Don’t Mess with Testicle Pain

father with two sons playing basketball

There is one type of pain that adolescent boys and their parents should never ignore – testicle pain.

Sudden onset of severe pain in the testicles or scrotum can indicate that an adolescent or teenaged boy has a condition called testicular torsion. And it needs immediate medical attention.

Testicular torsion is a condition where the testicle twists around the spermatic cord – the structure from which the testicle hangs – within the scrotum. The spermatic cord contains the sperm ducts and blood vessels that supply the testicle. When the testicle twists, so do the blood vessels. This can cut off circulation to the testicle and can lead to permanent damage or death of the testicle in as little as 4-6 hours.

Along with sudden, severe pain, many patients who have testicular torsion also have abdominal pain and nausea or vomiting. The testicle is also usually elevated in the scrotum and extremely tender. The scrotum may also appear red, swollen and very firm to the touch.

If your son complains of testicle pain

First: Ask him when the pain started and what he was doing just before it began. It is important to know if there was an injury, pain with urination or nausea/vomiting.

Then: As uncomfortable as it may be for both of you – it is important to have the child show you his scrotum and testicle. Look for redness and swelling. Touch the area to gauge how firm and/or tender it is.

If the scrotum and testicle within are firm swollen and extremely tender: Call your child’s primary care physician and plan to go to the emergency department – preferably, pediatric – without delay.

If the pain is mild or comes and goes: Call your child’s primary care physician for an appointment to have it checked in the office.

Bottom line: Always seek the advice of a medical professional if an adolescent boy suddenly develops testicular pain.

What to expect in the Emergency Department

If you see symptoms that warrant a trip to the ED, you can expect the patient to be assessed quickly by a physician. The diagnosis of testicular torsion may be made based on the patient’s history and examination alone. In this case, the emergency department staff will immediately consult with a urologist, as an operation called detorsion, will be necessary to treat the condition.

If the patient’s pain is not severe or the examination does not immediately suggest torsion, the ED physician may order an ultrasound of the scrotum and urine tests to help determine the cause of the pain.

Surgical Treatment

The detorsion procedure will be performed by a urologist and will involve twisting the testicle back into its normal position. Both the affected and unaffected testicles will then also be “tacked down” in a manner which prevents another torsion in the future.

Detorsion within 4-6 hours of onset of pain assures near 100% viability of the testicle. After 12 hours, that rate drops to 20%. Detorsion after 24 hours is almost never successful.

If a torsion has gone untreated for too long and the testicle is found to be too damaged to be saved, the affected testicle would be removed as part of the procedure as well.

This condition comes on quickly and without warning. There isn’t anything to do to prevent it, so it’s incredibly important that families talk about this type of pain and what to do if it happens.

We’ve seen too many cases where kids are too embarrassed to talk to a parent about what’s going on with their scrotum and we don’t see the patient until it is too late.

Please, talk to your sons about the importance of telling you if they have this type of pain. And please, seek help as quickly as you can – call your primary care physician first, but be ready to head to the emergency department.

Remember, time is testicle.

Brad Sobolewski, MD

About the Author: Brad Sobolewski, MD

Brad Sobolewski, MD, MEd is an Assistant Professor of Clinical Pediatrics at Cincinnati Children’s in the Division of Emergency Medicine. He is also an Assistant Program Director for the Pediatric Residency Training Program. In addition to providing care for children in the Emergency Department, Dr. Sobolewski is interested in enhancing online and multimedia education for medical professionals as well as patients and their families.

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