From intermittent twinges to constant aches, testicular pain can trigger a significant amount of worry. While sore balls are a common experience and usually no cause for concern, it's important to familiarise yourself with symptoms in case it's a sign of something serious.
Like the organs themselves, testicular pain is a sensitive topic. To help put your mind at rest, we spoke to men's health specialist Dr Jeff Foster, GP Dr Roger Henderson, and Dr Naveen Puri of Bupa Health Clinics about the most common causes of testicular pain, how to self-check and when to see a doctor:
What is testicular pain?
Testicular pain describes a feeling of pain or discomfort in one or both testicles. Testicles are part of the male reproductive system, and they sit inside the sac-like structure called a 'scrotum', which is located between the penis and anus. Testicular pain can be acute (short-term) or chronic (long-term); dull or sharp; and felt constantly or intermittently.
'The testicles are a very sensitive part of your body, and a minor injury to this area can cause pain,' says Dr Puri. 'You may experience pain within the testicle itself, or around the supporting tissues that anchor the testicle (the epididymis). It's important to regularly check your testicles and speak to your doctor if you notice any pain.'
10 common causes of testicular pain
There are lots of possible causes of testicular pain, and some are more serious and severe than others. 'Depending on the cause of your testicular pain, you may experience side effects, or complications afterwards,' says Dr Puri. Read on for 10 of the most common causes and their associated symptoms:
Trauma or injury sustained through a blow to the testicles – while playing sports or due to a car accident, for example – is the most common cause of testicular pain, and is usually accompanied by bruising and swelling. If the trauma is severe, seek immediate medical attention. If minor, care for the injury at home. 'If you're suffering from mild testicular pain, you may find it helpful to take over-the-counter painkillers for pain relief,' says Dr Puri. 'A warm bath and ice to reduce swelling may help, too.'
The epididymis is a coiled tube that sits on the back of the testicle and stores the sperm that are released during ejaculation. The epididymis can become swollen and increasingly painful over time as it becomes more inflamed. It's usually caused by a sexually transmitted infection (STI) or urinary tract infection (UTI) and can affect one or both testicles simultaneously. Bacterial infections normally respond to a course of antibiotics.
Exposure to a bacterial or viral infection – such as the mumps virus – can cause orchitis, which leads to testicular pain and inflammation that can become severe. Additional symptoms can include:
Tender, swollen testicle
Scrotum hot to touch
Corticosteroid medication may be prescribed to treat the inflammation associated with mumps orchitis. Epididymitis and orchitis can occur at the same time, known as epididymo-orchitis.
A spermatocele is a fluid-filled cyst that develops in the epididymis, and often contains dead sperm. It's not harmful or cancerous. If the cyst stays small, you may never experience symptoms – however, as it grows, it can feel sore and heavy, so you may notice a change during a self-exam. If you do, you should see your doctor. Small cysts may disappear without treatment, but larger ones can require surgical removal.
Varicoceles are an abnormally large group of veins in the testicles. As many as 90 per cent of them occur in the left testicle. Sometimes the condition has no symptoms, but when it does, it's characterised by testicular pain that worsens over the day, or during a workout. Your doctor will easily distinguish between normal and swollen veins through a routine examination. It's said to feel like a 'bag of worms' and can be linked to infertility.
When a layer of fluid collects in a sac around the testicle, it's called a hydrocele. Up to 10 per cent of male newborn babies are born with a hydrocele, though they usually settle without treatment by the time the child is one. In children and adults, hydroceles form as due to inflammation or injury to the testicle. They often appear and disappear spontaneously, and may or may not be painful. They can be drained and the sac removed.
Known as an inguinal hernia, this condition occurs when part of your bowel protrudes through your abdominal wall and into the scrotum, resulting in testicular pain and swelling. Other common symptoms include a visible bulge in the scrotum that becomes more pronounced with coughing or straining, and a dull ache or burning sensation.
8. Testicular tumour
When a tumour forms, it can cause testicular pain and swelling – though not always – along with changes in the texture of the testicle, a dull ache in the groin area, and a feeling of heaviness in the scrotum. The symptoms resemble several other conditions, like inguinal hernias and epididymitis, so it's best to get checked. A tumour isn't necessarily cancerous.
9. Kidney stones
When kidney stones cause testicular pain, it's called 'referred pain', because it doesn't actually relate to an issue with the testicles. As well as a sharp, cramping pain in the groin, common symptoms include:
Blood in your urine
Burning pain while peeing
Pain at the tip of the penis
Nausea and vomiting
If kidney stones are the cause of your testicular pain, your testicles would appear normal with no signs of swelling or redness.
10. Testicular torsion
Testicular torsion is a serious condition that occurs when the spermatic cord gets twisted, restricting blood flow to the testes. This leads to sudden and severe testicular pain, along with symptoms like:
Darkening of the scrotum
The condition can happen spontaneously, but may also occur gradually after an injury. Testicular torsion can be resolved through surgery, if carried out within six hours. The surgeon will untwist the spermatic cord and fix the testicle with stitches. In very rare cases, if a surgeon can't repair the torsion, they may have to remove the testicle.
Do I have testicular cancer?
When you experience testicular pain, your racing mind might jump straight to testicular cancer. However, the condition accounts for just one per cent of all cancers in men. 'Testicular cancer is rare,' says Dr Foster. 'In the UK, around 2,300 men are diagnosed with testicular cancer each year. That's about one out of every 100 cancers diagnosed in men.'
The incidence is highest in men aged between 30 and 34 and it's more common in white men than Asian or black men. The most common symptom of testicular cancer is a painless lump or swelling the size of a pea (or larger) in one of the testicles. Additional symptoms may include a dull ache or feeling of heaviness in the scrotum.
'I probably have a man come to me once a week complaining of testicular pain, often because they are worried about testicular cancer,' says Dr Henderson. 'However, that is very rarely the cause. Testicular cancer usually manifests itself as a very dull low ache rather than a sharp pain.'
When to visit the doctor for testicle pain
If your testicular pain is sudden and severe, it requires urgent medical attention, 'so it's important to ring NHS 111, or head to hospital,' says Dr Puri. 'This type of pain can indicate a torsion (twisting) of the testicle and its support structures, or an injury to the testicle.'
You should speak to your GP if your testicle pain lasts longer than a few days, there is a lump or swelling in or around a testicle, or you have a fever, says Dr Puri. 'Seek advice from your doctor if your scrotum is red, warm to touch, or tender, too,' he adds.
When you go to the surgery, your doctor will examine your abdomen, groin, and testicles to help determine what's causing your pain, says Dr Puri. At this stage, it's important to mention any other symptoms you're experiencing – for example, nausea or a fever.
'If additional tests are required, your doctor may send you for STI tests, an ultrasound scan, or take a urine sample for analysis,' he continues. 'They will be able to answer any questions you have and let you know what they're checking for.'
How to check your testicles
You don't need to experience v pain or discomfort to keep an eye out for abnormalities. Despite this, one in four (24%) men have never checked for testicular cancer, research from Bupa UK revealed, with nearly half (45%) admitting they 'regularly forget' to look for symptoms. 'It's important to regularly check your testicles for lumps and swelling – at least once a month – to know what's normal for you,' says Dr Puri.
Perform this routine check at home once a month after a warm bath or shower:
✔️ Grab a handful: 'Cup your hands under them to feel how heavy they are,' says Dr Puri. 'They should feel roughly the same size and weight, with the right testicle slightly larger and sitting slightly lower.'
✔️ Check them individually: Examine one testicle at a time using both hands, and roll it between your thumb and fingers. Start at one end and work up or down.
✔️ Get to know the area: There is a rubbery, cord-like structure behind each testicle that stores and moves sperm. You may also feel the cord above the testicle. This is totally normal.
✔️ Take changes seriously: 'If you notice swelling, change in the size, lumps or pain while checking your testicles, it's important you seek medical help without delay,' says Dr Puri. 'A lump should always be checked out as soon as possible.'
How to prevent testicular pain
While causes of testicular pain can't be prevented, there are several things you can do to look after your balls:
✔️ Practise safe sex: Using a condom will help to lower your risk of sexually transmitted infections. Visit a sexual health clinic for a screening test if you have unprotected sex, and also when changing sexual partners.
✔️ Examine yourself: Get into the habit of checking your balls once a month. If you do it regularly, you'll know what to look for and will easily be able to spot changes.
✔️ Take action: If you discover any changes, or experience sudden and severe pain in one or both testicles, see your doctor.
✔️ Protect your balls: Avoid injury while playing high-risk sports like cricket, rugby and boxing by wearing boxes, cups or groin guards.
Last updated: 29-04-2021
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