Doppler ultrasound is the most appropriate imaging modality for evaluation of the acute testicular pain when it does not delay definitive surgical consultation in cases of presumed testicular torsion. A low inguinal incision is made and carried down to the level of the external inguinal ring. It is best to see a doctor if any of the following symptoms accompany testicular pain: Anyone with symptoms of testicular torsion should seek emergency medical attention.

Clinical characteristics and surgical outcomes in adolescents and adults with varicocele. But groin pain occurs in the fold of skin between the thigh and abdomen — not in the testicle. Korean J Urol. Infertility — Not just a female condition, FREE book offer – Mayo Clinic Health Letter. 's editorial policy editorial process and privacy policy.

Varicoceles have been associated with male infertility, although the exact cause-and-effect relationships have not been established. Patients may also have a history of scrotal pain that may be related to prior ischemic episodes that resolved spontaneously. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. J Urol. Levine L. Chronic orchialgia: evaluation and discussion of treatment options.

In contrast to testicular torsion, patients with torsion of a testicular appendage (appendix testis or appendix epididymis) rarely have systemic complaints and typically present with a gradual-onset, less intense, unilateral scrotal pain that is localized to the superior pole of the testis 30). The annual incidence of testicular torsion, however, is estimated 1 in 4000. Orchitis is most often the result of a bacterial infection, such as a sexually transmitted infection (STI). Microsurgical denervation of the spermatic cord treats chronic orchialgia by denervating the chronically up-regulated pathways theorized to cause the pain. The cremasteric reflex is fickle and may be absent in up to 30% of normal males without any pathology. Even a minor injury can cause pain. Van Glabeke E, Khairouni A, Larroquet M, Audry G, Gruner M. Acute scrotal pain in children: results of 543 surgical explorations. Did it start suddenly or slowly? Preventive measures to take: Sudden, severe testicle pain needs immediate medical care. Urine test for sexually transmitted infections. 2011;52:489–493.

Kim HT, Song PH, Moon KH.

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. The degree of torsion may be variable, usually causing venous occlusion and congestion first. The testicles are very sensitive, and even a minor injury can cause testicle pain or discomfort. Take an over-the-counter pain reliever such as aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others), unless your doctor has given you other instructions. Each ejaculatory duct is about two centimeters in length…, The epididymis is a long, coiled tube that stores sperm and transports it from the testes. A study conducted by Chiou et al.

The diagnostic approach involves making sure no serious conditions are present. Antidepressants used are amitriptyline (10-25 mg per oral at bed time) or nortriptyline (10-150 mg per oral daily), which inhibits norepinephrine release, thereby attenuating the neuronal pain pathways. Evaluation of the urologic patient: history, physical examination, and urinalysis.

This content does not have an English version. Do NOT give aspirin to children.

Boettcher M, Bergholz R, Krebs TF, Wenke K, Treszl A, Aronson DC, et al. Your doctor might also do a rectal examination to check for prostate enlargement or tenderness. Pediatrics. A single copy of these materials may be reprinted for noncommercial personal use only. Stem cells repair damaged circuits in mice with Parkinson’s, Conspiracy beliefs hamper US response to COVID-19, Research gives green light for migraine relief, Vitamin D sufficiency may reduce complications of COVID-19, sharp, cramping pain that may radiate from the back to the groin, sudden, severe pain that occurs on one side of the scrotum, unusual, bloody or cloudy discharge from the penis. If history and physical examination do not identify a cause, a spermatic cord block using 20 mL of 0.25% bupivacaine without epinephrine should be performed. The character of the pain, onset, duration, severity (using a standardized pain scale), location, referral of pain, and psychosocial impact should be investigated. https://www.uptodate.com/contents/search. Acute scrotal swelling from blunt trauma should be studied by radionuclide angiography and explored for rupture or torsion. The cause of testicle pain can’t always be identified. 2011; doi:10.1542/peds.2010-3852. Discerning epididymitis from torsion may be difficult; however, a history of prior genitourinary tract procedures and sexual activity are more suggestive of epididymitis 42). However, it is important to take into consideration the physiological and psychological damage that is frequently associated with this procedure 83). Therapeutic nerve blocks with or without steroids can be done to provide relief from pain. Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Do NOT give aspirin to children. Nearly one-third of males who contract the mumps after puberty develop orchitis, usually four to seven days after onset of the mumps. ; Causes of the pain can range from common to rare, for example: A small incarcerated inguinal hernia can cause inguinal and testicular pain by compression of the genital branch of the genitofemoral nerve, Kidney stones. 2013;54:135–138. Failure to treat promptly will result in loss of the affected testicle. All rights reserved. Current treatment includes epididymectomy, vasovasostomy and vasectomy reversal for postvasectomy cases, orchiectomy, laparoscopic testicular denervation, and microsurgical denervation of the spermatic cord (MDSC). Leading theories suggest that elevated scrotal temperature, hypoxia secondary to stasis, and reflux of renal and adrenal metabolites result in impaired spermatogenesis and infertility 54).

Notably, the testicular vein drains directly into the inferior vena cava on the right while it drains into the left renal vein contralaterally. Testicular Symptoms to Watch For, damage to the nerves of the scrotum caused by, your scrotum is red, warm to the touch, or tender, you’ve recently been in contact with someone who has the mumps, is caused by an injury that’s painful or if swelling occurs after one hour. A body of literature exists which also supports the role of point-of-care ultrasound by the treatment provider for the evaluation of the acute scrotum. The pain may involve any of the scrotal contents including the testicle, epididymis, paratesticular structures, and spermatic cord 69). With the use of this technique, 71% had complete resolution of pain, 17% had greater than 50% reduction, and 12% had no resolution of pain. 2010;2:209–214. Polyarteritis nodosa very rarely may present with bilateral testicular pain and tenderness as well as testicular induration, Prostatitis (infection or inflammation of the prostate). 2004;42:349–363. [Updated 2018 Dec 16]. Call your provider right away or go to an emergency room if: Your provider will do an exam of your groin, testicles, and abdomen. The right…, On each side of the prostate gland (in the male reproductive system) is an ejaculatory duct. Can J Urol. Furthermore, it has been postulated that the longer length of the left gonadal vein, as well as insertion into the left renal vein, results in greater hydrostatic pressures and thus more common expression of varicocele on the left side 53). The “classic” cutoff for salvage of testicular torsion is surgical exploration and detorsion within six hours of symptoms onset. Provide support to the scrotum by wearing an athletic supporter. Use ice to reduce swelling in the scrotum. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Cases that persist for 6 to 8 weeks after completion of antimicrobial therapy should be reevaluated with a higher index of suspicion for unusual organisms (i.e., tuberculous or fungal etiology) 50). is also a founding member of Hi-Ethics.

Seek immediate medical attention if you have: Knowledge of the relevant anatomy is essential to understanding the possible causes and subsequent steps in the evaluation of testicle pain. Agarwal A, Sharma RK, Desai NR, Prabakaran S, Tavares A, Sabanegh E. Role of oxidative stress in pathogenesis of varicocele and infertility. Sometimes the pain can be so severe that it is similar to testicular torsion, which is a medical emergency.