Why do my balls hurt? Testicle pain explained

Painful testicles can be very worrying. We discuss the potential causes and treatments.

Male testes, illustration
SEBASTIAN KAULITZKI/SCIENCE PHOTO LIBRARYGetty Images

Men are notoriously sensitive about their testicles. After all, they are sensitive structures. But discomfort and pain in the ballsack causes a disproportionate amount of concern for men.

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The family jewels

This concern is often over and above vulnerability. As well as being directly linked to masculinity, testicles are the starting point for procreation, which is why they are still often referred to as the 'family jewels'. So when anybody talks about a man being kicked 'where it hurts most', we know what they are talking about.

Testicles are situated externally to the body for a reason. This is to maintain optimum temperature for sperm production (2°F lower than the rest of the body), which unfortunately makes them more susceptible to injury.



Testicle talk

Testicles are also sensitive in that men often find it difficult to talk about them.Abnormality in the ball area is, for many men, a source of embarrassment. This results in an inability to make GP appointment, a reluctance to discuss the issue with partners or friends, and a potentially life threatening delay in the diagnosis and treatment of more serious problems.

A recent spate of high profile awareness campaigns has highlighted the issue of testicular cancer, because it is the most common cancer affecting young men in the 15 to 35 age group.

The fact that this cancer is relatively rare and has a successful cure rate of 99 per cent if captured early seems to escape many men.

No pain no gain

Testicular pain itself is a very uncommon sign of cancer. A painless lump in the testicle is more suggestive of a tumour. So, ironically, the presence of pain, excruciating though it may be, is in some ways a very positive sign.

Any pain or discomfort in a testicle is abnormal and although many lumps that may be felt are benign, it is always essential to have them checked by a doctor, especially if they are painless.



Common causes of testicular pain

There are eight main types of testicular pain:

1. Direct injury

Direct blows to the scrotum will cause a nauseating dull ache. Any man who has ever suffered a knock in this area will agree. Because testicles are so vulnerable, all contact sports should be played wearing supporting underwear or a jock strap.

  • Cricket: A box should be used, especially when fielding near to the stumps or when batting, as a a hard cricket ball can cause considerable damage. Usually, bruising or swelling are the worst consequences of a direct blow. However alarming it looks, it will tend to settle within a few days with the help of supportive underwear, painkillers and warm baths.
  • Vasectomy: The bruising and swelling resulting from a normal vasectomy operation will repair itself in the same way to a sporting injury and in a similar amount of time.
  • Cycling: Bike injuries are not uncommon, for long-distance cycling in restrictive shorts on poorly padded saddles and stunt riders slipping off the peddles and falling heavily onto the cross bar.

    2. Infection

    Both the testicle itself and the epididymis (the tube at the back of the testicles) are prone to infection with microorganisms. Inflammation of the testicle is known as orchitis, and in the epididymis as epididymitis.

    When both occur together, as they often do, it's called epididymo-orchitis and makes the testicle feel tender, swollen and hot to touch.

    Bacterial infections often start in the urinary system and usually respond well to a course of antibiotics.

    Mumps: This viral infection is not an uncommon cause of orchitis in adult men who are not immune, usually affecting one ball, but sometimes both.

    Mumps orchitis is usually preceded by facial swelling due to an inflamed salivary gland just below and in front of one or both ears. Because viruses do not respond to antibiotics, the best treatment is usually pain relief and rest. In a small proportion of cases, mumps orchitis can lead to infertility if both testicles are involved.



    3. Varicocele, epididymal cyst and hydrocele

    Just like the veins in the leg, the veins that drain blood away from the testicles in the scrotum can become varicose and a varicocele is formed. This feels like a bag of worms at the top of the testicle on the affected side and the veins themselves may be tender to the touch.

    Varicocele, epididymal cyst and hydrocele can each lead to discomfort around the testicle, rather than actual pain in the testicle itself. The discomfort is achey, and wearing a supportive pair of pants or a jock strap will help.

    A doctor can distinguish between swollen veins and the normal underlying testicle through an examination. In moderate to severe cases, an operation to remove the varicose veins is necessary.

    Cysts: The epididymis or sperm collecting apparatus at the rear of the testicle can sometimes form one or more cysts that may become enlarged and on occasion painful.

    Small cysts may resolve without treatment. Larger can be mistaken as lumps within the testicle itself. If they are repeatedly painful despite adequate support, surgical removal is sometimes indicated.

    Hydrocele: This is a bag of clear fluid that collects in a sac around the testicle and may be the result of a direct injury. Alternatively, it can occur spontaneously in the remnants of an embryonic sac that remains formed around the testicle from birth.

    Small hydroceles often disappear without treatment. Larger ones, however, can be drained and the remaining sac removed surgically so it does not reoccur.



    4. Hernia

    A hernia occurs when a weakness in the muscular wall of the abdomen allows a loop of intestine to push through it, causing a lump to form on the outside.

    In the groin area, a large hernia can descend into the scrotum making it appear more bulky. The pain, which is usually abdominal rather than scrotal, can be made worse by movement, coughing or sneezing. An operation called a herniorrhaphy is required to correct the underlying muscle weakness.

    5. Torsion of the testicles

    The testicles are fairly mobile structures but they are attached to the scrotum to prevent them twisting too far in any direction. Testicular torsion occurs when excessive twisting does happen and the blood supply is cut off from above.

    The testicle then swells and becomes acutely painful. While sometimes the swelling can allow the torsion to correct itself, permanent torsion can be serious and the testicle will die after six hours without a blood supply.

    An operation can resolve the situation, but if gangrene has occurred the testicle on the affected side will need to be removed. But many men still function perfectly normally with only one testicle and their ability to perform sexually and to father children is not affected.

    6. Blue balls

    Sexual arousal that does not terminate in ejaculation can cause congestion in the sperm carrying tubes, resulting in a dull aching sensation in the testicle. This is sometimes referred to as 'blue balls', which is inconvenient but entirely harmless.

    The pain disappears within a few hours, although some men relieve the discomfort through masturbation.

    ⚠️ Nowadays, testicular cancer is curable in more than 99 per cent of cases, so it's essential that you visit your GP.

    7. Kidney stones

    A kidney stone on the move from the kidney area downwards to the bladder and out through the penis will usually cause intense sharp pains in the abdomen. Also, blood may sometimes appear in the urine.

    When the doctor finds no abnormality in the scrotum in the presence of these symptoms, they often start treatment for kidney stones.

    8. Testicular cancer

    This rarely causes pain and discomfort. Typically, testicular cancer produces a painless swelling of one testicle, which cannot be distinguished from the testicle itself by examination and does not appear to be located in the epididymis or surrounding area.

    Any lump in the scrotum that is new and abnormal should be reported urgently to your doctor. Testicular cancer is the commonest cancer in young men aged between 18 and 35, and can become serious if neglected and left untreated,

    Based on a text by Dr Hilary Jones

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