Causes and Symptoms of Testicular Pain in Men

Pain in the testicles usually occurs due to some injury or disease of either one or both of the testes. It may range from a dull ache to a sharp persistent pain depending on the cause. Many people experience this pain due to a number of causes, but a very few consult their doctor in initial stages due to social or personal reasons.

Testicles are very delicate organs and have a vital function in the reproductive system of men. They have a good nerve supply, and even mild trauma or disease of this gland can cause immense pain and discomfort.

The most important cause of testicular pain is trauma. It can be of any form. For example, when something strikes the testicles, or it can be due to involuntary compression during sleep or excessive physical activity. In cases of mild trauma, there is a feeling of dull ache and heaviness in the scrotal sac. But in severe cases, the pain can be excruciating.

Another important cause is the torsion of the testis. Normal testicles are suspended from the body and cannot rotate. In torsion of the testis, there is usually an abnormal rotation of the testicles. The pain is excruciating and is felt in the scrotal sac. It is a medical emergency and has to be addressed in the emergency department of a hospital to prevent permanent damage to the testicles. This condition is very common between the ages of 10 – 25 years and can be due to straining, lifting heavy weights, masturbation and coitus. Nausea and vomiting may accompany the pain. The affected testicle appears at a higher level.

Other causes of testicular pain include

  • Orchitis & epididymitis, which is basically the inflammation of the testicles due to infection or any other condition. An important infective condition is Chlamydia, a sexually transmitted disease.
  • Hydrocele, which is the accumulation of fluid inside the scrotal sac
  • Varicocele, that is the tortuous enlarged veins of the testicles. It is especially common in children with mumps infection in the childhood
  • Haematocele, which is an accumulation of blood in the scrotal sac
  • Inguinal hernia, which is the protrusion of abdominal contents, mainly the intestines, into the scrotal sac
  • Gangrene, that is basically the death of testicular tissue as a result of untreated torsion or trauma
  • Diabetic neuropathy affecting the nerve supply of the testicles.

Testicular cancers do not present with pain. They usually present as painless lumps that are best assessed by the consulting physician.

Most Common Causes of Testicular Pain include:

  1. Trauma (Can be obvious or subtle such as from pressure)
  2. Infection or inflammation – Epididymitis, orchitis
  3. Testicular torsion
  4. Varicocele
  5. Spermatocele
  6. Hydrocele
  7. Referred pain from Kidney Stones, Pelvic pain or Inguinal hernia
  8. Post-vasectomy pain syndrome
  • Referred pain from kidneys or kidney stones may occur due to the common nerve supply of scrotal structures and abdominal organs.
  • Testicular trauma can cause severe testicular pain.  Testicular trauma may be blunt or penetrating. The common modes of blunt injury include sports injuries during cycling, contact sports and straddle injuries. The pain can be minimal or excruciating. Significant pain is often an indication of serious injury.
  • Orchitis is an inflammation of the testes; epididymo-orchitis refers to inflammation of testis and epididymis. Acute inflammation can be extremely painful as it causes stretching of tunica albuginea. Orchitis may be caused by viral or bacterial infections. Sexually transmitted diseases such as gonorrhea and chlamydia infection can cause testicular pain. Other symptoms may include blood in the ejaculate and urine and enlarged groin nodes that are also painful. Chronic inflammation of epididymis may be caused by a low-grade bacterial infection (chlamydia), tuberculosis, filariasis, drug-induced by amiodarone, obstruction after vasectomy and Behcet’s disease.
  • Testicular torsion is a urological emergency caused by torsion of the spermatic cord. This results in loss of blood supply to the testis. The severity of testicular ischemia depends on the degree of torsion and causes ischemic orchitis which is responsible for severe pain. It is most often seen in children and but may also occur in young adults and older men. This is an emergency situation and requires immediate management to prevent permanent ischemic damage to the affected testis. Intermittent testicular torsion is known to occur in many people. It produces low-grade pain which disappears after some time when the testis untwists spontaneously.
  • Torsion of testicular appendage resembles testicular torsion.
  • Varicocele is dilatation of veins which carry blood from the testes. It appears like a bag of worms just above the testes. It may result in discomfort, mild pain or a sensation of heaviness in the affected side of testis.
  • A hydrocele is an accumulation of fluid around the testes between two layers called tunica vaginalis. It occurs due to inflammation, tumors, trauma or its cause may be unknown. The secondary hydrocele may subside spontaneously once the inflammation subsides. If there is an accumulation of blood, it takes longer to resolve.
  • Spermatocele is a cyst originating from the epididymis which is filled with sperms. Larger spermatoceles may cause discomfort though usually there is no pain.
  • Pain syndromes such as testicular pain syndrome, epididymal pain syndrome and post-vasectomy pain syndrome present with.

Testicular Anatomy and Innervation

Testes are a pair of male reproductive organs located in the scrotum. Each testis is 4 to 5 cm long and about 3 cm wide and deep.  The epididymis is a long worm-like structure located just behind each testis. Sperm cells are produced in the testes and are stored in the epididymis where they also undergo maturation. During ejaculation, the sperm cells along with the secretion of seminal vesicles are ejected through the urethra. Testes also produce a hormone called testosterone.

Each testis is supplied with blood through the testicular artery and drains through plexus of veins.

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