Archive for the ‘orchalgia’ Category

Blue Balls-Sex and Painful Testicles

May 12, 2013

You are a young man. Just getting started with sex and engage in heavy petting resulting in sexual arousal. After 45 minutes of heavy petting, you have an ache and discomfort in your testicles. What is this? What should you do?

Blue balls are not just a figment of a male’s imagination or a lame excuse to try and get you in the sack. Though it doesn’t happen to all men, it is a very real condition that results from a prolonged state of sexual arousal. When a guy is physically turned on, blood flows to his penis, which is what gives him an erection, which is a good thing, and his testicles, causing them to swell, not such a good thing! If he doesn’t ejaculate, there is a buildup of pressure, and his supersensitive testicles start to hurt. The sensation can range from a mild ache to worse-than-getting-kicked-in-the-crotch pain.

Bottom line: Blue balls are not dangerous, and a young man can resolve it. The easiest solution is for the man to masturbate as an orgasm and ejaculation will cause the congestion in the penis and scrotum to abate. Just as the erection will subside after an ejaculation, the congestion around the testicles will also subside and the pain will go away. If the young man has an aversion to masturbation, then just waiting it out is also a solution as the blood will eventually drain, and any discomfort will disappear on its own.

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Blue Balls-When It Hurts Down There During Sexual Activity

May 11, 2013

Screen Shot 2013-05-11 at 12.51.26 PMNearly every young man has had the experience of intense sexual stimulation and an aching sensation in his testicles. It is common in young men just experiencing sexual activity and has been a source of pain and discomfort for nearly every man who embarks on his sexual career.

Blue balls is a slang term referring to testicular aching that may occur when the blood that fills the vessels in a male’s genital area during sexual arousal is not dissipated by orgasm and ejaculation.

When a man becomes sexually excited, the arteries carrying blood to the genital area enlarge, while the veins carrying blood from the genital area are more constricted than in the non-aroused state.

The good news is that this uneven blood flow causes blood to be trapped in the two chambers of the penis resulting in the penis becoming erect. This increase of blood supply to the testicles and the trapping of blood around the testicles because the outflow of blood has been decreased causes vasocongestion or engorgement of the testicles resulting in an increase in size of the testicles by 25-50 percent. This distension of the testicles results in the pain and discomfort referred to as blue balls.

If the male reaches orgasm and ejaculates, the arteries and veins return to their normal size, the volume of blood in the genitals is reduced and the penis and testicles return to their usual size rather quickly.

If ejaculation does not occur there may be a lingering sensation of heaviness, aching, or discomfort in the testicles due to the continued vasocongestion.
The condition usually does not last long and the level of pain associated with blue balls is usually minor and can be exaggerated. Most men have been socialized to ejaculate when they get an erection during sexual activity. Failure to ejaculate and to feel orgasm often adds frustration and disappointment to the reality of the physical sensation.

Men who believe that they should ejaculate every time they have an erection are likely to exert pressure on their partner to proceed with sex without taking her feelings into consideration.
Some men find that masturbation is a viable solution and are realizing that ejaculation is not a requirement in every sexual situation. This attitude allows both men and their partners to relax more and to learn that pleasure and meaning can exist without having to reach ejaculation and orgasm during every sexual encounter.

It’s nice to know that men are not alone with this problem as it impacts both sexes. Both men and women experience the discomfort of unrelieved vasocongestion. Women’s genitals also become engorged with blood during sexual arousal and, like their male counterparts, women can experience pelvic heaviness and aching if they do not reach orgasm.

When There’s a Problem In the Jewel Sack-Scrotal Pain

September 1, 2012

Every man has taken one in the jewel box that bends him over in excruciating pain and discomfort. Fortunately, most of the pain goes away in a few minutes. However, the scrotum and its contents are very vulnerable to injury and disease. This blog will describe the most common conditions affecting men “down there”.

The scrotum is located outside the rest of the body in order to keep the testicles a few degrees cooler than the rest of the body. This is intended to keep the testicles which contain the sperm factories just the right temperature for sperm production.

Normal Anatomy of the Scrotum

The testicles have two functions: 1) sperm production and 2) testosterone production. Testosterone is the male hormone responsible for developing male characteristics like a deep voice, a beard, and the all-important sex drive.

Evaluation of the painful scrotum
Your doctor will take a careful history and find out how long the pain or swelling has been present. The doctor will want to know if the pain is associated with trauma like a soccer ball or someone’s foot to the “vital parts.” The association of pain and swelling with a fever is a sign of infection and inflammation. A physical exam will be conducted and a light may be used to see if there is excess fluid in the scrotum. This is followed by a urine exam and an ultrasound of the scrotum. This makes use of high frequency sound waves that are sent from a transducer and then reflected back to the transducer to be processed by a computer and then projected onto a computer screen. This test will usually diagnose most of the conditions that cause pain and swelling the scrotum.

Torsion

torsion of the testicle

This occurs when the testicle twists and inside the scrotum and cuts off the blood supply to the testicle. Although torsion of the testicle can occur at any age, it is most common in young boys and young men between the ages of 12 and 18. The chief compliant is the sudden onset severe pain in one testicle. It usually begins after exercise but can occur when the boy is at rest or even awaken the boy from sleep. The physical exam reveals that the testicle is painful to touch and drawn up high in the scrotum. The diagnosis is confirmed by the ultrasound exam. Immediate surgery is required in order to save the testicle. If surgical treatment is delayed beyond 4 hours, it is less likely that the testicle can be saved. Although torsion only occurs in one testicle, the urologist will always repair the opposite testicle so that torsion cannot occur on the opposite side in the future.

Testicular cancer

Testis Tumor


Most men with scrotal swelling worry about testicular cancer, it is actually relatively uncommon with only 7000 new cases diagnosed each year. The disease usually affects young men between the ages of 15-40. The cause is not known but it is much more common in males who have a testicle that has not descended into the scrotum at the time of birth. The man with testicular cancer usually notices a hard lump on the scrotum. The lump is usually painless. The diagnosis is confirmed with a blood test looking for tumor markers, beta HCG and alpha feto-protein, and a scrotal ultrasound. The treatment is to remove the testicle and the cancer. Testicular cancer has a very high cure rate. All men should learn to do a testicle self exam at least once a month. Any suspicious lumps or bumps should be brought to the attention of a physician.

Orchitis

Orchitis is an inflammation of the testicle that is associated with pain and fever and swelling. Mumps is the most common cause. It is not very common thanks to the use of vaccination in young boys. Mumps orchitis is caused by a virus and there is no treatment except bed rest, anti-inflammatory medication, and pain medication.

Epididymitis

This is a inflammatory condition involving the gland and ducts that are behind the testicle and are responsible for allowing sperm to mature until they are ready to enter the semen. It is usually a bacterial infection that starts in the urine or the prostate and then backs up and goes down the vas to cause an infection in the epididymis. The problem may be accompanied by burning on urination and a urethral discharge. Men may also have a fever.

The diagnosis is made with a physical examination, a urine test which may show evidence of infection. The treatment is bed rest, a scrotal support or tight jockey underwear to support the scrotum, antibiotics and anti-inflammatory medication.

Hydrococele

hydrococele


A hydrococele is a swelling that takes place slowly over time. Usually months or even years. A hydrococele is a collection of fluid around the testicle, which remains entirely normal. A doctor can easily make the diagnosis by simply transilluminating the scrotum with a bright flashlight held up against the scrotum. The diagnosis can be confirmed with an ultrasound examination.

The treatment is usually surgical procedure which is brief operation, done on a one day stay basis and most men can return to all activities two weeks after the operation.

Spermatococele

Spermatococeles are fluid filled cysts in the epididymis. Spermatococeles are usually painless swellings that can also be diagnosed by tranillunination. Surgery is the treatment of choice if the spermatococele causes discomfort because of its size or if it is cosmetically unacceptable.

Varicocele

varicocele


Varicoceles consist of dilated network of veins in the spermatic cord. This problem is common and occurs in 15% of men and occurs most commonly on the left side. It usually causes minimal discomfort but can be associated with infertility. Treatment consists of surgically tying off the abnormal veins or using a coil placed by a radiologist to occlude the abnormal veins.

Bottom Line: A lump or bump down there should get a man’s attention. Most scrotal conditions can be easily diagnosed in the doctor’s office or with a scrotal ultrasound. Most cases are not serious and prompt treatment will nearly always put a man back in action.

When You Have A Tack In Your Sack-Chronic Testicular Pain

June 15, 2012
When It Hurts Down There

Chronic Testicular Pain

Chronic testicular pain is a common malady causing havoc in men with this problem. The pain can be so debilitating that men lose productivity in the work place, have sexual problems and even depression that requires treatment. Men often have anxiety about cancer. Chronic testicular pain is also called orchialgia, orchidynia, chronic pelvic pain syndrome, or chronic scrotal pain syndrome. These are all terms used to describe intermittent or constant testicular pain.

Chronic testicular pain occurs at any age but the majority of the patients are in their mid to late thirties. The pain can involve one or both testicles. The pain can remain localized in the scrotum or radiate to the groin, perineum, back or legs. On clinical examination the testis may be tender but in the majority of men is otherwise unremarkable.

Causes of orchialgia include infection, tumor, testicular torsion, varicocele, hydrocele, spermatocele, trauma and previous surgical procedures such as a vasectomy.

Any organ that shares the same nerve pathway with the scrotal contents can present with pain in this region. Pain arising in the kidney, hip, prostate gland or back pain caused by a herniated disc can present as testicular pain. Injury to nerves following a hernia repair can cause chronic testicular pain. Chronic testicular pain has been recognized as a feature of diabetic. Some men attribute the start of their chronic testicular pain to some form of blunt injury to the testicles. Unfortunately in a large proportion of patients the cause of their pain remains unknown.

Post vasectomy chronic pain syndrome
It is not common but there is a possibility that following a vasectomy an obstruction or congestion of the vas or in the epididymis may be the cause of the pain.
If the man has an injection of local anesthetic, such as xylocaine, prior to cutting the vas, this may reduce both immediate and long term post vasectomy pain.

The formation of spermatic granuloma following a vasectomy has been well documented but its protective or causative role as been controversial.

Testing
Scrotal ultrasonography is usually part of the evaluation of patients with scrotal pain. However, in the absence of significant clinical findings during physical examination and in the presence of negative urinalysis, the only real benefit of scrotal ultrasound is reassurance to the patient worried about cancer

Treatment
Surgery is to be avoided if possible. Even if infection has not been identified a small number of patients may respond to a combination of antibiotics and non-steroidal anti-inflammatory drugs. Tricyclic antidepressants, such as imipramine, sometimes relieve the pain. Those with intractable symptoms may benefit from a multidisciplinary team approach involving a urologist and a pain clinic specialist including a psychologist. Transcutaneous electrical stimulation or TENS analgesia often have favorable results. This works on the principle that transcutaneous electrical stimulation causes release of endorphins in the nerves of the spinal cord that supply the scrotum.

A spermatic cord block with a local anesthetic such as xylocaine can be done in the doctor’s office. The procedure, if successful, can be repeated in regular intervals.

For patients who fail to respond to conservative management and wish to avoid the surgical options that are available in treating chronic orchialgia, a trial with an alpha blocker might be an option.

For patients in whom all medical treatments have failed and testicular pain continues to impair their quality of life, surgical intervention may be indicated as a last resort. A number of surgical strategies have been described.

Microsurgical denervation of the spermatic cord may provide relief of chronic testicular pain. Another technique is to divide the ilioinguinal nerve and its branches.

Removal of the epididmymis or epididymectomy should be performed only if the patient had been counselled regarding the likelihood of poor results.

Vasectomy reversal
Putting the vas back together or a vas reversal has helped a number of men with chronic testicular pain.

Unfortunately a small number of patients who fail to respond to medical or more invasive treatment will ultimately undergo removal of the entire testicle for pain relief. This procedure must be the last resort.

Bottom Line:
Chronic testicular pain remains a challenge to doctor as well as the patient.
Help is usually available with medication, nerve stimulation with TENS, and only surgery as a last resort.