Testalgia (Testicular Pain) / Scrotalgia (Scrotal Pain)
Testalgia (testicular pain) / Scrotalgia (scrotal pain)
Testalgia is testicular pain or discomfort felt in the testicles (testes) or scrotum. This is termed as testalgia, scrotalgia or orchialgia.
At times, testicular pain, discomfort or swelling may be very serious and constitutes a medical emergency, for example testicular torsion which requires a patient to come down to the emergency to see the urologist within 4-6 hours of onset of symptoms for emergency intervention. At times, testicular pain may be due to a benign condition.
Causes of testicular pain include:
- Testicular torsion (emergency)
- Torsion of the testicular appendage (twisting of the testicular appendix)
- Kidney stones
- Infection of the testicles or scrotum (acute epididymitis / epididymo-orchitis)
- Sexually transmitted diseases (STD)
- BPH (“enlarged prostate”)
- Referred pain from abdominal and pelvic organs, including inguinal hernia, obstructing ureteral stone, vascular aneurysm, retroperitoneal mass, and hip and spine pathology.
- Testicular trauma (injury)
- Testicular cancer – rarely causes pain unless there is bleeding or infection
- Abscess (pus collection)
- Fournier’s gangrene (infection by a flesh eating bacteria)
- Post-vasectomy pain syndrome (very uncommonly seen after vasectomy)
- Neuropathic causes (due to spinal disc prolapse, compression of nerves along its path in the body)
- Pain due to spasms of the pelvic floor muscles
- Chronic pelvic pain syndromes – pelvic floor dysfunction (chronic pelvic pain syndrome or pelvic floor tension myalgia) may also present with testicular pain
- Idiopathic testalgia (no cause can be found)
Treatment of testalgia is dependant on the cause of the pain. This will require a consultation with the urologist who will obtain a detailed history and conduct a physical examination.
As for idiopathic testalgia / orchalgia, there are no standardized guidelines for evaluation and management of this condition as the cause is unknown or indeterminate. In cases of idiopathic testalgia (where no cause can be determined), your urologist will plan a management strategy for you consisting of various stages of treatments. At times a spermatic cord block (injection of local anesthetic), or even rarely an operation known as microsurgical cord denervation (where the nerve structures supplying the testicle is cut) may be necessary.
When to see your doctor:
All children, adolescents and young adults with testicular pain must view testicular pain as an emergency until proven otherwise, as testicular torsion needs to be ruled out.
In testicular torsion, the testicle twists inside the scrotum. When the testicle twists, the blood vessels contained within the spermatic cord also twist leading to an interruption of blood flow to the affected testicle, which may eventually die off. For more information on this urological emergency, kindly see the section on Testicular Torsion.
Other conditions of testicular pain needs an appointment with a urologist.
The treatment of testalgia is based on the cause of the pain.