Testicle Pain Is Rarely Cancer – But Don’t Ignore It

It’s not unusual for men to experience testicle pain at some time in their lives. The testicles are sensitive organs, and pain can be caused by many things, including injury, infection and fluid buildup.

“Testicular pain is a very common condition that we see,” says University Hospitals urologist Ramy Abou Ghayda, MD. “Many of my patients present at my clinic with discomfort, pain or pressure localized to the genital area, particularly the testicles.”

He shares more about common causes of testicular pain, as well as treatment and prevention strategies.

Inflammation and Infection

Inflammation is a leading cause of acute and chronic testicular pain. Inflammation of one or both testicles is called orchitis. Inflammation of the duct that stores and carries sperm is called epididymitis.

“Inflammation could be from a variety of causes,” Dr. Ghayda says. “It could be a bacterial or viral infection. It could be overexertion or trauma.”

• Infections can be caused sexually transmitted infections, mumps, urinary tract infections or other sources.
• Reflux of urine into ducts that carry sperm and seminal fluid can cause inflammation.
• Young adults can experience inflammation due to very active sperm production.

“Inflammation may be associated with high intratesticular pressure in younger men and boys due to increased sperm production or not ejaculating regularly. Strenuous exercise without adequate recovery can worsen symptoms,” Dr. Ghayda says.

Testicular Torsion

A twisting of the testicle that impedes blood flow, torsion causes sudden, severe pain and is a medical emergency. Surgery is needed to restore blood supply to the testicle. Torsion may be accompanied by nausea, vomiting and a high-riding testicle.

“Peak incidence is during adolescence, but torsion can occur at any age,” says. Dr. Ghayda. “Time to intervention is critical. Irreversible damage may occur within 4 to 8 hours.”

“If a patient comes to the office and then they're complaining that they woke up in the morning because of a severe, sharp pain of the testicle, then I'm suspecting a testicular torsion. The next step would be going to the emergency department.”

Testicular Tumors or Cancer

Tumors may be painless or cause a dull ache or a sensation of heaviness. Tumors are most common in men ages 20 – 40, but can occur at any age. It often presents as a lump or bump on the testicle. Testicular cancer requires surgery to remove the testicle.

“Any mass should be considered malignant, until proven otherwise,” Dr. Ghayda says. “Ultrasound is used to image the mass, followed by further oncological workup if needed.”

Varicocele

Swelling of the veins in the scrotum, varicocele typically cause pressure or dull pain in the testicles, most often on the left side. The condition often requires surgery.

• Pain often worsens with standing or exertion.
• Varicocele may be associated with infertility in some patients.
• Diagnosis is confirmed with ultrasound imaging.

Inguinal hernia

A common type of hernia where part of the intestine protrudes through the abdominal wall, often causing testicular pain. A physical exam may detect a bulge in the groin or scrotal sac, and imaging with ultrasound or CT scan may be needed.

Hydrocele

A collection of fluid around the testicle, hydrocele usually occurs in men 60 and older.

• May present as painless swelling and a feeling of heaviness.
• Surgery may be needed to drain fluid.

Sexually Transmitted Infections (STIs)

STIs such as chlamydia and gonorrhea can cause inflammation in the testicle and the tube the stores and transports sperm.

• Symptoms include pain, swelling, urethral discharge and burning sensation while urinating.
• Treated with antibiotics.

Other Possible Causes

• Injury or trauma to the testicles.
• Referred pain from stones in the urinary tract such as kidney stones.
• Referred pain from nerve impingement due to lumbar disc herniation or other spine conditions.

“In cases of referred pain, the origin is frequently spinal or neuropathic,” Dr. Ghayda says. “When you have spinal disc disease and you have a compression of the nerve in your back, you might have a referred pain in the testicles because it's the same nerve that goes to both.”

Diagnosing & Treating Testicle Pain

Sometimes the source of testicle pain can be determined with a thorough patient history and a physical examination. Dr. Ghayda says patients are asked about the type of pain, when it started, whether the patient has done strenuous physical activity, their history of injury and sexual activity.

“We need to examine the size of the testicles to check for any hard masses or hard areas in the testicle that would suggest testicular cancer,” Dr. Ghayda says. “We also do a physical exam of the veins to make sure the patient doesn't have a varicocele. A physical exam typically gives us plenty of information about what we might be dealing with.”

Additional tests may include ultrasound, CT scan, urinalysis and STI screening. “A focused physical examination combined with ultrasound provides diagnosis in most cases,” Dr. Ghayda says.

Easing Testicular Pain

For inflammation, doctors recommend anti-inflammatory pain relievers and ice or cold compresses. They also recommend patients wear supportive underwear. “The more gravity pulls down on the testicle, the more inflammation and pain and discomfort patients are going to feel. We suggest to always wear supportive of underwear,” Dr. Ghayda says.

Another common suggestion is regular ejaculation to release some of the pressure. “Frequent ejaculation, icing, elevation and supportive underwear reduces scrotal strain and can significantly alleviate discomfort.”

Dr. Ghayda says a trend of voluntary abstinence can be harmful to young men. “Some young patients think abstinence is a good thing, that gives them more testosterone and more focus, which is a big myth. What happens is the more they abstain, the more they're going to accumulate sperm and fluid, which is not healthy for the prostate and will make them prone for inflammation. Abstinence is harmful more than beneficial. Regular ejaculation is beneficial for most men.”

Prevention Tips

• Use a condom to avoid sexually transmitted infections.
• Wear protective athletic gear during contact sports.
• Warm up and stretch before vigorous physical activity.
• Avoid prolonged sitting, which increases pelvic pressure.
• Conduct monthly self-examinations for signs of tumor / cancer.
• Don’t ignore testicular pain. Early intervention improves outcomes.

“With any testicular pain or discomfort, it’s very important not to brush it off, even if it’s light pain,” says Dr. Ghayda. “Reach out to a urologist or primary care doctor because it could be the early signs of something that's severe. I would encourage every patient to embrace these symptoms, take ownership of their health and always seek help.”

Related Links

The experts at the UH Urology Institute offer a wide range of general urology services and specialty care for men and women.

The pediatric urology experts at UH Rainbow Babies & Children’s collaborate with our team to provide highly specialized, family-centered care for children of all ages.