Posts Tagged ‘scrotal pain’

“Oh, my aching balls!” -Blue Balls

November 26, 2016

“Oh, my aching balls!” A comment that every young man makes or thinks when he is engaged in heavy sexual activity and his testicles are causing aggravating pain and discomfort. This blog will describe the condition and what can be done to relieve the discomfort.

‘Blue balls’ is the popular slang term for vasocongestion in the testicles. The testicles do not actually turn blue. Instead, a bluish tint appears on the skin of the scrotum because of the increase in blood supply to the area that is trapped there by constriction of the venous blood vessels giving the bluish discoloration. However, this may not happen in all young men.

Cause and Symptoms
When a sexually-matured male is aroused, the following happens:
• His parasympathetic nervous system increases its inputs, causing an increased flow of blood and lymphatic fluids to the genital area.
• Concurrently, muscles that control fluid outflow constrict, resulting in a net increase of fluid concentration.
• These actions combine to ensure that regional blood pressure is high enough to sustain an erection for penetration during sexual intercourse.
• During this process, the testicles also increase in size by about 25 – 50 percent.
When the male reaches orgasm and ejaculates, the constricted muscles relax and the additional fluids flow out from the genital area. The penis and testicles then return to their normal size.
However, when there is prolonged sexual arousal without eventual ejaculation, the bodily fluids will pool, causing congestion in the testicles and the prostate region. The blood becomes oxygen-deprived and turns bluish, giving the condition its slang term, blue balls.
The technical term for this condition is vasocongestion, which is often accompanied by a cramp-like ache at the lower abdomen, pain and tenderness of the testes, and a lingering sensation of heaviness and discomfort in the lower body.
The female homologue is usually referred to by the more general term ‘pelvic congestion’ or ‘pink ovaries’.

Treatments
Vasocongestion does not cause any short- or long-term physical harm to the person, and neither is it contagious or infectious. Although it can be very uncomfortable, it is definitely not life-threatening or an emergency. Even if nothing is done, the symptoms usually subside within an hour of onset.
If one is eager for a quick relief, the easiest way is through ejaculation, i.e., masturbation or enough genital stimulation that results in an orgasm and ejaculation. That will jump-start the parasympathetic nervous system, decreasing the blood flow through the genital area and dissipating the build-up of fluids.

Bottom Line: Blue balls is not a serious condition. However, if the symptoms last for several hours or days after sexual arousal has ceased, then do consult a health care professional to be certain that there is not an underlying cause(s) of the pain and discomfort.

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 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.

Orchitis-A Royal Pain In the Nutt

June 13, 2012

Orchitis is a painful inflammation of the testicle usually caused by a bacterial or a viral infection.  The most common virus that causes orchitis is mumps. It most often occurs in boys after puberty. Orchitis usually develops 4 – 6 days after the mumps begins. Because of childhood vaccinations, mumps is now rare in the United States.

Orchitis may also occur along with infections of the prostate or epididymis, which is the gland behind the testicle that is responsible for sperm maturation.  Orchitis may be caused by sexually transmitted diseases (STD), such as gonorrhea or chlamydia. The rate of sexually transmitted orchitis or epididymitis is higher in men ages 19 – 35.

Risk factors for sexually transmitted orchitis include: High-risk sexual behaviors, multiple sexual partners, personal history of gonorrhea or another STD, having a sexual partner with a diagnosed STD or having a urinary tract infection. 

Risk factors for orchitis not due to an STD include: Being older than age 45, long-term use of a Foley catheter (a tube used to drain the urine from the bladder to the outside of the body), surgery of the urinary tract such as a prostate or bladder operation. 

Symptoms of orchitis

The symptoms of orchitis include: Blood in the semen, a clear or yellow discharge from penis, fever, groin pain, painful ejaculation, Pain with intercourse or ejaculation, pain with urination, scrotal swelling, tender, swollen groin area on affected side, tender, swollen, heavy feeling in the testicle, and testicle pain that is made worse by a bowel movement or straining.

Signs and tests

A physical examination may show: an enlarged or tender prostate gland, tender and enlarged lymph nodes in the groin (inguinal) area on the affected side, and usually a tender and enlarged testicle on the affected side.

Tests may include:  Complete blood count (CBC) which usually shows an elevated white blood cell count, a esticular ultrasound, tests to screen for STDs, and a urinalysis and a urine culture (clean catch).

Treatment

Treatments may include:  Antibiotics — if the infection is caused by bacteria (in the case of gonorrhea or chlamydia, sexual partners must also be treated), anti-inflammatory medications such as ibuprofen, pain medications, and bed rest with the scrotum elevated and ice packs applied to the affected area.

Expectations (prognosis)

Getting the right diagnosis and treatment for orchitis caused by bacteria can usually preserve the normal testicle function.

If the testicle does not completely return to normal after treatment, further testing to rule out testicular cancer should be done.  Usually this can be done with the scrotal ultrasound. 

Mumps orchitis cannot be treated, and the outcome can vary. Men who have had mumps orchitis can become sterile if the condition affects both testicles.

Complications

Some boys who get orchitis caused by mumps will have shrinking of the testicles (testicular atrophy).  Orchitis may also cause infertility.  Other potential complications include:  Chronic epididymitis, death of testicle tissue (testicular infarction) and scrotal abscess.

Acute pain in the scrotum or testicles can be caused by twisting of the testicular blood vessels (torsion), which is a surgical emergency. If you have sudden pain in the scrotum or testicles, get immediate medical attention.

Calling your health care provider

All testicle abnormalities should be medically evaluated. Call your physician or go to the nearest emergency room if you experience sudden pain in the testicle.

Prevention

Getting vaccinated against mumps will prevent mumps-associated orchitis. Safer sex behaviors, such as having only one partner at a time (monogamy) and condom use, will decrease the chance of developing orchitis as a result of a sexually transmitted disease.

Bottom Line: Orchitis is usually caused by an infection and prompt treatment is required in order to save the testicle.  Call your physician or go to the emergency room for evaluation and treatment. 

Pain in the Pouch- Scrotal Pain May Be Coming From Somewhere Else

June 9, 2012

By far, most causes of pain in the pouch is from the testicles and the epididymis, the gland behind the testicle where sperm are nurtured and mature. But there are other causes of scrotal pain that must be considered and which have different treatments.

Testicular tumors do not usually cause pain, but it is possible. Since testicular cancer is common in young men (between the ages of 18 and 32) and is often cured if treated early, prompt medical attention to any lump is important. If you feel something down there that is new or is hard, see your doctor right away.

Inguinal hernia—An inguinal hernia is part of the intestines which protrudes through the inguinal canal (passageway connected to the scrotum). Inguinal hernia is suspected if swelling or pain above the scrotum worsens with coughing, sneezing, movement, or lifting. This condition is fairly common, especially in young boys, and it occasionally causes pain in the scrotal area. Premature infant boys have the highest risk for inguinal hernia. This condition usually results from an abdominal wall weakness present at birth, but symptoms may not appear until adulthood.
Hernias do not resolve without treatment and may cause serious complications if not treated. Hernia repair surgery is usually required to treat this condition. Often this surgery can be done through a laparoscope which consists of a several pencil sized openings in the lower abdomen. Most men can go home the same day of the surgery and resume all activities, including heavy lifting in 3-4 weeks after surgery.

Pudendal nerve damage (neuropathy), also called “bicycle seat neuropathy,” may cause numbness or pain. Pudendal nerve damage can result from the pressure of prolonged or excessive bicycle riding (e.g., competitive cycling), especially improper seat position or riding techniques are used. Special bicycle seats have been designed to decrease pressure on the area between the scrotum and the rectum, potentially preventing or resolving this problem. Pudendal neuralgia is the painful type of this nerve damage. Sometimes called “cyclist’s syndrome,” pudendal neuralgia is painful inflammation of the pudendal nerve. The pudendal nerve carries sensations to the genitals, urethra, anus, and perineum (area between the scrotum and anus), so the pain can be felt in any of these areas. Pain can be piercing and is more likely to be noticed while sitting. If untreated, nerve damage can lead to erectile dysfunction or problems with bowel movements or urination, such as involuntary loss of feces or urine (e.g., urinary incontinence).

Pudendal Nerve Damage

Narrow bike seat can cause pudendal nerve injury

Surgery—Temporary testicular pain and swelling can be expected after surgical procedures in the pelvic area, such as hernia repair and vasectomy. Post-surgery pain that lasts longer than expected should be reported to a physician. Chronic or recurring pain may be the result of a surgical complication or an unrelated problem, and may need treatment.
Kidney stones—Stones usually cause abdominal pain, but the pain radiates into the testicular area in some cases. Intense, sudden, and severe pain in the scrotum that cannot be explained by a problem in the scrotum may be caused by kidney stones.

Swelling with mild discomfort—Conditions that cause swelling in the scrotal area also may occasionally result in mild discomfort. These conditions include varicocele, hydrocele, and spermatocele. Many cases are benign (mild and non-threatening), but swelling and discomfort in the scrotal area should be addressed by a doctor. If a hydrocele (an abnormal fluid-filled sac around the testicles) becomes infected, it can lead to epididymitis, which can cause severe pain.
Unrelieved erection—An erection that does not end in ejaculation sometimes can cause a dull ache in the testicles. This minor ache, commonly called “blue balls,” is harmless and usually goes away within a few hours or when ejaculation occurs.

Bottom Line: Scrotal pain is common condition that usually involves the structures in the scrotum. However, there are other conditions that can cause scrotal pain. If your doctor evaluates these other causes of scrotal pain, effective treatment can relieve the discomfort.

When It Really Hurts Down There-Epididymitis

June 3, 2012

When men experience a painful testicle, it can be frightening and a source of not only pain but anxiety as most men associate the testicles with pleasure and reproduction. This article will discuss a common cause of pain in the scrotum and what treatment options are available.
Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Pain and swelling are the most common signs and symptoms of epididymitis. Epididymitis is most common in men between the ages of 14 and 35.
Epididymitis is most often caused by a bacterial infection or by a sexually transmitted disease (STD), such as gonorrhea or chlamydia. In some cases, the testicle also may become inflamed.
Epididymitis symptoms include: Testicle pain and tenderness, usually on one side, painful urination, painful intercourse or ejaculation, chills and fever, a lump on the testicle, discharge from the penis especially if the cause is from a STD, and discoloration of the semen.

Location of the epididymis

Location of Epididymis On Top and Behind the Testicle

Causes
Epididymitis has a number of causes, including: STDs, particularly gonorrhea and chlamydia, are the most common cause of epididymitis in young, sexually active men. Boys, older men and homosexual men are more likely to have epididymitis caused by a nonsexually transmitted bacterial infection. For men and boys who’ve had urinary tract infections or prostate infections, bacteria may spread from the infected site to the epididymis. Rarely, epididymitis is caused by a fungal infection. Epididymitis may be caused by urine going backward into the epididymis. This is called chemical epididymitis and may occur with heavy lifting or straining.

Diagnosis
Your doctor will do a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.
Other tests your doctor might order include: STD testing. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.
Ultrasound imaging is a noninvasive test, which uses high-frequency sound waves to create images of structures inside your body and is used to rule out conditions, such as twisting of the spermatic cord (testicular torsion) or a testicular tumor. Your doctor may use this test if your symptoms began with sudden, severe pain.
A nuclear scan of the testicles is also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, supporting the diagnosis of epididymitis.

Treatment
Epididymitis caused by a sexually transmitted infection (STI) or other infection is treated with antibiotic medications. If you have significant pain, you will probably receive an anti-inflammatory medication. Your sexual partner will also need treatment.
When you’ve finished your medication, it’s a good idea to return to your doctor for a follow-up visit to be sure that the infection has cleared up. If it hasn’t, your doctor may try another antibiotic. If the infection still doesn’t clear, your doctor may do further tests to determine whether your epididymitis is caused by something other than a bacterial infection or an STD.

To ease your symptoms, try these suggestions: Bed rest-depending on the severity of your discomfort, you may want to stay in bed one or two days. Mild relief will occur if you place a folded towel under your scrotum. Wear an athletic supporter or jockey underwear. A supporter provides better support than boxers do for the scrotum. Apply cold packs to your scrotum. Wrap the pack in a thin towel and remove the cold pack every 30 minutes. Don’t have sex until your infection has cleared up. Ask your doctor when you can have sex again.

Bottom Line: Epididymitis is a common cause of scrotal pain. Epididymitis is usually a result of an infection and can be successfully treated with antibiotics. See your doctor whenever you have scrotal pain or you find a lump or bump in your scrotum.

An Unkind Twist of Fate-Testis Torsion

June 2, 2012

There are very few surgical emergencies in medicine but one of them is torsion of the testicle. Testicle torsion is caused by the twisting of the spermatic cord, which causes a loss of blood flow to the testicle and a lack of life-sustaining oxygen to the testicular tissue. Torsion is the most common cause of testicle loss in adolescent males.
Causes
The cause of the majority of cases is the result on not having the testicle anchored to the bottom of the scrotum. As a result the testicle is allowed to twist more easily, resulting in compromise of the blood supply to the testicle. This can occur spontaneously or may be associated with blunt trauma to the testicle. This anatomic defect is present in both testicles.

Normal testis on left and torsion on the right

Torsion of the testis with loss of blood supply and oxygen to the testicle


Symptoms
Testicular torsion is characterized by excruciating one-sided testicular pain with sudden swelling. Men may also have nausea and vomiting.
Testicular torsion is seen most frequently in the 12-18-year-old age group, and most cases occur in men under 30 years of age. However, it can occur at any age, including in newborns.
Getting help
Testicular swelling and pain should be evaluated immediately. The diagnosis is easily made with a scrotal ultrasound. Once the diagnosis of torsion is confirmed, immediate surgery is indicated. There is about a six-hour window for the testicle to be salvaged; surgical treatment within this time frame is associated with a 100% salvage rate for the testicle. After six hours, the salvage rate decreases, and if surgical repair is performed after 24 hours, the testicle is no longer salvageable. The surgeon, usually a urologist, will untwist the spermatic cord and which will improve the blood supply to the testis. The testis is then anchored to the bottom of the scrotum and the opposite testicle is also surgically secured to the bottom of the scrotum since the condition frequently affects both testicles.
Bottom Line: Testicle torsion is a surgical emergency. With early diagnosis the testicle can be saved by surgically securing the testicle to the bottom of the scrotum.