The testicles are paired structures located in the scrotum. They are the male gonads, responsible for the production of sperm and also of the “male” hormone testosterone.
Many men of all ages experience pain in their testicles at some point in their lifetime. The pain may be felt in one or both testicles and may also radiate to other regions, such as the groin, penis, or leg. Some problems may not directly involve the testicles but may be felt there; for instance, some men with kidney stones may feel pain in their testicle when the stone gets close to passing.
One common cause of testicular pain is trauma; the testicle are outside of the body and as such as vulnerable to injury from being struck while playing sports or engaging in sexual activity. Infection or inflammation of the testicle is also common and can be a source for testicular pain. Sometimes issues with structures adjacent to the testicle can cause pain; examples include hydroceles (a sack of fluid around the testicle), varicoeles (varicose veins of the scrotum), large epididymal cysts (fluid pockets within the epididymis where sperm mature), or inguinal hernias.
Less common but potentially serious causes of testicular pain include testicular torsion (when the testicle twists on its blood supply) or testicular tumor, usually detected as a mass inside the testicle. Any pain that is associated with trauma, is sudden and severe (consistent with testicular torsion) or that is associated with a nodule inside the actual testicle should prompt an immediate evaluation.
The evaluation of testicular pain is directed towards finding reversible or serious causes. A history and physical exam is always warranted in cases of testicular pain. In some cases additional testing such as urinalysis or scrotal ultrasound is indicated. In many cases no specific cause for testicle pain is identified. This can be frustrating but can also be seen as reassuring as the evaluation is very good at detecting serious or life-threatening issues.
Management of testicular pain is directed towards resolving whatever condition lead to the pain in the first place. This may involve medications or surgery, depending on the root cause. If a specific cause is not identified, treatment is geared towards managing symptoms; options in these cases include behavioral changes, anti-inflammatory medications such as ibuprofen, medications for neuropathic pain, spermatic cord injections, pelvic floor physical therapy, and in some cases surgical intervention.