Scrotal pain is defined as any discomfort in the scrotum and its contents, the testicles, and their structures. This is a relatively common problem for men of all ages, but especially for young adults and middle-aged men. Although they may be boring in the long run, scrotal pain is rarely a sign of a more serious health problem.
The testicles make the sperm and the male hormone (testosterone). Sperm produced in each testicle is stored and matured in the epididymis, a crescent-shaped organ attached behind the testicle. At the moment of orgasm, the sperm is projected from the epididymis and transported in vas deferens, mixed with prostatic secretions and other glands, and then ejaculated.
Thorough examination by your doctor and an investigation if necessary can reliably eliminate several causes of scrotal pain, including:
• A testicular tumor
• Scrotal trauma
• A cyst of the epididymis (a collection of localized fluid)
• Hydrocele (accumulation of fluid around the testicle)
• A hernia (a lump in the groin or abdomen by an intra-abdominal organ)
• A twist of the spermatic cord (a twist of the testicle on his vessel
• blood, cutting off blood circulation and causing sudden and intense pain)
Your assessment was used to eliminate these possible causes of scrotal pain.
Inflammation of the testis ( orchitis ) or epididymis ( epididymitis ) is likely to cause scrotal pain. Sometimes both structures are involved ( orchiepididymitis ). These conditions can be brief (acute) or last several weeks or months (chronic).
Epididymitis and acute orchitis
Acute orchitis is characterized by sudden pain and swelling of the testicle. This pain may be associated with fever, abdominal and pelvic pain and nausea with occasional vomiting. An infection can be the basis of inflammation but often the cause remains undetermined. A bacterium contracted during sexual contact (in sexually active adults) or following a urinary tract infection (especially in young boys and older men) may be the cause. Viruses or other infectious organisms can also cause acute orchitis.
Sudden inflammation of the epididymis is called acute epididymitis . The symptoms of pain and swelling of the scrotal contents are similar in cases of acute epididymitis as in those of acute orchitis. It is often secondary to an infection of the bladder, urethra or prostate. A sexually transmitted infection is often the cause of acute epididymitis in sexually active men. An enlarged prostate in older men, causing difficulty in emptying the bladder and urinary tract infections and prostate, can cause subsequent acute epididymitis. In infants and boys, acute epididymitis is usually related to an infection of the bladder or kidneys, and sometimes to a malformation of the urinary tract.
The diagnosis of orchitis or acute epididymitis can often be made based on the symptoms of scrotal pain and the physical examination of the patient. Urine tests or urethral smears for microscopic examination and culture may be useful. An ultrasound of the scrotum makes it possible to highlight the scrotal structures.
When a bacterial infection is suspected to be the cause of acute orchitis or epididymitis, initiation of antibiotic therapy will usually help to relieve symptoms and cure the infection within a week. The swelling can easily take several weeks to disappear. Anti-inflammatory drugs such as ibuprofen (Advil ™) and pain relievers such as acetaminophen (Tylenol ™) can help reduce pain and temperature. Bed rest, scrotal support and good hydration will speed healing. In most cases, hospitalization or surgery is rarely necessary.
Orchitis and chronic epididymitis
Inflammation of the testis and epididymis may persist for a prolonged period and become chronic. Chronic orchitis is a painful inflammation of the testis, often without swelling, that persists for more than six weeks. Prolonged scrotal pain without inflammation or apparent cause is called chronic orchialgia. It may be impossible to distinguish chronic orchitis from chronic orchialgia. Chronic epididymitis is characterized by a painful epididymis, showing little swelling and persisting for more than six weeks.
The cause of chronic orchitis or epididymitis is uncertain but is sometimes due to testicular trauma or infection or untreated or recurrent epididymis. Men affected by this frustrating problem sometimes experience considerable and prolonged (back and forth) pain that can seriously affect their normal functioning. Long-term complications are possible and are decreased volume of the affected testicle, infertility and chronic pain. There is no known association between chronic orchitis, epididymitis and cancer. The prescribed examinations are the same as in acute cases.
Treatment of acute orchitis or epididymitis can be difficult. Your doctor may recommend the use of anti-inflammatory drugs such as ibuprofen, analgesics such as acetaminophen, scrotal support, heat application or nerve blockage. Antibiotic therapy lasting four to six weeks may also be recommended. In the absence of clearly demonstrated infection, prolonged or repeated antibiotic therapy is rarely effective. In rare cases, testicular or epididymal excision surgery may be used as a last resort for chronic testicular pain. Over time, these conditions usually disappear completely but may persist for several years.
Scrotal pain is a frustrating problem that can have a significant impact on the quality of life of the man. Fortunately, in most cases, this problem completely disappears over time and is rarely associated with a serious condition.