What is testicular pain (pain in the testicles)?

Testicular pain refers to pain or discomfort that is felt in one or both testicles. The pain may originate from the testicle itself, or it may be the result of other conditions affecting the scrotum, groin or abdomen. Though there are numerous medical conditions that can cause testicular pain, it is important to understand that a few of them constitute medical emergencies that require immediate medical attention in order to prevent the loss of testicular function.

What function do the testicles have?

The testicles form part of the male reproductive organs, with a primary function of producing sperm and the male hormone testosterone.

The testicles are contained within an external sac-like structure called the scrotum, which is located between the penis and the anus. Adult testicles are similar in size to large olives, and it is common for one testicle to hang lower than the other within the scrotum. Located near the back of each testicle lies the epididymis, a coiled tubular structure which functions to store and transport sperm. The spermatic cord (a tubular structure containing blood vessels, nerves, lymphatic vessels and the vas deferens) courses from the abdomen and is connected to each testicle. Apart from containing vital structures for each testicle, the spermatic cord also suspends the testicles within the scrotum.

What causes testicular pain?

There are several medical conditions that can lead to testicular pain. As already described, some of these conditions require urgent evaluation and management in order to preserve testicular function.

Testicular torsion

This condition occurs when the testicle twists spontaneously within the scrotum, leading to a decrease in blood flow to the affected testicle (from the twisting of the vessels within the spermatic cord). If the blood supply is cut off for too long, the testicle will be permanently damaged. This condition is a medical emergency and requires immediate medical attention.

Testicular torsion typically occurs because of an anomaly affecting the normal attachment of the testicle within the scrotum, often referred to as the bell-clapper deformity. This abnormality allows the testicle to be freely suspended and twist spontaneously. Often times, this anomaly is present in both testicles. Trauma to the testicle is a rare cause of testicular torsion.

Testicular torsion is most common in males younger than 30 years of age, with a peak incidence between 12-18 years of age. It can also occur more frequently during the neonatal period. Testicular torsion most often affects the left testicle.