, and guided imagery, all of which are very effective techniques in controlling chronic pain.
Physical therapy
Physical therapy for testicular pain can include pelvic floor muscle training, hot and cold applications, ultrasound therapy, and stretching.
Pelvic floor muscle relaxation techniques can also help treat challenging testicular pain that has become chronic but does not have a clear cause (referred to as idiopathic pain).
Nerve blocks
Neuropathic testicular pain may respond well to various nerve blocks. Some peripheral nerve blocks include ilioinguinal, iliohypogastric, or genitofemoral nerve blocks. These can be very beneficial in those who suffer from chronic testicular pain.
Localized injections such as those into the lumbar area can also be performed to relieve pain. Other injections (e.g., lumbar (L1) sympathetic nerve blocks and sacral nerve blocks) can be helpful in treating testicular pain, as well as some other male pelvic pain conditions.
Spinal cord stimulation
For testicular pain that does not respond to more conservative treatments, a spinal cord stimulator may be beneficial. Spinal cord stimulation (SCS) is like a pacemaker for pain. It uses groundbreaking technology that works by introducing an electrical current into the epidural space near the source of your chronic pain impulses.
Under a local anesthetic and minimal sedation, your doctor will first place the trial SCS leads into the sacral space (the base of the spine). The SCS lead is a soft, thin wire with electrical leads on its tip. The lead delivers an electrical current that disrupts the pain signals and replaces it with a gentle buzz. You typically wear the trial stimulator for five to seven days. If the trial successfully relieves your pain, you can decide to undergo a permanent SCS.
Surgery
Some types of pain in the testes (e.g., hernia and testicular torsion) is best treated with surgery. Spermatic cord denervation and a reversal of vasectomy seem to help some patients with intractable, chronic testicular pain.
