Testicular pain can arise in the testicle, in the epididymis behind it, in the spermatic cord, or be referred from somewhere else such as a kidney stone, a groin hernia or the lower back. It is divided into acute pain, which comes on over minutes to days, and chronic pain, lasting 3 months or longer.
The first priority with sudden pain is to exclude testicular torsion, a twist of the cord that cuts off the blood supply. It is most common between 12 and 25 but can occur at any age. Once emergencies are excluded, most testicular pain is due to infection or benign causes, and a cause is found in about half to three quarters of chronic cases.
Symptome
- Sudden, severe one-sided pain with nausea or vomiting, characteristic of torsion
- A testicle that sits higher or lies sideways
- Pain building over a day or more with swelling, redness, warmth and sometimes fever or burning urine, typical of epididymo-orchitis
- A dull ache or heaviness that worsens through the day or on standing, typical of varicocele
- Pain spreading from the flank to the testicle with blood in the urine, typical of a ureteric stone
- Groin pain with a bulge on coughing
- Persistent aching after vasectomy or hernia repair
- A lump found together with the ache
Ursachen und Risikofaktoren
Acute causes are torsion of the testicle; torsion of a small appendage on the testicle, mainly in boys; epididymo-orchitis due to chlamydia or gonorrhoea in younger men and urinary bacteria in older men; mumps orchitis; trauma; and a trapped hernia. Chronic causes include varicocele, epididymal cysts, hydrocele, post-vasectomy pain syndrome in a small minority of men, nerve entrapment after groin hernia surgery, chronic prostatitis or pelvic floor tension, and referred pain from the hip or lumbar spine. Testicular cancer is usually painless but causes aching in a minority. In some men with chronic pain every test is normal, and nerve sensitisation is thought to be responsible.
Wie es diagnostiziert wird
- Urgent clinical assessment: Onset, position of the testicle, and the cremasteric reflex. When torsion is strongly suspected, surgeons explore without waiting for scans.
- Doppler ultrasound: Shows blood flow, inflammation, masses, varicocele and fluid. A normal scan does not completely rule out intermittent torsion.
- Urine dipstick, culture and STI testing: Identify the organism in epididymo-orchitis.
- Examination of abdomen, groin, hip and back: Looks for hernia and for sources of referred pain.
- CT of the urinary tract: When a ureteric stone is suspected.
- Spermatic cord block: A local anaesthetic injection. Temporary relief predicts benefit from microsurgical denervation in chronic pain.
Behandlungsmöglichkeiten
- Emergency surgery for torsion: The testicle is untwisted and both sides are fixed to prevent recurrence. A testicle that is no longer viable is removed.
- Antibiotics: Chosen by likely cause: ceftriaxone with doxycycline for sexually transmitted infection, or a quinolone for urinary organisms, for 10 to 14 days, with partner notification.
- Rest, support and anti-inflammatories: Supportive underwear, ice in the first days and ibuprofen. Swelling from epididymitis can take weeks to resolve fully.
- Treating the underlying cause: Varicocele repair, hernia repair, stone treatment or excision of a symptomatic cyst.
- Chronic pain management: Nerve pain medicines such as amitriptyline or gabapentin, pelvic floor physiotherapy and psychological support.
- Microsurgical cord denervation: Offered to selected men with chronic pain who respond to a cord block. Vasectomy reversal or epididymectomy may help post-vasectomy pain. Removing the testicle is a last resort and does not always relieve pain.
Wenn es dringend ist
Sudden severe testicular pain is an emergency at any age. Go immediately to the nearest emergency department and do not eat or drink on the way in case surgery is needed. The chance of saving a twisted testicle falls steeply after about 6 hours. Pain after an injury with marked swelling, or pain with high fever, also needs same-day care. Never travel for this.
Reisen nach Türkiye zur Behandlung
Only chronic testicular pain is a candidate for care abroad. A visit of a few days can include ultrasound, examination by a urologist with an interest in male pelvic pain, a diagnostic cord block and, where appropriate, varicocele microsurgery or cord denervation, with 5 to 7 days before flying. Be realistic: surgery helps selected men, not all, and physiotherapy or medication adjustments need a provider where you live.
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Häufig gestellte Fragen
Could it be cancer?
Pain is not the usual presentation, but an ultrasound is sensible for any persistent ache or lump, and it is normally reassuring.
Can pain come from my back or hip?
Yes. The testicle shares nerve supply with the upper lumbar spine, hip and ureter, so normal scrotal findings prompt a search elsewhere.
Pain that comes and goes suddenly: should I worry?
Short, severe episodes that resolve by themselves can be intermittent torsion. Mention it to a urologist, as preventive fixation may be advised.
Does epididymitis harm fertility?
A single treated episode rarely does. Severe or repeated infection on both sides can cause blockage, so complete the antibiotics and make sure partners are treated.