How do you deal with testicular pain

Doctor's letter : Testicular pain

The testes are the male gonads, which means that this is where the sperm are produced - and stored in the epididymis until they mature. The development of the sperm in the seminiferous tubules within the testes takes 64 days in humans, after which the sperm cells in the epididymis mature for a further eight to 17 days. In addition, most of the male sex hormone testosterone is formed in the gonads.

Explanation: The structure of the gonads makes them prone to dysfunction. In the scrotum there is a dense network of nerves, muscles, the spermatic cord and numerous blood vessels next to the testicular sheaths. These are arranged in such a way that they have the largest possible contact area with the testicles, because their task is not only to supply the testicular tissue with nutrients, but also to cool it. Because only when the temperature is a few degrees below that in the body, the sperm cells can grow. This anatomical arrangement of the vessels with their many coils can promote a backlog of blood, i.e. the development of varicose veins. While these may be a fertility problem, they are rarely associated with pain.

The testicles are also located outside the body for reasons of cooling. However, they are not there from the start. They form within the body during the embryonic phase and migrate - from around the seventh month of pregnancy - down into the scrotum until the time of birth. During this process, the gonads have to "take along" the vessels, the spermatic cord and nerves through the inguinal canal. This process is also prone to failure. Because this lowering of the testicles is not always completed by the time of birth. Doctors call this undescended testicles.

The migration of the testes can also promote other diseases, such as an inguinal hernia. Because a loop of intestine can slip into the canal through which the spermatic cord leads downwards.

In addition, the testicles are very mobile, which also causes problems. Because that can lead to a dangerous twist that interrupts the blood supply. And finally, in and around the testicles, there is a dense network of nerves that, on the one hand, control the kremaster muscle attached to the testicles, which pulls the testicles up for protection or in the event of sexual arousal.

On the other hand, the nerves also transmit pain sensations. "The species-preserving function is the likely reason why the testicles are so sensitive to pain," says Götz Geiges, a resident urologist and andrologist in Berlin-Charlottenburg. The man should be so motivated to protect the gonads from the effects of blunt force so that fertility is not endangered.

Symptoms: Testicular pain can be chronic or acutely triggered by a specific cause. The dull, cramp-like acute pain can spread into the abdomen and be so severe that it literally brings the man to his knees. No wonder that torturers often take advantage of this weak point, for example with electric shocks or beatings.

Root cause: The anatomical structure of the testes is as complicated and prone to failure as the factors that can possibly trigger pain. A twisted testicle - medically: torsion - suddenly triggers very severe pain, for example, which can be accompanied by nausea and vomiting. It may be sufficient to have been wrong during the night. A malignant tumor may, but rarely, lead to pain.

And of course, a blow to the gonads - from a kick, from falling on a bicycle pole, from being hit with a football - is extremely painful. The urologist Geiges calls this a "classic" because such accidents lead boys and men to the urologist particularly often. Such an impact of violence, which doctors call trauma, can permanently damage the testicles, and even lead to a tear in the tissue, i.e. a rupture.

Pathogens that have spread through the urethra or prostate to the testicles or epididymis can also cause persistent pain and swelling. Even from more distant parts of the body, such as an inguinal hernia or a herniated disc, the symptoms can radiate into the testicles. This is often accompanied by signs of infection such as fever, overheating and redness.

Even previous operations, such as an inguinal hernia operation or an intervention for sterilization, can be responsible for testicular pain due to late side effects.

After all, in addition to the purely organic causes, the psyche also plays a major role in chronic testicular pain. So just expecting it to become painful can actually cause pain. Even if an acute pain lasts so long that a pain memory is formed. Because then this remains even if the cause has long since disappeared. If the pain lasts longer than three months, doctors speak of chronic pain.

Because the causes are so diverse and their effects on fertility, for example, can be considerable, the urologist Geiges advises that you always consult a specialist in the event of sudden pain. "If the pain does not subside within a quarter or half an hour on an acute occasion, if a twist is visible or if swelling is palpable in addition to the pain, then you should definitely see a doctor quickly." torn testicles only a few untreated hours to irreversibly damage the testicles and thus fertility as a result of the interrupted blood supply.

Diagnosis: The doctor will first talk to the patient. Because the urologist can determine the probable cause of the discomfort from the type and intensity of the pain as well as the occasion. And in most cases he will also do a palpation of the testicles. An ultrasound examination of the abdomen, for example to rule out an inguinal hernia or a ureteral stone, and a swab from the urethra to clarify infections are also part of the diagnostic instruments. The doctor may also have urine or ejaculate samples examined in the laboratory, also to track down infections.

Therapy: Because the causes of testicular pain are so diverse, the treatment options are also numerous. In the case of testicular torsion, the doctor has to operate quickly, because the twisted vessels no longer supply the testicles with sufficient oxygen. The scrotum is opened, the twisted gonad is correctly positioned and fixed to the inner wall of the scrotum in order to avoid a new misalignment. And because the susceptibility to such a torsion is dictated by the individual anatomy, the doctor will also fix the unaffected gonad when the opportunity arises. "The operation is a routine procedure," says Geiges.

Even if the tissue is torn, the doctor has to use a scalpel and needle to sew up the tear. If the violence "only" left a bruise, it is sufficient to cool the testicle and wait for it to swell.

If an inflammation in the epididymis is detectable, the doctor will treat it with antibiotics, as this disease is often triggered by bacteria - in contrast to the much rarer testicular inflammation, which is usually caused by viruses.

It becomes more difficult and protracted if, despite all the examinations, no organic causes of the pain can be found. Then the doctor tries to directly combat the pain that has become chronic and has lost its warning function and only stands on its own. The usual pain medication that you can swallow - such as acetylsalicylic acid, paracetamol, ibuprofen and the like - are inadequate for this type of pain because they are distributed through the digestive and circulatory systems. But like the brain, the testicles are separated from the general bloodstream by a barrier in order to protect the developing sensitive sperm from possible harmful substances in the blood. An active ingredient that is swallowed does not reach them either. "Acupuncture, biofeedback or relaxation techniques such as autogenic training can be possible alternatives," says urologist Geiges. Possibly, after critical consideration, drug therapies using antidepressants, possibly in combination with special pain medication, should be considered.

If the pain is unbearable, there is another radical possibility: cutting the nerve tracts. "This is a rather rare procedure," says Götz Geiges, who also performs urological operations. The success rate is only 30 to 60 percent. In the other patients there was no improvement - or even a deterioration. Geiges therefore recommends: "In this case, getting a second opinion is always helpful."

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