Testicular pain

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Testicular pain
Other namesScrotal pain, orchialgia
chronic pelvic pain syndrome[2]

Testicular pain, also known as scrotal pain, occurs when part or all of either one or both

testicles hurt. Pain in the scrotum is also often included. Testicular pain may be of sudden onset or of long duration.[1][2]

Causes range from non serious muscular skeletal problems to

urine tests, and blood tests.[1][2]

Pain management is typically given with definitive management depending on the underlying cause.

Definition

Testicular pain is when part or all of either one or both

testicles hurt. Pain of the scrotum is often included. It may be either acute, subacute or chronic depending on its duration.[citation needed
]

Chronic scrotal pain

Chronic scrotal pain (pain for greater than 3 months) may occur due to a number of underlying conditions.[3] It occurs in 15-19% of men post vasectomy, due to infections such as epididymitis, prostatitis, and orchitis, as well as varicocele, hydrocele, spermatocele, polyarteritis nodosa, testicular torsion, previous surgery and trauma.[3] In 25% of cases the cause is never determined.[3] The pain can persist for a long and indefinite period of time following the vasectomy, in which case it is termed post-vasectomy pain syndrome (PVPS).[citation needed
]

Differential diagnosis

The differential diagnosis of testicular pain is broad and involves conditions from benign to life-threatening. The most common causes of pain in children presenting to the emergency room are testicular torsion (16%), torsion of a testicular appendage (46%), and epididymitis (35%).[4] In adults, the most common cause is epididymitis.[citation needed]

Testicular torsion

Testicular torsion usually presents with an acute onset of diffuse testicular pain and tenderness of less than 6 hrs of duration. There is often an absent or decreased cremasteric reflex, the testicle is elevated, and often is horizontal.[5] It occurs annually in about 1 in 4,000 males before 25 years of age,[3] is most frequent among adolescents (65% of cases presenting between 12 and 18 years of age),[6] and is rare after 35 years of age.[7] Because it can lead to necrosis within a few hours, it is considered a surgical emergency.[7] Another version of this condition is a chronic illness called intermittent testicular torsion (ITT) which is characterized by recurrent rapid acute onset of pain in one testis which will temporarily assume a horizontal or elevated position in the scrotum similar to that of a full torsion followed by eventual spontaneous detortion and rapid solution of pain. Nausea or vomiting may also occur.[8]

Epididymitis and orchitis

E. coli is the most common bacterial infection.[7] Treatment involves the use of antibiotics.[7]

Fournier's gangrene

Fournier's gangrene (an aggressive and rapidly spreading infection of the perineum) usually presents with fever and intense pain. It is a rare condition but fatal if not identified and aggressively treated with a combination of surgical debridement and broad spectrum antibiotics.[9]

Others

Segmental testis infarction in a patient presenting with right testis pain.

Many other less common conditions can lead to testicular pain. These include

epididymal hypertension (also known as "blue balls").[13]

Diagnostic approach

Physical findings

The

cremaster reflex (elevation of the testicle in response to stroking the upper inner thigh) is typically present in epididymitis but absent in testicular torsion as the testis is already elevated.[7] Prehn's sign (the relief of pain with elevation) though a classic physical exam finding has not been found to be reliable in distinguishing torsion from other causes of testicular pain such as epididymitis.[14]

Laboratory tests

Useful tests that may help in the determination of the cause include a

Imaging

Ultrasound is useful if the cause is not certain based on the above measures.[15] If the diagnosis of torsion is certain, imaging should not delay definitive management such as physical maneuvers and surgery.[7]

References

External links