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6-Week Swimsuit Shape-Up: Secrets to a Beach-Ready Body
14 Surprising Energy Zappers
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What is acne? What are the different types of acne?
Acne (acne vulgaris, common acne) is not just a problem for teenagers; it can affect people from ages 10 through 40. It is not unusual for women, in particular, to develop acne in their mid- to late-20s, even if they have not had breakouts in years (or ever). On the positive side, those few individuals who have acne into their 40s may well grow out of it. Acne can appear on the skin as any of the following:
- congested pores ("comedones"),
- whiteheads,
- blackheads,
- pimples ("zits"),
- pustules, or
- cysts (deep pimples, boils). The pus in pustules and cysts is sterile and does not actually contain infectious bacteria.
These blemishes occur wherever there are many oil (sebaceous) glands, mainly on the face, chest, and back.
You can do a lot to treat your acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, you should consult a physician for treatment options.
What causes acne?
No one factor causes acne. Acne happens when oil (sebaceous) glands come to life around puberty, stimulated by male hormones from the adrenal glands of both boys and girls. Sebum (oil) is a natural substance which lubricates and protects the skin, and under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria (which live on everyone's skin and generally cause no problems) to multiply and cause surrounding tissues to become inflamed.
Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt, and do not reflect poor hygiene.
Here are some factors that don't usually cause acne, at least by themselves:
- Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.
- Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and dairy products in aggravating acne, these findings are far from established.
- Dirt: As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.
- Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.
- Hormones: Some women break out cyclically, but most women (and men) don't. Some oral contraceptive pills may help relieve acne, but unless a woman has abnormal menstrual periods and excessive hair growth, it's unlikely that hormones play much of a role in causing acne. Pregnancy has a variable effect on acne; some women report that they clear up completely, and others get worse, while many others see no overall change.
- Cosmetics: Most cosmetic and skin-care products are not pore-clogging ("comedogenic"). Of the many available brands, those which are listed as "water-based" or "oil-free" are generally a better choice.
In occasional patients, the following may be contributing factors:
- Pressure: In some patients, pressure from helmets, chinstraps, collars, suspenders, and the like can aggravate acne.
- Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium, which is used to treat bipolar disorder. Most cases of acne, however, are not drug-related.
- Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.
Testicular Pain At A Glance
- Testicular pain refers to pain or discomfort that is felt in one or both testicles.
- The primary role of the testicle is to produce sperm and the hormone testosterone.
- There are numerous conditions that can cause testicular pain, and a few of them constitute medical emergencies.
- The signs and symptoms may include pain, swelling, redness, and tenderness of the testicle and/or scrotum. Nausea, vomiting and fever may also be present.
- The different causes of testicular pain can be diagnosed using blood tests, urinalysis and imaging studies, in addition to a complete physical exam.
- The treatment for testicular pain varies depending on the underlying cause, and may include pain medication, antibiotics, and surgical intervention.
- The complications of the conditions causing testicular pain may include infection, impaired fertility, permanent damage to the testicle or loss of the testicle.
- Only a few causes of testicular pain are preventable.
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What are the complications of the conditions causing testicular pain?
The complications associated with the different causes of testicular pain may include the following.
Testicular torsion
- permanent damage to the testicle
- loss of testicle
- infertility
- infection
- cosmetic deformity
Epididymitis
- epididymo-orchitis
- abscess formation
- impaired fertility
- systemic blood infection (sepsis)
Torsion of a testicular appendage
- no significant complications exist
Trauma
- permanent damage to the testicle
- atrophy of the testicle
- loss of testicle
- infertility
- abscess formation
- cosmetic deformity
- testicular torsion
Inguinal hernia
- incarceration (hernia unable to be pushed back in)
- strangulation (disruption to the blood supply)
Orchitis
- atrophy of the testicle
- impaired fertility
- abscess formation
Kidney stone
- permanent kidney damage
- urosepsis (systemic blood infection arising from infected urine)
Testicular tumor
- The complications of a testicular tumor vary depending on the underlying type of tumor and the extent of disease.
How can testicular pain be prevented?
There are a few measures that you can take to prevent certain causes of testicular pain. However, many of the causes are not entirely preventable.
- For epididymitis or bacterial orchitis caused by sexually transmitted
- Diseases, condom use can reduce the risk of transmission
- The use of appropriate protective gear during sporting activities can prevent
- testicular trauma.
- Mumps immunization can decrease the incidence of viral orchitis.
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When Allergies Cause Throat Pain: What to Do
 | Monday, May 17, 2010 | |||||||||||||||||||||||||||
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How are the causes of testicular pain diagnosed?
In order to diagnose the underlying condition causing testicular pain, a complete history and physical exam will be performed by a health care professional. Laboratory testing and imaging studies may also be ordered depending on the health care professional's initial impression and evaluation.
Laboratory testing may include:
- blood work
- urinalysis
- a swab of the urethra (if the patient has penile discharge suggestive of a sexually transmitted disease)
Imaging tests may include
Ultrasonography
A non-invasive imaging study that can evaluate the blood flow to the testicles, as well as the presence of testicular tumors, fluid collections, testicular rupture, hernias, and kidney stones (renal ultrasound).
Radionuclide imaging
An imaging study requiring the intravenous administration of a radionuclide, useful for the evaluation of testicular torsion, as well as other causes of testicular pain.
CT scan or a kidney/ureter/bladder (KUB) X-ray
These imaging studies are sometimes used for diagnosing kidney stones.
For certain testicular pain, such as those that are strongly suggestive of testicular torsion, immediate urologic consultation prior to testing should be obtained in order to prevent potential delays in definitive surgical management.
What is the treatment for testicular pain?
The treatment for testicular pain varies depending on the underlying cause. As already noted, some conditions causing testicular pain are medical emergencies requiring immediate surgical intervention.
Testicular torsion
Definitive management of testicular torsion requires surgery by a urologist. During surgery, the affected testicle is untwisted, and if it is found to be viable, the testicle is secured to the scrotal wall (orchiopexy). The unaffected testicle may also be secured to prevent testicular torsion from occurring on the other side.
Sometimes, the affected testicle can be manually untwisted by a physician without necessitating emergent surgery, though this is a temporizing measure that ultimately still requires definitive surgical repair. Likewise, some testicular torsion can occur and then resolve spontaneously, and the health care practitioner must maintain a high index of suspicion in order for this condition to be diagnosed and ultimately surgically repaired.
The more rapidly the testicle is untwisted and blood flow is restored, the better the chances for salvaging the affected testicle. If treated within 6 hours of symptom onset, the salvage rate nears 100%, while after 24 hours the salvage rate is between 0% to 10%.
Epididymitis
The treatment of uncomplicated epididymitis can generally be managed as an outpatient, and consists of the following treatment measures:
- Antibiotics (which may vary depending on the patient's age and sexual history), pain medication and anti-inflammatory agents
- Rest
- Scrotal support and elevation
- Ice packs
In general, treated acute epididymitis resolves without complications. However, in severe epididymitis associated with systemic symptoms or in those accompanied by complications, hospitalization may be necessary.
Torsion of a testicular appendage
The treatment for torsion of the testicular or epididymal appendage is directed toward relief of symptoms, and consists of the following measures:
- Pain medication and anti-inflammatory agents
- Rest
- Scrotal support and elevation
- Ice packs
Most patients improve with these treatment measures within 1 week, though symptoms may last longer. In cases of testicular pain refractory to conservative management, surgical excision of the affected tissue is considered.
Trauma
The treatment and management of testicular trauma depends on the severity of injury. Minor cases of testicular trauma without suspected serious underlying testicular injury can be managed as an outpatient with the following measures:
- pain medication and anti-inflammatory agents;
- rest;
- scrotal support and elevation; and
- ice packs.
With testicular rupture, immediate surgical repair is necessary to preserve testicular function and viability. Other situations requiring surgical management include certain blunt trauma injuries with associated hematoceles, penetrating trauma, and certain cases of testicular dislocation.
Inguinal hernia
The definitive treatment of inguinal hernias requires surgical repair, sometimes electively as an outpatient, while others require intervention on a more emergent basis. Occasionally, inguinal hernias may not be repaired even electively because a patient is too high-risk to undergo surgery.
Prompt surgical intervention is necessary in cases of inguinal hernias that are not reducible (unable to be pushed back into the abdomen) and in those cases of strangulation (disruption to the blood supply).
Orchitis
The treatment of orchitis depends on the infectious organism responsible for causing the testicular inflammation. Both viral and bacterial orchitis can be treated with the following measures:
- pain medication and anti-inflammatory agents;
- rest;
- scrotal support and elevation; and
- ice packs.
Bacterial orchitis and epididymo-orchitis require antibiotics. Those cases caused by viruses do not require antibiotics.
Kidney stone
The treatment for kidney stones generally depends on the location of the kidney stone, the size of the kidney stone, and any associated complications, such as infection. An uncomplicated kidney stone can typically be treated with the following measures:
- adequate fluid intake;
- pain medication;
- anti- nausea medication; and
- medications, such as tamsulosin (Flomax), which facilitate the passage of kidney stones.
Several different measures exist for treating kidney stones that do not pass spontaneously, such as lithotripsy (the use of shock waves to break up the kidney stone) and other more invasive surgical procedures.
Certain patients with intractable pain, intractable vomiting or those with signs of infection require hospitalization. In those with infection and obstruction, antibiotics and emergent urologic intervention is necessary.
Testicular tumor
The treatment for a testicular tumor depends on various factors. A testicular mass is considered cancer until proven otherwise. If testicular cancer is diagnosed, patients are referred to an oncologist who will discuss the different treatment options available.
Testicular Disorders (cont.)
Inguinal hernia
An inguinal hernia is a bulge or protrusion of intestine through a defect in the abdominal wall musculature of the groin area. This protrusion can sometimes cause swelling of the scrotum and testicular pain.
Orchitis
This condition is characterized by inflammation of the testicle, typically as a result of an infection. Most cases of orchitis arise from a viral infection, with mumps being the most common causative illness. Mumps orchitis most commonly occurs in children less than 10 years of age. Less commonly, orchitis can occur from a bacterial infection, most often as a result of epididymitis (epididymo-orchitis).
Kidney stone
Occasionally, the pain associated with kidney stones can radiate into the groin area and cause testicular pain.
Testicular tumor
Though generally painless, tumors of the testicle can sometimes cause pain and discomfort of the testicle.
What are the signs and symptoms of conditions causing testicular pain?
Because there are numerous medical conditions that can lead to testicular pain, the symptoms and signs may vary depending on the underlying cause. However, often times the symptoms can be very similar between the various causes, making it difficult to distinguish among the conditions which require urgent medical attention. Therefore, if you experience testicular pain, seek medical evaluation immediately by a trained professional.
Testicular torsion
Testicular torsion generally presents as sudden onset, severe testicle pain (localized to one testicle) that may be accompanied by any of the following signs and symptoms:
- Nausea and vomiting
- Testicular and/or scrotal tenderness
- Testicular and/or scrotal swelling and redness
- Abdominal pain
- Fever
- Elevation of the affected testicle within the scrotum
- Horizontal positioning of the affected testicle within the scrotum
- Loss of the cremasteric reflex on the affected side (normally, the testicle elevates with light stroking of the upper inner thigh area).
Epididymitis
Epididymitis generally presents as gradual onset, mild to severe testicle pain (localized to one testicle) that may be accompanied by any of the following signs and symptoms:
- Nausea and vomiting
- Testicular and/or scrotal tenderness, typically localized to the area of the epididymis, though it can become more generalized and involve the whole testicle as the illness progresses.
- Testicular and/or scrotal swelling and redness
- Abdominal pain
- Fever
- Urethral discharge
- Urinary symptoms, such as burning, urgency, or frequency
Torsion of a testicular appendage
With torsion of a testicular appendage, the onset of testicle pain may be sudden or gradual, and the severity of pain may range from mild to severe. Generally, patients do not experience systemic symptoms, such as nausea, vomiting, and fever. Other signs and symptoms may include the following:
- the testicle and/or scrotum generally appear normal, without swelling and redness, though these findings may be present;
- testicular tenderness, typically only localized to the top of the testicle;
- in about 20% of cases, a small blue-dot is visualized near the top of the affected testicle (blue-dot sign);
- preservation of the normal vertical positioning of the affected testicle within the scrotum, and
- preservation of the cremasteric reflex is generally maintained.
Trauma
In general, patients will relate a history of trauma to the genital area and testicular pain may range from severe to absent at the time of presentation to a health care practitioner. Though in some cases the mechanism of injury may seem minor, serious underlying testicular injury may be present, and the following signs and symptoms may be observed:
- Testicular and/or scrotal tenderness, swelling or bruising
- Bruising of the area between the scrotum and the anus (perineum)
- Nausea and vomiting.
Inguinal hernia
Inguinal hernias are common and they can sometimes cause discomfort in the scrotum and/or testicles. Signs and symptoms an inguinal hernia may include:
- a bulge in the scrotum or in the inguinal area, that may become more pronounced with coughing or straining; and
- a dull ache or burning sensation in the scrotum and/or testicles.
Orchitis
Because orchitis generally occurs as a consequence of an infection (most often mumps), it is typically also accompanied by other systemic infectious symptoms. Testicular pain may range from mild to severe. Signs and symptoms of orchitis may include the following:
- testicular and/or scrotal tenderness, swelling or redness;
- fever and chills;
- headache;
- body aches;
- nausea;
- fatigue; and
- parotid gland inflammation (parotitis) in cases of mumps.
Kidney stone
Occasionally, kidney stones can cause pain in the testicles. The testicles, however, appear normal without swelling or redness. Other signs and symptoms of kidney stones may include:
- back (flank) pain and tenderness,
- abdominal pain,
- nausea and vomiting,
- urinary symptoms, such as blood in the urine, discomfort with urination and urinary frequency.
Testicular tumor
Although testicular tumors can occasionally cause testicular pain, they are usually painless. Signs and symptoms may include:
- a lump or mass of the testicle,
- a change in the size or texture of the testicle,
- a dull ache of the lower abdomen, lower back or groin area, and
- a feeling of heaviness in the scrotum.
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