What are the causes of testicular pain?
The causes of testicular pain are many and varied. The most frequent are as follows. In sudden acute testicular pain:
- Acute appendicitis
- Epididymitis
- Strangulated inguinal hernia
- Lumbosacral radiculopathy
- Orchitis (for example, mumps)
- Testicular cancer
- Testicular torsion
- Trauma
On the other hand is chronic testicular pain, which is a complex urogenital syndrome with focal pain in which inflammation of the nerves is the main mediator. This type of pain is associated with anxiety and frustration and is characterized by intermittent or constant unilateral or bilateral testicular pain that occurs for at least 3 months and has a significant negative impact on activities of daily living and activity physical. The causes are usually the following:
- Diabetic neuropathy
- Cyst of the epididymis
- Infectious epididymitis (eg, Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum, coliform bacteria)
- Non-infectious epididymitis (eg, reflux of urine)
- Fournier gangrene
- Gout
- Purple Henoch-Schönlein
- Herniated lumbar disc
- Hydrocele
- Inflammation of unknown origin
- inguinal hernia
- Interstitial cystitis
- Nephrolithiasis (stones in the ureter)
- Orchitis (eg, mumps)
- Polyarteritis nodosa
- Surgical interventions (vasectomy)
- prostatitis
- Psychogenic (eg history of sexual abuse, stress)
- Referred pain arising from a problem in the abdomen / pelvis due to entrapment of nerves
- Testicular cancer
- Testicular vasoconstriction during sexual arousal without ejaculation
- Testicular torsion
- Trauma
- Varicocele
In many cases testicular pain has a psychological origin. One study identified a somatization disorder by no less than 56% of patients with no identifiable organic cause. Major depression or dependence on chemicals was the cause in 27% of cases.
What are the medical tests in the case of chronic testicle pain?
Before a man with chronic testicular pain the urologist performs the following:
A physical examination of the scrotum, testicles, spermatic cords, penis, inguinal region, and prostate.
A urine test to rule out an infection or identify the presence of blood in the urine.
A medical and psychosocial / sexual history of the patient
Asks for an ultrasound of the scrotum and testicles.
Chronic testicular pain after vasectomy
Several years after vasectomy, the diameter of man's ejaculatory ducts is often doubled in size to counteract the increase in seminal fluid pressure that has no outlet. This results in what is termed post-vasectomy testicular pain syndrome and in a congestive epididymitis, affecting 5% and 43% of men who have undergone this procedure. Sperm granules or granulomas are also produced by increasing fluid pressure. Although these granulomas are benign lesions, their presence may predispose to the onset of pain.
What is the treatment for chronic testicular pain?
In the absence of any finding that requires surgical intervention, in cases of chronic pain, anti-inflammatory drugs are usually prescribed for at least 1 month, although this treatment only helps a small percentage of men.
Elevating the scrotum by wearing underwear with suspenders as well as changing the sitting posture to avoid pressure on the scrotum can relieve testicular pain and pose no risk.
Epididymitis, caused by chlamydia or gonorrhea in men 14 to 35 years of age and by coliform bacteria in the remaining ages, can be treated with antibiotics.
Tricyclic antidepressants and gabapentin treat psychogenic type of testicular pain.
Sometimes the urologist injects anesthetic into the spermatic cord which provides relief for weeks to several months, and may be repeated at intervals of several months.
Resection of the epididymis is a viable option for the treatment of chronic testicular pain related to post-testicular pain syndrome or chronic epididymitis.
Vasectomy reversal (vasovasostomy) should be considered only after all treatment modalities have failed. Vasovasostomy has the potential to restore fertility in up to 98% of cases, which may or may not be desirable, but it is clear that testicular pain disappears in the vast majority of cases.
Sometimes it is necessary and very effective to remove the testicle.