Scrotum pain: Possible causes (and what to do?)

Since the testicle is a sensitive and complex organ, pain or swelling in it should not be taken lightly.

Whether acute or chronic, testicular pain should always encourage you to consult a general practitioner or urologist as soon as possible in order to treat or prevent the more or less serious complications that may result.

But how can you recognize pain or swelling in the scrotum? What are the causes ? what would be the behavior in front of such a symptom? We tell you everything!

What is the scrotum?

The scrotum is the pocket in which the two testicles fit. It is an anatomical structure made up of muscles and a skeleton divided into two parts, each containing an appendix and a spermatic cord.

The scrotum is characterized by its role of positioning the testicles according to the external temperature, lowering them in hot weather and withdrawing them towards the body in cold weather. Moreover, it always keeps the testicles at a comfortable temperature which is around 34,4 degrees.

How to recognize testicular pain?

Testicular pain is pain in the entire scrotum. It begins at the scrotal level, then goes up along the path of the anatomical structures forming the scrotum (testicles, canals, etc.), to radiate into the iliac or even lumbar region.

Scrotal pain takes two forms:

• Acute pain: localized, sharp, occurring suddenly.
• Chronic pain: persistent and felt, most often, as a feeling of heaviness.

The causes of pain in the scrotum

Testicular torsion

Testicular torsion, also called torsion of the spermatic cord, corresponds to a torsion of the pedicle contained in the testicular bursa. The testicle therefore undergoes a total rotation around its vascular bundle, which prevents its blood supply and thus exposes it to the risk of necrosis. This is why testicular torsion represents an absolute surgical emergency.

Clinically, the pain from the torsion often comes on suddenly, intense, starting in one side only, the other testicle being painless, but the pain radiates into the groin and abdomen. The pain is followed by other symptoms such as a hematoma or scrotal hardening.

Necrosis of the testicle occurs in the absence of any urgent treatment beyond 6 hours of torsion.

From a therapeutic point of view, the management of testicular torsion is always surgical and is always done in the context of an emergency.

On the technical level, it is a question of exploring the twisted testicle and making an incision on the envelopes in order to untwist it under general anesthesia.

Some surgical teams perform, in addition to detorsion, preventive testicular fixation.

Injury or trauma

The diagnosis of testicular trauma is always obvious given the context. Clinically, we are in front of a purse whose volume is quite large compared to its normal state. Inflammatory signs are most often present in the form of edema, pain or tenderness, redness, hematoma, contusion, etc.

In some cases, the doctor may have to carry out an additional examination, such as a scrotal ultrasound in order to explore and comparatively assess the entire envelope of the two testicles (albuginea).

However, in the case of a surgical emergency, when the context and the clinic are obvious, it is essential to intervene as soon as possible in order to relieve testicular compression and thus allow rapid and adequate revascularization.

Inguinal hernia

testicular hernia, commonly called inguinal hernia, corresponds to the presence of a lump in the groin, an anatomical area located between the abdomen and the thigh.

In the vast majority of cases, it is a part of the intestine (intestinal loop or other organ of the abdomen), which comes out of its usual anatomical location (abdomen) and which herniates in the groin.

In some cases, the inguinal hernia may be asymptomatic and show no discomfort, but most patients with an inguinal hernia report the notions of pain, discomfort, a feeling of heaviness in the groin.

Hydrocele

Hydrocele is the presence of fluid in the testicular wall that causes one or both testicles to temporarily increase in size.

Symptoms include filling of the scrotum, with varying degrees of severity. This causes discomfort because the scrotum cannot expand enough to accommodate the available space.

Symptoms can be mild or severe and can lead to painful swelling and discomfort. Also, the discomfort increases when both testicles are involved due to the high pressure in the system.

Visual inspection of the testicle with ultrasound (ultrasound) reveals it to be a watery sac with no discernible contents. This confirms the diagnosis of hydrocele.

Generally, the hydrocele is a benign and painless disease that only requires minor surgery when it poses a cosmetic problem or causes significant discomfort.

Varicocele

A varicocele occurs when the veins under the spermatic cords enlarge. This is because the spermatic cord is a vein-like structure located in the scrotum that connects each testicle to the bursa above.

Varicocele is usually painless and unnoticed by the patient. Most often, it is discovered fortuitously during a fertility check-up or by fortuitous means.

Varicocele pressure can cause testicular pain, weight gain, or scrotal swelling. This pressure can also be felt during high temperatures or exertion.

A urologist diagnoses the disease through clinical observations and a physical exam. These determine whether varicose veins have developed above the testicles. If in doubt, the doctor may perform an ultrasound to confirm the varicocele and rule out other possible causes for the problem, such as an inguinal hernia, spermatic cord cyst, or fluid in the bursa.

Prostatitis

Prostatitis is an inflammation of the prostate which can cause considerable pain. It is a common health problem that can affect people of all ages. Generally, the cause of prostatitis is bacterial or infectious, but some cases remain unexplained.

A person suffering from prostatitis may present with the following clinical picture:

• Fever ;
• Burning sensation during urination;
• Chills;
• Tiredness
• Myalgia or muscle pain
• Presence of blood in the urine
• More or less intense pain in the pelvis, testicles or lower abdomen
• Cloudy and malodorous urine.
• Sexual disorders: difficult or painful ejaculation.

Oncological diseases (cancer)

Testicular cancer usually presents as a visible lump in the scrotum. It is a relatively rare condition that does not often show up in medical records.

Others :

• STIs (sexually transmitted infections) such as epididymitis-orchid infection 
• Sexual arousal without intercourse.

Treatment of pain in the scrotum

The management of scrotal pain includes several therapeutic components and is dependent on the disease in question.

Analgesics are indicated to relieve acute pain in the scrotum; morphine or other opioids can be shown in pathologies requiring surgical treatment.

Any trauma or torsion of the testicle requires immediate medical attention requiring hospitalization. Alternatively, doctors often recommend the use of corrective medications.

Ibuprofen effectively relieves pain. Do not take more than three 600 mg tablets per day.

Due to the cause of the pain, antibiotics are given to eliminate it. A quarter of a 0,25 milligram tablet is taken six times a day.

Essential oils that include lemon balm, juniper, myrtle, rosemary, yarrow, tea tree, and thyme can relieve pain in the scrotum. Adding 5 to 10 drops to a bath can be done to treat or prevent this condition.

If you didn't have time to get to the ER, try keeping the scrotum in an elevated position (lying on a back pillow under the sacrum) and applying ice cream to the sore spot (15 minutes, rest 10 minutes ).

Finally, other therapeutic approaches can be recommended by health professionals, such as alternative medicine, the most recommended of which is acupuncture.

In any case, do not hesitate to consult a health professional for appropriate care.