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.