From the Guidelines
Testicular pain in teenagers should be evaluated promptly as it may indicate serious conditions requiring immediate attention, with a focus on ruling out testicular torsion, which requires surgical intervention within 6 hours to save the testicle 1. When managing testicular pain in teenagers, it is crucial to consider the potential causes, which include testicular torsion, epididymoorchitis, and torsion of the testicular appendage, accounting for approximately 85% to 90% of cases 1.
Key Considerations
- For mild pain, over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (650-1000mg every 6 hours) can provide relief, along with applying ice packs for 15-20 minutes several times daily and wearing supportive underwear to reduce discomfort.
- Sudden severe testicular pain requires emergency medical evaluation to rule out testicular torsion, which needs surgical intervention within 6 hours to save the testicle 1.
- Other common causes include epididymitis, which can be treated with antibiotics like doxycycline 100mg twice daily for 10 days, varicocele, hydrocele, or trauma.
Recommendations
- Teenagers experiencing testicular pain should be encouraged to report it promptly and avoid self-diagnosis, as timely treatment is essential for preventing long-term complications like fertility issues.
- Regular testicular self-examinations are also recommended for adolescent males to familiarize themselves with normal anatomy and detect any changes early.
- Parents should accompany teenagers to medical appointments, but physicians may request private discussions with the patient to address sensitive concerns. Given the potential for serious underlying conditions, it is essential to prioritize prompt evaluation and treatment to minimize morbidity, mortality, and impact on quality of life 1.
From the Research
Testicular Pain Management in Teenagers
- Testicular torsion is a urological emergency that can occur in teenagers, with an incidence of 3.8 per 100,000 males younger than 18 years 2
- The standard of care for a patient with testicular pain to rule out testicular torsion is a Doppler ultrasound scan and an emergent urology consult 2
- Hand-held Doppler (HHD) examination can be used as a first-line triaging tool to rule out testicular torsion in patients presenting with acute testicular pain, with a specificity of 97.8% 3
- Rare differential diagnoses of acute scrotal pain in adults include tumors, segmental testicular infarction, testicular vasculitis, pancreatitis, brucellosis, spermatic vein thrombosis, acute aortic syndrome, and appendicitis 4
- Prompt diagnosis and management of testicular torsion are essential to prevent complications, including testicular infarction, necrosis, and sub/infertility 5
Diagnostic Approaches
- Doppler ultrasound scan is a crucial diagnostic tool for testicular torsion 2, 5
- Hand-held Doppler (HHD) examination can be used as a rapid bedside diagnostic tool for the evaluation and triaging of subjects with acute testicular pain 3
- A thorough history and physical examination are essential for the diagnosis of scrotal pain, including testicular torsion, epididymitis, and other conditions 6
Management Strategies
- Surgical management is indicated in case of suspicion for torsion or tumor 4
- Prompt diagnosis and management of testicular torsion are essential to prevent complications, including testicular infarction, necrosis, and sub/infertility 5
- Emergent urology consult is recommended for patients with testicular pain to rule out testicular torsion 2