Pain in a sensitive area

Whether you call them the 'family jewels', 'nuts', 'nads' or even 'lefticle and righticle' all would agree that the testicles are sensitive structures.

Fortunately they are very mobile which helps prevent injury and can be retracted upwards as a protective mechanism. The testicles produce testosterone and sperm. Low testosterone in adult men can cause symptoms of low mood, reduce libido, erectile dysfunction and muscle weakness.

So, what are some of the causes of pain in the 'private area'?

INJURY is an obvious one which is normally short lived but possibly very serious. Post- vasectomy pain syndrome (persistent pain after 3 months interfering with daily activities) occurs in about 15% (there is a wide variation) of men after this procedure.

INFECTION can occur usually in the epididymis which is a coiled tube at the back of the testicles involved with storing and maturing sperm. There is a gradual onset of pain on one or both sides possibly with scrotal swelling. Often sexually transmitted infections can cause this in younger men (Chlamydia or Gonorrhoea) so it would be reasonable to see the GP who may refer to the Genito-Urinary Medicine Clinic. Antibiotics (usually a longer than normal course) are needed to treat this condition. Swollen testicles can also occur in association with epididymitis or rarely with viral infections like mumps.

TESTICULAR TORSION (twisted, raised testis) is a surgical emergency. It usually occurs in those aged under 30 especially in adolescents but also can occur in babies. There is rapid onset of severe pain and swelling of a testicle. There may be pain in the abdomen and vomiting. It is best to attend A&E immediately if there is sudden onset of severe pain (even if it occurs after an injury) as the testicle can die (needs to be removed surgically). It is possible to have a twisted appendage of the testicle which can cause less severe pain.

VARICOCELE is a common swelling of veins (like varicose veins) in the scrotum which can be associated with infertility and a mild ache. Surgical repair is possible but not often needed.

HYDROCELE is the term for fluid in the scrotum which children can be born with or adults can develop after trauma, infection or cancer (although often the cause is unknown. It may be necessary to have an ultrasound scan and see a urologist. Hernias can sometimes cause scrotal swelling and pain.

TESTICULAR CANCER is rare (about 2000 new cases per year in the UK) but is the commonest cancer in men aged 15-35. Half of cases occur in men under 35 and 90% before 55 years. There are different types but a good cure rate can be expected. Most commonly a lump is found in the testicle but occasionally it may cause pain or swelling. However most lumps found in the scrotum are not cancer. Self-examination once a month can be performed by rolling each testicle between the fingers and thumb and checking for any swelling or lump. Risk factors for testicular cancer include undescended testicle (remains in abdomen), family history (of testicular cancer), abnormal genital development and white skin. It would be advisable to visit the GP if a lump is found.

Other causes: Pain can be referred from other areas for example from a kidney stone or prostate infection.

If you experience any testicular pain do not hesitate to visit your GP it’s worth any potential embarrassment!

 

You may find these sites useful.

Boots Men’s Health website, Patient UK, NHS direct, Cancer Research UK

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Guest Tuesday, 22 January 2019

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