From the Guidelines
Testicular pain is a medical emergency that requires immediate attention, and patients should seek medical evaluation within 6 to 8 hours after symptom onset to prevent potential testicular loss due to conditions like testicular torsion. The acute scrotum, which includes testicular pain, swelling, and redness, can be caused by various conditions, including testicular torsion, torsion of the testicular appendage, and epididymoorchitis, with the latter being the most common cause in adolescent boys and adults 1. While waiting for medical care, patients can take over-the-counter pain relievers like ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) and apply ice packs wrapped in cloth for 15-20 minutes every hour.
Some key considerations for testicular pain include:
- The clinical presentation can overlap between different conditions, making diagnosis challenging 1
- Torsion of the testicular appendage is the most common etiology in prepubertal boys, and clinical presentations such as focal tenderness over the upper pole of the testes and sudden onset of symptoms can be similar to those of epididymitis and testicular torsion 1
- Testicular torsion is a surgical emergency that requires prompt recognition and surgical exploration within 6 to 8 hours after symptom onset to prevent testicular loss 1
- A validated clinical risk scoring system, Testicular Workup for Ischemia and Suspected Torsion Score, has shown high positive predictive value, but it has not been widely adopted 1
It is essential to prioritize testicular torsion in the differential diagnosis, given its potential for permanent damage if not treated promptly. Patients with testicular pain should be evaluated promptly, and treatment should be guided by the underlying cause, which may include antibiotics for epididymitis or immediate surgery for testicular torsion 1.
From the Research
Causes of Testicular Pain
- Testicular pain can be caused by various conditions, including epididymo-orchitis, testicular torsion, and chronic orchialgia 2, 3, 4, 5, 6
- Epididymo-orchitis is a common cause of testicular pain, especially in younger men, and is often caused by sexually transmitted infections such as N gonorrhoeae and C trachomatis 2
- Testicular torsion is a surgical emergency that requires immediate attention, and is characterized by sudden onset of severe testicular pain, often accompanied by nausea and vomiting 3, 6
Diagnosis of Testicular Pain
- Diagnosis of testicular pain requires a thorough history and physical examination, including a digital rectal exam to check for bladder outflow obstruction and prostate cancer 2
- Doppler ultrasound scan is a useful diagnostic tool for ruling out testicular torsion, and can be performed by emergency department physicians using a hand-held Doppler device 3
- Point-of-care hand-held Doppler examination can safely rule out testicular torsion in patients with acute testicular pain, with a specificity of 97.8% 3
Management of Testicular Pain
- Management of testicular pain depends on the underlying cause, and may include antibiotics for epididymo-orchitis, pain relief for chronic orchialgia, and surgical intervention for testicular torsion 2, 4, 5
- Patients with suspected testicular torsion should be referred to secondary care immediately, as surgery is required within four to six hours to salvage the testes 2, 6
- Patients with chronic testicular pain may require a multidisciplinary approach to management, including pain relief, counseling, and surgery in some cases 4