What is the cause of the scrotal pain?

"Pain in the balls" is a popular online term recently. The "pain in the balls" here actually refers to pain in the male scrotum, but jokes aside. If a male friend really has "pain in the balls" or scrotum pain in life, he must pay attention to it and never take it lightly. Because scrotal pain may indicate a more serious disease, it is best to get checked and treated in time.

Why do young people feel "painful in the balls"?

Common causes of testicular pain in adolescents

Acute scrotal pain generally refers to sudden testicular pain, sometimes accompanied by testicular swelling. Acute scrotal pain is not uncommon in children and adolescents, and a considerable number of causes can lead to loss of fertility in the future.

Although the incidence varies between different situations, in general, 85% of acute scrotal pain in adolescents is caused by the following three causes:

Testicular torsion:

The incidence of testicular torsion in men under 25 years of age is as high as 1 in 4000. This disease requires urgent treatment as soon as possible, otherwise loss of fertility is inevitable.

In patients with testicular torsion, the spermatic cord, a vital part that connects the testicle to the body, twists spontaneously, cutting off the blood supply to the testicle and causing symptoms such as severe pain.

Testicular torsion can usually be divided into intrathecal and extrathecal types. The former is caused by the congenital absence of the structure that fixes the testicle to the tunica vaginalis (the membranous tissue that wraps the testicle and spermatic cord) (i.e. "pendulum deformity", with an incidence rate of up to 12% in the population), which causes the testicle to twist inside the tunica vaginalis; the latter is generally only seen in fetuses and newborns, because the structure that fixes the testicle to the scrotum has not yet fully developed, causing the testicle, spermatic cord and tunica vaginalis to twist together.

Why do young people feel "painful in the balls"?

Schematic diagram of normal testicular anatomy, intrathecal torsion, and extrathecal torsion

Epididymal orchitis:

Epididymo-orchitis is an inflammation of the testicles and epididymis, usually caused by bacterial or viral infection. In some sexually active adolescents, the disease may be due to a sexually transmitted disease, while in sexually inactive adolescents and children, urinary tract infection is the main cause.

Many children and adolescents who develop epididymo-orchitis can be found to have an unclean sexual history or risk factors for urinary tract infection (such as urinary tract anatomical abnormalities, recent urethral examinations, etc.). However, the cause of epididymo-orchitis remains unknown in about 25% of cases.

It is worth mentioning that mumps can also cause epididymal orchitis, and for a long time, it has been the main cause of it.

Testicular appendage torsion:

The testicular appendages are the remnants of the testicles during embryonic development. Sometimes they can twist, causing ischemia and pain in the testicular appendages. This disease usually occurs in prepubertal boys.

In addition to the three common causes mentioned above, varicocele, testicular cancer, testicular injury, etc. can also cause acute scrotal pain, but they are not common and do not require emergency treatment in most cases.

Characteristics of different causes of "testicular pain"

Because the severity of acute scrotal pain caused by different causes varies greatly, and the treatment methods are also very different, it is necessary to simply identify the characteristics of acute scrotal pain and provide accurate information to the doctor when seeing a doctor. Usually, adolescents who see a doctor for scrotal pain need to provide the doctor with the following information about the condition:

- Age. The causes of acute scrotal pain vary greatly among patients of different age groups;

- The location of the pain and how long the symptoms last are important in determining whether emergency measures (such as surgery) are needed;

- Whether the patient has fever, recent sexual intercourse or urinary tract examination, painful or frequent urination, previous urinary tract infection, etc. All of these manifestations can help the doctor identify whether the patient has epididymal orchitis.

- If the following features are present, then the possibility of testicular torsion is high. In view of the seriousness of testicular torsion, if you suspect testicular torsion, you should seek medical attention as soon as possible to avoid serious consequences.

- Sudden onset of severe pain in the testicles, especially when accompanied by nausea or vomiting. As with other causes of acute scrotal pain, the pain often develops slowly over several days;

- Severe pain caused by minor testicular trauma, or severe testicular pain that comes and goes within a few days and resolves;

- Testicular pain in newborns or adolescents aged ≥13 years. Testicular torsion accounts for nearly 90% of testicular pain in adolescents.

How to deal with "egg pain"?

For all adolescent patients with acute scrotal pain, the occurrence of testicular torsion should be considered. Ultrasound examination can assist in the diagnosis of testicular torsion, but sometimes surgical exploration may still be required. Urine tests and (if necessary) blood pathogen tests can help diagnose epididymal orchitis. For patients with acute scrotal pain with a clear cause, specific treatment is necessary.

Testicular torsion and testicular appendage torsion:

Testicular torsion can usually be diagnosed through surgical exploration, and the testicle can be repositioned and fixed through surgery. Since there is a 40% chance that the contralateral testicle will also be torsion, it is necessary to perform surgery at the same time. Of course, if the repositioning treatment is unsuccessful, the only option is to remove the diseased testicle.

According to the data, the success rate of testicle rescue is as high as 95% if it is relocated within 0 to 4 hours, but if it is within 8 to 10 hours, this number will drop rapidly to 45% to 60%.

For testicular appendage torsion, if it is confirmed by other examination methods, conservative treatment is sufficient. Surgical resection is generally only suitable for patients diagnosed by surgical exploration.

Epididymal orchitis:

Patients with epididymo-orchitis need to undergo bacterial culture and other tests for pathogens to determine the medication regimen. Generally, most patients can recover with adequate antibiotic treatment and retain testicular function. For prepubertal boys with epididymo-orchitis, there is no need for active treatment.

In addition to causal treatment, conservative treatments such as rest, scrotal support, and the use of painkillers can effectively relieve the discomfort caused by epididymo-orchitis. If the patient has fever and a history of mumps before the onset of the disease, it may be epididymo-orchitis caused by mumps. Such patients generally only need conservative treatment, but sometimes they may also need antibiotic treatment due to secondary bacterial infection.

Scrotal pain is very harmful to men's health. Once a male friend experiences this condition, he should go to the hospital for examination immediately to understand the cause and then receive targeted treatment. This can prevent the disease from getting worse due to untimely treatment. The earlier the disease is discovered and treated, the lower the chance of worsening and the less harm the disease causes to the patient.