Frequencies and prognosis

The frequency peak for testicular pain is beyond the age of 45. It is estimated that up to 50% of men suffer from testicular pain problems during their lifetime. The risk is increased in men who had an undescended testicle (maldescensus testis) as a child. Testicular pain should always be clarified by a doctor as soon as possible. With adequate treatment, a transition to a chronic problem can usually be avoided.

Causes

Isolated inflammation of the testes (orchitis) is, like inflammation of the epididymis, a rather rare disease. It develops when viruses or bacteria reach the testicles either through the bloodstream, through lymphatic vessels or directly through the vas deferens. More often, however, the inflammation of the testicles is due to systemic infections.

These infections include above all mumps, but also chickenpox, Pfeiffer’s glandular fever or malaria. However, especially after the introduction of the vaccination against mumps, the incidence of testicular inflammation and the infertility often resulting from it have decreased considerably. If the testicle inflammation is caused by an ascending urinary tract infection, the epididymis is usually also affected.

In addition to the testicular pain itself, the inflammation manifests itself by swelling, redness and overheating of the affected testicle. However, similar symptoms can also occur in the case of testicular torsion, which is why a urologist should be consulted without delay. The diagnosis can then usually be made by ultrasound and urine examination.

The testicle should then be immobilized and elevated, cooling can relieve the pain. In the case of bacterial infections, the treating doctor will also prescribe an antibiotic. Painkillers and anti-inflammatory drugs that inhibit the inflammatory reaction can be taken as a support.

More often, however, the inflammation of the testicles occurs on the basis of systemic infections. These infections include above all mumps, but also chickenpox, Pfeiffer’s glandular fever or malaria.However, especially after the introduction of the vaccination against mumps, the incidence of testicular inflammation and the infertility that often results from it have decreased considerably. If the testicle inflammation is caused by an ascending urinary tract infection, the epididymis is usually also affected.

In inguinal hernia, abdominal organs, i.e. mainly parts of the intestine, pass through the so-called inguinal canal. Through this channel blood vessels, nerves, muscles and also the spermatic duct to the testicles normally pass through. If parts of the intestine enter this narrow channel or press on the structures lying in it, this causes, among other things, testicular pain.

It can even happen that parts of the intestines in the inguinal canal sink down into the testicles. The inguinal hernia is caused by a disproportion between muscle and connective tissue, which stabilize the inguinal canal and the pressure in the abdominal cavity. Therefore inguinal hernias often occur after physical exertion, such as heavy lifting, or heavy sneezing or coughing.

However, inguinal hernias can also be congenital. As a rule, the inguinal hernia must be treated surgically. In the case of testicular torsion, the testicular pain is usually very severe and sudden.

The reason for this is that in testicular torsion the so-called vascular stem, which supplies the testicles and epididymis with blood, is twisted in such a way that the blood supply to the testicles is cut off. The testicle is no longer supplied with blood and oxygen. In addition, the blood that has reached the testicle can no longer flow off, which leads to severe swelling and congestion in the testicle.

If the testicular torsion is not detected and treated early, the entire testicle can die after about 4-6 hours. Accordingly, the pain in the testicles is usually much more severe than in the case of testicular inflammation. In addition, the pain in testicular torsion does not improve when the testicle is lifted.

In this case the emergency room of a hospital with urological department should be visited immediately. The torsion of the testis must then usually be treated surgically. The torsion itself is removed in the operation, or if the testicle has already died, it is removed.

In addition, the other, non-twisted testicle is usually fixed in such a way that there is no danger of torsion. Fertility is normally fully maintained even with only one testicle. Testicular cancer originates from the different cells of the testis.

In this context, it is sometimes referred to as a germ cell tumor. A malignant tumor of the testis leads to death if left untreated. However, if detected early, it can usually be treated well.

Testicular cancer usually occurs between the ages of 20-40 years. In the beginning, the testicular pain usually manifests itself by a slight pulling in the testicle or a pulling in the groin. Sometimes an enlargement or swelling of the testicle can also be felt.

In the advanced stages, back pain can also occur due to lymph nodes in the abdomen. In order to detect testicular cancer at an early stage, the testicle should be palpated regularly in a relaxed state. In the case of palpable nodules or the pulling pain described above, a urologist should be consulted.

A precise clarification of the malignancy of the tumor can often only be made after removal by pathological examination. Even after removal of one testicle, the other testicle can usually take over the functions without any problems. Overall, testicular cancer, if detected early, has a good prognosis.

Since the spinal column, or rather the spinal cord running through it, is the nervous connection between the body and the brain, damage to the spinal column can also cause testicular pain. If the nerve is damaged within its course, the pain is assigned to the organ to be treated and not necessarily to the damaged area. This means that nerves that supply the testicle trigger testicular pain even if the actual cause lies elsewhere.It is therefore possible that a herniated disc in the lumbar spine or degenerative changes in the spine can lead to feelings of pain in other parts of the body, such as the testicles in this case.

In addition, the so-called ilioinguinal nerve also controls many of the muscles that are responsible for the holding apparatus of the testes. This nerve emerges in the lower back area and can therefore be the cause of testicular pain if there is tension in the lumbar region. So if no direct urological causes of the testicular pain itself can be found, an orthopedic search for the cause should be considered.

The symptoms often improve under physiotherapy or after treatment of the back problems. A seminal congestion (accumulation of seminal fluid in the testicles) does not exist physiologically. This is based on the idea that the testicles continue to produce sperm and that these sperm will accumulate in the testicles if they are not regularly removed by ejaculation.

However, this does not take into account that old sperm is absorbed and broken down by the body itself, or is discharged in the form of sometimes unnoticed nightly ejaculations. Exceptions to the above are men after vasectomy, i.e. after surgical cutting of the spermatic duct. In these cases, directly after the operation, there may actually be a short-term backlog of sperm in the testicles.

However, here too, these are resorbed and broken down after a short time, so that here too the sperm congestion has no disease value. Colloquially, the term “testicular pain due to seminal congestion” is used to describe pain caused by sperm congestion, but also often pain caused by sexual arousal or activity. It is therefore quite possible that prolonged arousal, especially if it does not end in ejaculation, leads to a state of irritation of the testicles and the spermatic ducts.

Short-term painful conditions of the testicles can also occur after sexual intercourse. Even if there is no accumulation of seminal fluid in the testicles, there are indications that good sexual hygiene, in the sense of regular sexual activity, can have a positive effect on the course of e.g. inflammation of the prostate. Many of the causes of groin pain described above can be influenced by changes in the position of the testicles or general activities.

In the case of inflammation of the testicles, for example, an improvement in pain when the testicles are elevated is typical. Accordingly, the pain can increase due to the constant up and down while walking. The nerves that supply the testicles can also be influenced in their course to the spinal cord or brain in many places.

A beginning inguinal hernia can put pressure on the nerves in the inguinal canal. Under certain circumstances this pressure is too low at rest to cause testicular pain. Pain can only occur at the higher impact load when running.

The same is possible with problems of the spinal column. A herniated disc of the lumbar spine can change its position through movement in such a way that it presses on the nerve during the additional load during running and irritates it. The fact that testicular pain occurs or worsens while running is therefore completely normal in many clinical pictures.

However, it is also possible that testicular pain, which e.g. is caused by tension in the muscles of the back or pelvic floor, may even improve with slight movement. Whether running is suitable as a sport for the respective disease or whether it should be paused is always to be discussed with the treating doctor. As with running, other sporting activities can also influence the occurrence or severity of testicular pain.

Especially sports with mechanical strain on the testicles and pelvic floor area, such as cycling or horseback riding, can cause problems. Also activities involving a lot of effort, such as heavy lifting or weight training, can cause testicular pain by increasing the pressure in the lower abdomen. In sports where there is a risk of traumatic testicular damage, such as martial arts, a suspensor should be worn anyway.

In addition to protecting against injuries, the jockstrap can also help to alleviate testicular pain during exercise, as the testicles are higher and more stable than normal. Any kind of direct injury can also be considered as a further cause. In these cases, however, the connection can usually be clearly established. But also a tension in the area of the pelvic floor, or a so-called pelvic pain syndrome can cause testicular pain.Especially if the pain is rather diffuse in the entire lower abdomen, the actual cause can also be in the area of the prostate, as in the case of an inflammation of the prostate or also in the area of the rectum or bladder. Kidney stones or bladder stones can also be a possible cause.