• Dr Xin Ya Lim

"I have been experiencing occasional pain in the testicles. Is this normal?"



It is common for adolescent males to experience pain in the testicles. In fact, this is the most likely age group to experience pain in the testicles as they enlarge during puberty. It may be normal to experience some pain, which may come on and off and gradually go away on their own or with pain medications. However, there are some conditions where emergency treatment is needed and you should seek a doctor immediately.


Testicular torsion

Testicular torsion is a surgical emergency. It occurs when a testicle twists around the spermatic cord that connects to it. The spermatic cord carries blood supply to the testicles. In testicular torsion, the cord essentially becomes strangled and blood is unable to reach the testicle. If left untreated, the testicle may need to be removed.


The cause of the testicular torsion is unknown, although some studies suggest that a preceding injury or vigorous activity may be associated with it.


Signs and symptoms

Those with testicular torsion will experience a sudden and severe pain in the testicular region. The scrotum, which is the bag of skin that contains the testicles, may also become swollen. Other signs and symptoms include:

  • Abdominal pain

  • Nausea and vomiting

  • The affected testicle positioned higher than the unaffected side

  • Fever

Treatment

The cord needs to be untwisted as soon as possible. Studies have shown that a delay of more than 6 hours may cause lasting damage and over 90% of patients require a removal of the testicle after more than 24 hours of delay.


Epididymitis

Epididymitis refers to the inflammation of the epididymis, a tube that carries and stores sperm from each testicle. This condition may affect men of all ages, though it is more common amongst young adults.


Some of the causes of epididymitis include urinary tract infections (UTIs), sexually transmitted diseases (STDs), viral infections such as mumps, and preceding trauma or vigorous activities.

Signs and symptoms

Those who have epididymitis may experience the following:

  • Gradual onset of pain in the testicular area

  • Fever

  • Painful urination

  • Penile discharge

  • Blood in the semen

  • Swollen, red, and tender testicles

  • Pain on digital rectal examination (DRE)

  • Abdominal pain

Risk factors

Fortunately, with the introduction of compulsory mumps, measles, and rubella (MMR) vaccines for all newborns in most developed countries, mumps are extremely rare amongst men. Men with structural problems to the urinary tract are also at greater risk of UTIs. Therefore, their risks of getting epididymitis are also greater. For men who are sexually active, it is important to prevent STDs. This includes using barrier protection (e.g., condoms) as well as regular STD testing.


Treatment

Treatment of epididymitis includes symptomatic relief of pain and fever (e.g., ibuprofen) as well as antibiotics. If pus has formed in the testicle, your doctor may drain the pus using a sterile needle or recommend surgery.


Lumps and bumps

There are quite a few lumps and bumps in the groin and scrotal region and most of them do not require immediate treatment. These include a hydrocele, which is a collection of fluid in the scrotal area and are usually managed conservatively, as well cysts in the epididymis. Most lumps and bumps are benign, and may go away on their own. At times, aspiration may be considered for large hydroceles or cysts, particularly if they cause discomfort. A varicocele may be seen in a handful of male adults, which may require further workup to rule out cancer. A varicocele occurs the same way as varicose veins - the veins within the scrotum become enlarged when the valves in the veins do not work well. Most varicoceles occur on the left side due to anatomical differences between the right and left. Conservative management may be recommended, though surgical treatment may be indicated particularly for those who are subfertile or experience discomfort.


Testicular cancer

Testicular cancer mainly occurs in young adults aged between 15-40 years. They usually do not present with pain. On examination, the most common finding is that of a painless lump in one testicle. At times, testicular cancer may affect both testicles.


It is important to consult a doctor, as a testicular tumour may be misdiagnosed as other conditions that cause lumps and bumps (see above).


Risk factors

Those at higher risks include men who have:

  • A family history of testicular cancer

  • Who are have one or more undescended testicles when they were born

  • Previous history of testicular cancer

  • Genetic conditions such as klinefelter syndrome

Diagnosis and treatment

If there is a clinical suspicion of testicular cancer, your doctor may send off some blood tests and perform some radiological investigations (e.g., x-rays and CT scans) to confirm the diagnosis.


Treatment of testicular cancer includes the surgical removal of the affected testicle. A more advanced cancer may require chemotherapy or radiation therapy. The prognosis for the most common type of testicular cancers is usually good, where a majority of people present to the doctor with stage 1 cancers.


Prevention

There is insufficient evidence to indicate that routine screening for testicular cancer is effective in preventing testicular cancers in the general population. However, if you are at higher risk of developing testicular cancer (see above), do speak to your doctor for recommendations on early detection.