Testicular pain, commonly known as “egg pain”, is one of the common clinical conditions in urology, often caused by trauma, inflammation, tumors and other lesions of the testicles. Testicular lesions often affect the normal functioning of important reproductive organs and can lead to male infertility, so testicular pain should seek medical attention in a timely manner, if the treatment is delayed, it is likely to be pain in the body, injury in the heart.
Acute pain is mostly seen in testicular inflammation, testicular torsion and trauma. In addition to bloodstream infection, orchitis is more commonly caused by bacteria retrograde through the urethra to the epididymis and testicles, resulting in epididymitis and orchitis, which is clinically seen as swelling and pain in the epididymis and testicles. There is a history of trauma and localized swelling and petechial hemorrhage in case of testicular injury. Strenuous exercise or intercourse or violence can sometimes cause strong contraction of the levator muscle, which can twist the tethered overgrown testicle and cause severe pain in the testicle. Because the testicular torsion blocks the blood supply to the testicle, the testicle is painful and the scrotum is enlarged and the skin is edematous. The diagnosis of acute pain is relatively easy.
In chronic pain, the milder ones are prolonged; the pain is milder, generalized and has radiating pain, so it is not easy to determine the exact site of inflammation. Testicular pain is not necessarily proportional to the severity of the inflammation; some people have high nerve sensitivity and mild inflammation can cause more severe pain sensation; while others are more sluggish and feel lighter in themselves. Some pain occurs after sexual intercourse, which may be due to sexual arousal that makes the genitals and gonads highly congested. In some cases, the pain is caused by varicocele or pain radiating from other areas, such as radioactive pain in the testicles caused by ureteral calculi.
The following is a brief classification of the common causes.
Trauma
The testicles are more mobile in the scrotum and are protected by a tough white membrane, so there is less chance of closed injury. Testicular injuries are mostly related to violence and car accidents. After the injury, the testicles are in severe pain with nausea and vomiting, and even fainting or shock occurs. On physical examination, there is testicular swelling, indistinct contour or scrotal petechial hemorrhage, and obvious pressure pain.
Testicular contusions are most often seen as a result of direct kicking, high fall riding injuries, and squeezing of the testicles. The pain after the injury is severe, often radiating to the lower abdomen and ipsilateral lumbar region and accompanied by nausea and vomiting, which can cause painful shock in severe cases. On examination, the scrotum can be seen to be enlarged, with subcutaneous bleeding and obvious pressure pain, and the hard testicle can be palpated because of the increased internal pressure due to the restriction of the firm testicular white membrane.
Testicular rupture is usually the result of an open injury, and the testicular tissue can often be seen exposed. Testicular rupture caused by blunt injury is less common. The main manifestation is severe pain after the injury, and even nausea, vomiting and fainting may occur. Examination reveals bruised scrotal spots, swollen testicles, unclear testicular contours, and obvious tenderness.
Open injuries are caused by direct injury from sharp objects, bullets, shrapnel, etc. Simultaneous damage with scrotal wall and other tissues can cause partial defect of testicular tissue, and in serious cases, the testicular artery can be injured, causing active bleeding or huge hematoma, and finally leading to atrophy and necrosis of the testicle; and may leave complications such as impotence and sexual dysfunction.
Testicular dislocation is caused by blunt violence in the perineum squeezing the testicle, resulting in the testicle being displaced and then unable to return to its original normal position by itself. The location of the testicle after dislocation depends on the size, direction, nature and local anatomical weakness of the violence. The testis is often dislocated in the inguinal canal and the perineum. It presents as severe pain in the groin or perineum after trauma, and on examination the scrotum is found to be empty, while a painful mass can be palpated in the corresponding area outside the scrotum.
Medically induced injuries are commonly caused by intra-scrotal surgery, such as epididymal surgery, sheath reversal, testicular biopsy, testicular puncture, etc., which can directly lead to testicular injury. However, local injury to the testis will not cause serious consequences if repaired in time.
Scrotal hematoma should be found immediately after stopping activities, and it is best to apply cold compresses with ice water to the affected area immediately after the injury if possible, and constantly apply cold compresses with ice water or cold water to the scrotum within 12 hours after the injury to achieve the purpose of constricting blood vessels and reducing local bleeding. At the same time, rest in bed and minimize unnecessary activities. When you have to move slightly, you should also wear tight and elastic swimming trunks to hold up the scrotum and reduce the pain and discomfort caused by the scrotum falling or moving around. After 24 to 48 hours, when the bleeding in the scrotum has completely stopped, hot compresses can be applied to the scrotum to speed up the local blood circulation and promote the absorption and dissipation of the bruises in the scrotum.
In general, the pain of scrotal hematoma is not excessively severe and some do not require pain management. For people with more severe pain, symptomatic treatment such as oral pain relief tablets can be administered. After 1-2 days of rest, the pain will be significantly reduced and the hematoma will subside in 1-2 weeks.
If the trauma is too severe, the scrotal pain is very intense, cold sweat is dripping, and it is difficult to take oral painkillers to relieve the pain. A huge and growing scrotal hematoma often suggests a more serious injury such as a ruptured testicle may be combined. In this case, the above mentioned principles should not be followed only, but the patient should be sent to the hospital as soon as possible for emergency treatment.
Testicular torsion
Testicular torsion is one of the common emergencies in the scrotum. It can occur from newborn to 70 years old, and 65% of them occur at the age of 12-19. Generally, there is strenuous activity a few hours before the onset, or the testicle has been subjected to external force. Sudden onset of severe testicular pain during sleep or quiet time is the first symptom of the disease and one of its main diagnostic bases, some patients are accompanied by nausea and vomiting, scrotal swelling, and obvious tenderness. For those with sudden onset of severe testicular pain, rapid enlargement of the testicle, accompanied by severe nausea and vomiting; obvious testicular tenderness, inability to relieve or aggravate the pain by elevating the testicle, abnormal position of the testicle and epididymis or unclear palpation; color Doppler ultrasonography: testicular blood circulation is impaired due to torsion of the spermatic cord itself, manifested by enlargement of the affected testicle, hypoechoic, and color Doppler flowmetry shows that the blood flow signal within it The testicular torsion should be highly suspected if there is a significant reduction or disappearance of the blood flow signal.
For patients who suspect or cannot exclude testicular torsion, early surgical investigation should be performed to reposition and fix the testicle in order to save the testicle and protect the spermatogenic function. After the diagnosis of testicular torsion is made, time should be sought for immediate surgical repositioning, aiming to complete the surgery within 6 hours of the onset of symptoms. After resetting the torsioned testis and observing normal blood flow, interrupted suture fixation of the testis, spermatic cord and inner scrotal sheath should be performed to avoid postoperative recurrence. If the blood circulation of the testis is found to be extremely poor intraoperatively and cannot be restored after reset, the testis should be removed.
It is generally believed that the testicular salvage rate can reach 80% for those who are treated within 6 hours of testicular torsion and only 20% for those who are treated after 24 hours, and even if the testicle can be preserved at this time, the function of the affected testicle is often damaged.
Infection
Testicular infection is a common cause of testicular pain. The reason for this is that there are many reasons for testicular pain, such as mumps, which can be complicated by testicular pain and enlargement; gonorrhea, which is the most prevalent sexually transmitted disease, can cause testicular pain and enlargement in severe cases; chronic prostatitis can also cause testicular pain, which is unilateral pain, mostly dull pain or pulling pain, which is persistent, and a large number of prostate fluid can be seen on microscopic examination. It is a very common condition in young adults and is rare in the elderly.
Ischemic pain
Ischemic pain in the testis is mostly seen in the elderly, the pain is more intense, aggravated by activity and relieved at rest, the prostatic fluid microscopy is normal, often due to testicular artery narrowing caused by testicular arteriosclerosis. Testicular atherosclerosis is often a local manifestation of systemic vascular lesions, mostly unilateral, with the left side being more common than the right. The diagnosis of this disease is mainly based on age, progressive worsening of unilateral testicular pain, and ultrasound showing insufficient blood supply to the affected testis. There is no effective treatment yet, vasodilators, enteric aspirin and calcium channel blockers can be used, and for those who have severe pain and the above treatment is ineffective, orchiectomy on the affected side can be considered.
In conclusion, “egg pain” is not a trivial matter, once the above causes and symptoms, must not be ashamed to consult the doctor and delay treatment; early detection, early diagnosis, early treatment, for “egg pain”, and even other diseases, are the principles of clinical management.