What are the common causes of testicular pain. How can you differentiate between various types of testicular discomfort. When should you seek medical attention for pain in the testicles. What are the treatment options for testicular pain.

The Complex Nature of Testicular Pain

Testicular pain is a complex issue that can stem from various sources, not all of which are directly related to the testicles themselves. The testicles are highly sensitive organs, and even minor injuries can result in significant discomfort. Pain may originate within the testicle or in the epididymis, the coiled tube and supporting tissue behind the testicle.

Interestingly, what appears to be testicular pain can sometimes be caused by problems originating in other areas of the body, such as the groin, abdomen, or even the kidneys. This interconnected nature of pain pathways in the human body makes accurate diagnosis crucial for effective treatment.

Common Causes of Testicular Pain

Testicular pain can be attributed to a wide range of conditions, some of which are more serious than others. Here are some of the most common causes:

• Epididymitis: Inflammation of the epididymis
• Orchitis: Inflammation of the testicle itself
• Testicular torsion: A twisted testicle, which is a medical emergency
• Hydrocele: Fluid buildup causing swelling of the scrotum
• Varicocele: Enlarged veins in the scrotum
• Inguinal hernia: A portion of intestine protruding into the scrotum
• Kidney stones: Can cause referred pain in the testicles
• Urinary tract infection (UTI)
• Prostatitis: Infection or inflammation of the prostate gland

In some cases, the cause of testicular pain remains unidentified, a condition known as idiopathic testicular pain.

Distinguishing Between Different Types of Testicular Pain

Differentiating between various types of testicular pain is crucial for proper diagnosis and treatment. Here are some key factors to consider:

Onset and Duration of Pain

Is the pain sudden and severe, or has it developed gradually over time? Sudden, severe pain might indicate testicular torsion, which requires immediate medical attention. Gradual onset of pain could suggest conditions like epididymitis or orchitis.

Location of Pain

Is the pain localized to one testicle or both? Does it radiate to other areas like the groin or lower abdomen? Localized pain in one testicle might indicate a problem specific to that testicle, while radiating pain could suggest referred pain from another source.

Associated Symptoms

Are there any accompanying symptoms such as fever, nausea, or swelling? These additional symptoms can provide valuable clues about the underlying cause of the pain.

When to Seek Medical Attention for Testicular Pain

While some cases of testicular discomfort may resolve on their own, certain situations warrant immediate medical attention. You should seek medical help if:

• The pain is severe and sudden
• The pain is accompanied by swelling or redness of the scrotum
• You experience nausea or vomiting along with the pain
• The pain persists for more than a few hours
• You notice a lump or mass in your testicle

Remember, conditions like testicular torsion require emergency treatment to prevent permanent damage to the testicle.

Diagnostic Approaches for Testicular Pain

When you visit a healthcare provider for testicular pain, they may employ several diagnostic methods to determine the underlying cause:

Physical Examination

A thorough physical examination of the testicles, scrotum, and abdomen is typically the first step. The doctor will check for swelling, lumps, or areas of tenderness.

Ultrasound

An ultrasound of the scrotum can provide detailed images of the testicles and surrounding structures, helping to identify conditions like varicoceles, hydroceles, or tumors.

Urinalysis

A urine test can help detect infections that might be causing the pain, such as urinary tract infections or sexually transmitted infections.

Blood Tests

Blood tests may be ordered to check for signs of infection or to measure hormone levels if a hormonal imbalance is suspected.

Treatment Options for Testicular Pain

The treatment for testicular pain depends on the underlying cause. Here are some common approaches:

Conservative Management

For mild cases of testicular pain, conservative measures may be sufficient. These can include:

• Rest and elevation of the scrotum
• Application of cold or warm compresses
• Over-the-counter pain relievers like ibuprofen or acetaminophen
• Wearing supportive underwear or a athletic supporter

Medications

Depending on the cause, your doctor may prescribe:

• Antibiotics for bacterial infections
• Anti-inflammatory drugs for conditions like epididymitis or orchitis
• Pain medications for more severe pain

Surgical Intervention

In some cases, surgery may be necessary. This is particularly true for conditions like:

• Testicular torsion, which requires emergency surgery to untwist the testicle and restore blood flow
• Inguinal hernias that don’t respond to conservative treatment
• Large hydroceles or varicoceles that cause significant discomfort

Preventing Testicular Pain

While not all causes of testicular pain are preventable, there are steps you can take to reduce your risk:

• Wear appropriate protective gear during sports or physical activities
• Practice safe sex to prevent sexually transmitted infections
• Maintain good hygiene to reduce the risk of infections
• Stay hydrated and maintain a healthy diet to reduce the risk of kidney stones
• Perform regular self-examinations to detect any changes or abnormalities early

Living with Chronic Testicular Pain

For some men, testicular pain can become a chronic condition. This can have a significant impact on quality of life, affecting everything from physical activity to intimate relationships. If you’re dealing with chronic testicular pain:

Explore Pain Management Techniques

Various pain management strategies can be helpful, including:

• Physical therapy
• Acupuncture
• Mindfulness and relaxation techniques
• Cognitive behavioral therapy

Consider Lifestyle Modifications

Some lifestyle changes may help alleviate chronic pain:

• Avoiding tight-fitting clothing
• Modifying your exercise routine
• Using a standing desk or ergonomic chair to reduce pressure on the groin area

Seek Support

Living with chronic pain can be emotionally challenging. Don’t hesitate to seek support from:

• Support groups for men with chronic testicular pain
• Mental health professionals specializing in chronic pain management
• Friends and family who can provide emotional support

Remember, while chronic testicular pain can be challenging, many men find effective ways to manage their symptoms and maintain a good quality of life.

The Role of Self-Examination in Testicular Health

Regular self-examination of the testicles is an important part of maintaining testicular health and detecting potential problems early. Here’s how to perform a self-exam:

1. Perform the exam after a warm shower or bath when the scrotum is relaxed
2. Use both hands to gently roll each testicle between your fingers
3. Check for any lumps, bumps, or changes in size or texture
4. Feel for the epididymis, the tube behind each testicle, which should feel soft and slightly tender
5. If you notice any changes or abnormalities, contact your healthcare provider

Regular self-exams can help you become familiar with what’s normal for your body, making it easier to detect any changes that might indicate a problem.

The Psychological Impact of Testicular Pain

Testicular pain, especially when chronic or unexplained, can have significant psychological effects. Men may experience:

• Anxiety about their health and fertility
• Depression due to chronic pain and lifestyle limitations
• Relationship stress, particularly if the pain interferes with sexual activity
• Feelings of isolation or embarrassment about discussing their symptoms

It’s important to address these psychological aspects as part of a comprehensive treatment plan. Mental health support, whether through individual counseling or support groups, can be invaluable in coping with the emotional challenges of testicular pain.

Future Directions in Testicular Pain Research and Treatment

As medical science advances, new approaches to understanding and treating testicular pain are emerging. Some areas of ongoing research include:

Advanced Imaging Techniques

Researchers are exploring more sophisticated imaging methods to better visualize the structures within the scrotum and identify subtle abnormalities that might be causing pain.

Targeted Pain Management

New approaches to pain management, such as nerve blocks or neurostimulation techniques, are being investigated for their potential in treating chronic testicular pain.

Genetic Factors

Scientists are studying whether genetic factors might predispose some men to certain conditions that cause testicular pain, which could lead to more personalized treatment approaches.

Microbiome Research

There’s growing interest in understanding how the microbiome of the urogenital tract might influence conditions like prostatitis or epididymitis, which can cause testicular pain.

As research in these areas progresses, we can hope for more effective diagnostic tools and treatment options for men suffering from testicular pain.

Understanding testicular pain is crucial for maintaining men’s health and well-being. While the causes can be varied and complex, prompt attention to symptoms and appropriate medical care can lead to effective management in most cases. By staying informed about potential causes, recognizing warning signs, and seeking timely medical attention when necessary, men can take proactive steps to protect their testicular health and overall quality of life.

Testicle pain Causes – Mayo Clinic

Testicle pain has a number of possible causes. The testicles are very sensitive, and even a minor injury can cause testicle pain or discomfort. Pain might arise from within the testicle itself or from the coiled tube and supporting tissue behind the testicle (epididymis).

Sometimes, what seems to be testicle pain is caused by a problem that starts in the groin, abdomen or somewhere else — for example, kidney stones and some hernias can cause testicle pain. The cause of testicle pain can’t always be identified.

Causes of testicle pain or pain in the testicle area can include:

1. Diabetic neuropathy (nerve damage caused by diabetes)
2. Epididymitis (testicle inflammation)
3. Hydrocele (fluid buildup that causes swelling of the scrotum)
4. Idiopathic testicular pain (unknown cause)
5. Inguinal hernia
6. Kidney stones
7. Mumps
8. Orchitis (inflamed testicle)
9. Prostatitis (infection or inflammation of the prostate)
10. Scrotal masses
11. Spermatocele (fluid buildup in the testicle)
12. Testicle injury or hard hit to the testicles
13. Testicular torsion (twisted testicle)
14. Urinary tract infection (UTI)
15. Varicocele (enlarged veins in the scrotum)

Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.

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• Definition
• When to see a doctor

Oct. 19, 2021

Show references

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Taming of the Testicular Pain Complicating Lumbar Disc Herniation With Spinal Manipulation

Am J Mens Health. 2020 Jul-Aug; 14(4): 1557988320949358.

New York Chiropractic and Physiotherapy Centre, Hong Kong, China

Eric Chun Pu Chu, New York Chiropractic and Physiotherapy Centre, 41/F Langham Place Office Tower, 8 Argyle Street, Hong Kong, China. Email: kh.moc.gmyn@cire

Received 2020 Mar 12; Revised 2020 Jun 23; Accepted 2020 Jul 20.

This article has been cited by other articles in PMC.

Abstract

Degenerative disease of the lumbar spine is often ignored as a potential cause of testicular pain because the exact link between the two remains uncertain. This article reports the case of a 60-year-old man with a 3-year history of low back pain and unexplained right testicular pain for 2 years. Painful symptoms were negatively affecting his social, physical, and sexual functions. After failure to achieve pain relief through multiple types of therapy, the patient sought chiropractic treatment for his condition. Lumbar spine magnetic resonance imaging (MRI) revealed disc protrusion at the L1/L2, L3/L4, and L4/L5 segments causing thecal sac indentations. Due to the absence of direct testicular causes, the medical impression was chronic testicular pain (CTP) complicating lumbar disc disease. The patient experienced regular improvement in his low back and testicular pain with complete resolution of both after 8 weeks of chiropractic treatment. This article describes an overlook of the etiology of this patient’s testicular pain and a successful option in treating the patient. CTP has multifactorial etiology. An excellent treatment outcome depends heavily on recognizing the origin of the pain.

Keywords: Back pain, chiropractic treatment, lumbar disc herniation, testicular pain

Chronic testicular pain (CTP) is a frustrating condition defined as constant or intermittent scrotal pain of at least 3 months duration that significantly interferes with daily activities. About 4.8% of men presenting at a urology clinic for other reasons also had CTP (Ciftci et al., 2010). The pathophysiology of CTP is multifactorial and poorly understood. There is no test to find the cause of testicular pain and the assessment is based on clinical criteria. Direct causes of CTP may include infection, tumor, testicular torsion, varicocele, hydrocele, spermatocele, and trauma. A variety of non-scrotal causes, such as ureteral stone, inguinal hernia, aortic aneurysms, and spinal disorders, can also result in referred pain to the scrotum. Patients complaining of CTP have often been evaluated by multiple providers from different disciplines but often are left with an unexplained etiology for their complaint. The most up-to-date guidelines on the diagnosis and management of CTP are based on expert opinion derived from small cohort studies (Tan & Levine, 2017). This study aims to provide a better picture of an overlooked cause, proposed pathophysiology, and relevant treatment options of testicular pain.

Case Report

A 60-year-old male security guard complained of low back pain for 3 years, along with right testicular pain for 2 years. He had recently experienced severe pain in the right lower back down to the right buttock. Lying supine, right lumbar lateral flexion or heavy lifting could trigger right buttock pain and episodic right testicular pain. The testicular pain was localized to his right hemiscrotum and was described as an aching sharp pain. Back and testicular pain negatively affected his social, physical, and sexual functions. Eventually, he was unable to sit up straight, get a good night’s sleep, or to continue working. The patient had no previous history of localized trauma or chronic systemic diseases. Initial workup by an urologist and an orthopedist found an insignificant right renal cyst, asymptomatic left varicocele, and degenerative lumbar spine disease. A scrotal ultrasound ruled out direct testicular pathologies. For nearly 2 years, he had received pain medication, fluoroscopy-guided lumbar facet joint injection, exercise rehabilitation, and acupuncture, all of which failed to provide substantial, lasting symptom relief. The patient then sought chiropractic care for his condition.

Upon presentation, the size, shape, and texture of his testicles were unremarkable and even bilaterally with unrestricted movement within the scrotal sac. Point tenderness was elicited by palpating at the T12/L1 and L4/L5 intervertebral spaces. A shock-like sensation (Lhermitte’s sign) could be induced by spinal percussion with a reflex hammer at the T12/L1 level. Mobility restrictions were present in the lumbar spine. Sharp pain from the right thoracolumbar area down to the right buttock and testicular pain were triggered with passive lumbar extension and right lateral lumbar flexion. A tight psoas muscle was speculated. Pinch–roll test of the skin revealed local hyperesthesia and tenderness over the right lumbar paraspinal region and right buttock. Lumbar spine magnetic resonance imaging (MRI; ) revealed disc desiccation (diminished signal intensity) and disc protrusion at the L1/L2, L3/L4, and L4/L5 levels, causing thecal sac indentation. In the absence of significant medical history and direct testicular causes, the subjective findings of this case were consistent with CTP caused by lumbar disc disease.

Sagittal T2 weighted magnetic resonance (MR) image revealed marginal osteophyte formation of the lumbar vertebrae and lumbar disc desiccation (low water content/diminished signal intensity) with posterior protrusion at the L1/L2, L3/L4, and L4/L5 levels causing thecal indentation.

The patient underwent chiropractic treatment consisting of therapeutic ultrasound and spinal manipulation with a high-velocity, low-amplitude force applied at the thoracolumbar junction daily for 6 days. Low back pain and subsequent sleep disturbance were reduced following 1 week of treatment. His pain score declined from 9/10 to 7/10 on the numeric rating scale (NRS-11). Subsequently, treatment sessions consisted of intermittent motorized traction (Spine Decompression Device, MID Series, WIZ Medical, Korea) focused on the T12/L1 segment, therapeutic ultrasound, and spinal manipulation. Frequency of treatments was reduced to twice weekly for the following 7 weeks. Both back and testicular pain diminished every week and were fully resolved near the end of treatment. Oswestry Disability Index (ODI) score decreased significantly (78% at intake, 6% at 8 weeks). He recovered and was able to resume normal daily activities with a sense of heightened well-being. A 12-month follow-up phone call confirmed that the patient did not have any delayed complications, nor did he experience a recurrence of his symptoms.

Discussion

The testicles develop embryologically in the upper abdomen and descend into the scrotum shortly before birth. On their descent, the testes bring their sympathetic nerve supply with them from T10 to L1 segments and parasympathetic nerve supply from the S2 to S4 segments (Patel, 2017; Quallich & Arslanian-Engoren, 2013). The somatic supply to the testicles and scrotum originates from the L1–L2 and S2–S4 nerve roots through the iliohypogastric, ilioinguinal, genitofemoral, and pudendal nerves (Patel, 2017). The genitofemoral nerve, formed by a union of branches from the L1 and L2, splits into the genital and femoral branches after passing through the psoas muscle (). The genital branch provides sensation to the cremaster muscle as well as the hemiscrotum in men and labia in women. The psoas major inserts on the lumbar discs, on the vertebral bodies, and on the transverse processes of the T12 to L5. As the psoas adheres to the lateral aspect of the fibrous annulus of the intervertebral discs, compression or inflammatory irritation derived from the lumbar discs can agitate the psoas muscle.

Schematic diagram showing anatomical relations of the lumbar spine, psoas muscle, and genitofemoral nerve. The genitofemoral nerve is formed from the L1 and L2 nerve roots and splits into the genital and femoral branches after passing through the psoas muscle. Nerve root impingement due to discitis and facet arthrosis could radiate pain into the ipsilateral testicle. A genitofemoral entrapment could also cause chronic testicular pain.

As shown in the present case, disc protrusion at the L1/L2, L3/L4, and L4/L5 levels was observed along with right psoas spasticity and right testicular pain. This patient had three potential pain sources. First, lumbar radiculopathy from encroachment or irritation of the L2 nerve root could radiate pain into the ipsilateral testicle (Patel, 2017). Second, discitis and/or facet arthrosis at other levels of the patient’s lumbar spine might also be capable of referring pain, transmitted nonsegmentally via the paravertebral sympathetic chain to the L1–L2 nerve roots and in the genitofemoral nerve to the testicle (Doubleday et al., 2003; Peng et al., 2014). Third, the genitofemoral nerve penetrates the psoas muscle before splitting into the genital and femoral branches (). Genitofemoral entrapment at the spastic psoas might also be involved in the advent of testicular pain (Masarani & Cox, 2003). Many of these hypotheses, as in this case, remain unconfirmed.

The pathophysiology of testicular pain is multifactorial and poorly understood. Diagnostic and treatment recommendations are based on expert opinion derived from small cohort studies (Patel, 2017). The appropriate approach to a patient presenting with CTP is to first rule out the possibility of serious pathology or red flag symptoms. When imaging is deemed necessary, a high-resolution scrotal ultrasound with color-flow Doppler is the primary modality used to detect and diagnose abnormalities within the scrotum. There can often be straightforward explanations for the CTP such as varicocele, infection, tumor, or referred pain from non-scrotal sources, but more often the etiology remains unexplained (Quallich & Arslanian-Engoren, 2013). Because of the overlapping sensory innervations and anatomic variability, it is difficult to differentiate the particular nerve involvement in cases of testicular pain.

The first step in the management of CTP with no red flag signs remains conservative in nature. Consideration should include the use of antibiotics, nonsteroidal anti-inflammatory medications, pelvic floor physical therapy, or spermatic cord block. When conservative measures have failed, microsurgical testicular denervation and orchiectomy have been described as procedures of last resort. Unsuccessful recognition of the causative factors for CTP often leads to surgical failure, poor outcomes, and years of psychological distress (Doubleday et al., 2003). There is a scarcity of data on the association of CTP with degenerative lumbar spine disease. Case reports (Doubleday et al., 2003; Rowell & Rylander, 2012) revealed significant efficacy of manipulative therapies for alleviating testicular pain of spinal origin. According to the Clinical Guidelines for Diagnosis and Treatment of Lumbar Disc Herniation With Radiculopathy (Kreiner et al., 2014), spinal manipulation is an option for radiculopathy caused by discogenic disease. Remission of CTP observed in the present case appears to support that spinal manipulation could be a treatment regimen for testicular pain from this cause.

The exact mechanism underlying the action of chiropractic for the relief of discogenic pain remains unclear. Chiropractic trial in this case consisted of therapeutic ultrasound and spinal manipulation, along with intermittent motorized lumbar traction. Reported thermal effects of ultrasound upon tissue include raised tissue temperature, enhanced circulation, reduced muscle spasm, and increased extensibility of collagen fibers and a proinflammatory response (Speed, 2001). Biomechanical effects of chiropractic manipulation on symptom relief include relaxation of hypertonic musculature, release of entrapped nerves, disruption of periarticular adhesions, and restoration of spinal alignment (Onel et al., 1989). Lumbar traction is a form of decompression therapy, creating increased space and negative pressure of the intervertebral space. Intermittent mechanical traction can facilitate diffusion of nutrients for the disc and initiate the healing process. The main limitation of the present study is that the cause of testicular pain and mechanism of symptom relief are still uncertain without a control group. As a study retrospective in nature, the items regarding diagnosis, management, and outcome monitoring were not necessarily comprehensive. Larger scale studies regarding the efficacy of nonsurgical regimens for CTP are needed to provide corroboration.

Conclusion

Testicular pain comes from muscle, joint, or nerve issues that cannot easily be identified. Recognition of pain referral patterns and appropriate intervention are essential for the management of testicular pain.

Footnotes

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Consent: A copy of the written consent is available for review by the editor-in-chief of this journal.

ORCID iD: Eric Chun Pu Chu https://orcid.org/0000-0002-0893-556X

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Nontraumatic Testicular Pain due to Sacroiliac-Joint Dysfunction: A Case Report

Patient Medical History

The patient was a 49-year-old man. He reported a work history as a traveling salesman when symptoms first presented but stated he was currently employed as a machinist. The patient described the onset of “tailbone bone” pain approximately 13 years earlier (2002) while traveling in an automobile. He stated that he was positioned “on the hump” in the center of the backseat between 2 other people for about 4 hours when the pain began. The pain was intermittent but had worsened in frequency, intensity, and duration over the past several years. He characterized the pain as a “knife being stuck through the left side of the rectum” that also radiated into both testicles. Pressure at the base of his spine was exacerbated by sitting. He also noted persistent numbness across both buttocks. Pain increased with any bending or lifting activities, and he found relief by performing Kegel exercises, which caused a “popping” sensation that temporarily eased the pressure. He also reported a decrease in pain when he lay on his back with his right knee bent and his left ankle across it (ie, figure-4 position). He had been a chiropractic patient during this time, but treatment that included manual manipulation, instrument-assisted mobilization, and flexion-distraction failed to relieve the pain. A full timeline of the patient’s symptoms, treatments, and progress is shown in the .

Table.

Summary of the Patient’s Medical Timeline

Date	Signs and Symptoms	Treatments	Progression
May 29, 2012	Low back pain Radicular testicular pain Tight hip musculature (adductors, gluteus maximus, iliacus, rectus femoris)	Manual therapies Postisometric relaxation SIJ distraction METs to gluteus maximus, medial hamstrings, piriformis, psoas	Noted improvement ↓ Neurologic symptoms ↑ Lumbo-pelvic-hip mobility, forward bending
June 5, 2012	Continued pressure and numbness in buttocks SIJ had left inferior rotation, posterior upslip, right side had anterior upslip	IASTM for gluteal muscles, prone stretching PIR to ↑ left hip flexion, extension METs to left psoas, inferior rotation Distraction to right ilium HEP to improve left hip extension	Noted ↓ sharp pain Improved mobility
June 14, 2012	Pain isolated to left SIJ Continued SIJ dysfunction with 1/4 in (0. 64 cm) leg-length discrepancy	IASTM to gluteal fascia Left ilium distraction HEP progressed to ↑ flexion, flexibility in latissimus dorsi, paraspinals, quadratus lumborum	Pain much improved ↓ Radiating testicular pain Left hip extension still restricted but inferior rotation resolved
July 9, 2012	↑ Lower back pain due to work ↓ Left hip external rotation, flexion, rotation	IASTM, PIR to improve motions METs to left psoas Left SIJ distraction HEP progressed to stretch left extensors, hip flexors, hip internal rotation and strengthen left psoas	Minimal tingling Setback due to work
July 26, 2012	↑ Pain due to prolonged sitting Left-leg discrepancy back to 1/4 in (0. 64 cm) Inferior, medial rotation of left ilium	Same treatment as 7/9/12 Kinesiology taping of SIJ Continued HEP adding left hip-abductor isometrics	Some setback No tingling
August 9, 2012	Minimal pain, tingling 1/4 in (0.64 cm) Leg-length discrepancy in prone position Medial tilt, rotation of left ilium	PIR to left hip adductors, internal rotators METs to hip abductors, external rotators Left ilium distraction	Overall much improved Tingling accompanied by SIJ pain
August 29, 2012	Transient tingling in posterior left hip with certain movements (forward flexion) Left medial tilt	Left medial tilt corrected with METs to left hip abductors	Overall improvement Released from treatment Advised to continue HEP

Physical Evaluation

The patient was a well-nourished man, 177. 8 cm tall, who weighed 74.8 kg. Postural evaluation revealed the left iliac crest and right acromioclavicular joints as superior, which corresponded with left trunk lateral flexion. He had external rotation of the hips; the left demonstrated more rotation than the right. The right hip was abducted.

Palpations revealed a functionally short left leg that was 0.75 in (1.9 cm) shorter than the right when supine and 0.5 in (1.27 cm) shorter when prone. Marked tenderness over the left sacroiliac (SI) joint was consistent with the Fortin area. The left anterior-superior iliac spine was posteriorly rotated with a medial tilt. Both the left anterior-superior and posterior-superior iliac spines demonstrated superior translations (upslips).

Diagnosis

The initial differential diagnosis included epididymitis, athletic pubalgia, testicular tumor, SIJD, and lumbar radiculopathy. No formal imaging was obtained during this time. The patient was treated with various muscle-energy techniques (METs) to help correct the SIJD. After treatment, he reported an immediate 90% improvement when he stood up from the treatment . Based on the initial physical findings, treatment results, and consultation with the referring chiropractor, we determined the patient had pudendal neuralgia due to bilateral SIJD. Because tissue-specific impairments were identified via palpatory and mobility assessments as well as pain-provocation tests, the condition was treated as being of musculoskeletal origin. Treatment of the impairments resulted in objective improvements in both position and mobility that corresponded with the patient’s reporting a decrease in symptoms. If symptoms had not improved or the index of suspicion for neoplasm was high based on the previous medical history and systems review, further diagnostic tests and referral would have been obtained. However, in this case, costs were controlled, and the patient experienced pain relief from therapy.

Treatment

Treatment focused on restoring hip mobility and SI-joint alignment via manual-therapy techniques. Contract-relax techniques, a form of postisometric relaxation (PIR), were used to increase hip mobility and specifically flexion, extension, and abduction of the left hip. The use of PIR helps to decrease muscle guarding at points of soft tissue barriers.¹³−¹⁵ The contraction decreases muscle tone and initiates a hyperreactive response that allows further stretching.^13,14 Joint mobilizations were used to distract the left ilia inferiorly with the patient both prone () and supine (). Muscle-energy techniques were used to facilitate the left iliotibial band and hip abductors to correct the medial tilt ().¹⁵ A summary of the clinical course and treatment is provided in the , and a detailed description follows.

Muscle-energy techniques for extension for the tensor fascia latae and iliotibial band.

Clinical Course

Visit 1: May 29, 2012. A chiropractor worked with the patient on alignment concerns. The patient was taking over-the-counter pain relievers but no prescription medications. He was treated with manual-therapy techniques to address hip hypomobility and SI-joint alignment. He was restricted in left hip flexion (tight gluteus maximus), extension (tight rectus femoris), abduction (tight adductors), and external rotation (tight iliacus). Postisometric relaxation was used to improve mobility in those directions (). The left SI joint was distracted in the supine and prone positions to correct the functionally short leg. Lastly, METs were applied to the hypotonic muscles (psoas, medial hamstrings, gluteus medius, and piriformis) to activate them and restore normal positioning of the left ilium. After treatment, the patient noted a reduction in symptoms with improved lumbo-pelvic-hip mobility, most notably with forward bending.

Postisometric relaxation for A, hip flexion; B, adduction; and C, extension.

Treatment 2: June 5, 2012. The patient stated he had not had any sharp pain since the first treatment 1 week prior. He reported continued pressure with numbness in his buttocks but noted that it was not as bad as before. He did carry a wallet in his back left pocket. Palpation of the SI joint revealed left inferior rotation with posterior upslip, whereas the right presented with an anterior upslip. Instrument-assisted soft tissue mobilization was performed to the left gluteal and lumbar paraspinals with significant petechiae formation (). He demonstrated restricted left hip flexion and extension; PIR was applied to improve these movements. To activate the left psoas and correct the inferior rotation, METs were applied. The right ilium was distracted with the patient supine, whereas the left was distracted in the prone position. He was assigned a home exercise program (HEP) consisting of lying with his left lower leg off his bed to work on improving left hip extension ().

Petechiae formation as a result of instrument-assisted soft tissue mobilizations.

Home exercise program to improve hip extension.

Treatment 3: June 14, 2012. The patient had only “minimal pain on occasion” at this time. He also had “occasional” tingling that no longer radiated into his testicles but was isolated to the left of his coccyx. Palpation of the SI revealed anterior and posterior upslips of the left ilium, resulting in the left leg being 1/4 in (0.64 cm) short in both positions. Left hip extension continued to be restricted, but the inferior rotation had resolved. He was again treated with instrument-assisted soft tissue mobilization to the left gluteal fascia. The left ilium was distracted in both the supine and prone positions. His HEP was progressed to include seated right trunk flexion with left shoulder abduction () to lengthen the left latissimus dorsi, lumbar paraspinal, and quadratus lumborum muscles to prevent further upslips.

Home exercise program: seated right trunk flexion with left shoulder abduction to lengthen the left latissimus dorsi, lumbar paraspinals, and quadratus lumborum.

Treatment 4: July 9, 2012. The patient presented with an exacerbation of left low back pain after being bent over sandblasting at work for 2 hours. He had “very occasional tingling that is there and gone,” which seemed to be movement specific. He demonstrated a decrease in left hip external rotation, flexion, and rotation. Instrument-assisted soft tissue mobilization and PIR were used to improve these motions along with METs to facilitate the left psoas. The left SI joint was again distracted in the prone position. His HEP was progressed to include supine stretching of the left hip flexors, extensors, and hip internal rotators (). He was also instructed in a strengthening technique for the psoas in the supine position ().

Home exercise program: supine stretching of the left hip: A, internal rotators, and B, flexors and extensors.

Home exercise program: strengthening technique for the psoas in the supine position.

Treatment 5: July 26, 2012. The patient reported tingling only with sneezing or coughing until 2 days earlier, when he sat in class for more than 5 hours. This led to an initial increase in pain that he rated as moderate, but it had lessened to minimal by the time of the appointment. His left leg was again 1/4 in (0.64 cm) short in the supine and prone positions with inferior and medial rotations of the left ilium. The same treatment given on July 9, 2012, was applied to correct the left ilium. Kinesiology taping (4 in [10–16 cm] I-strip; RockTape USA, Campbell, CA) was then applied horizontally across the SI joints to simulate the use of an SI belt (). He was instructed to continue with the previously prescribed HEP and add left hip-abduction isometric exercises.

Kinesiology taping to simulate the use of a sacroiliac belt.

Treatment 6: August 9, 2012. The patient felt he was much improved overall, with tingling present “every couple of days.” He had begun noticing that, when the tingling was present, he also had “twinging” in the area of his left SI joint. Evaluation revealed no leg-length discrepancy in the supine position but 1/4 in (0.64 cm) in the prone position. He had also developed a medial tilt and rotation of the left ilium. To lengthen the left hip adductors and internal rotators, PIR was applied; to facilitate the hip abductors and external rotators, METs were applied. The left ilium was again distracted in the prone position.

Treatment 7: August 29, 2012. The patient reported overall improvement in symptoms. His primary complaint was a transient tingling in the back of his left hip that occurred every few days. He had identified the triggering factor: bending forward into a vat at work, a task that he did not perform on a regular basis. Palpation of the SI joints revealed a left medial tilt that corrected with METs to the left hip abductors. At this time, he was released to continue the previously prescribed HEP.

Deviation From Expected

Typically, testicular pain is caused by epididymitis or torsion.^3,7 However, this case demonstrates that testicular pain can also be due to neural tensioning of the pudendal nerve. This can occur via compression by the sacrotuberous or sacrospinous (or both) ligaments, pelvic musculature, or innominate bones of the pelvic region. Often, individuals with pelvic floor dysfunction are prescribed Kegel strengthening exercises, but these would have exacerbated our patient’s symptoms because his left pelvic floor was overly tight due to the shortened position created by altered left ilium alignment, primarily the superior translations or upslips. With sufficient compression, vascular flow through the internal pudendal artery may also be altered, which could lead to testicular necrosis. Last, despite the complications of pudendal neuralgia, the patient reported no instances of sexual dysfunction.

Symptoms, Causes, Treatments & Complications

Because groin pain can be a symptom of a serious or life-threatening condition, you should seek prompt medical care and talk with your medical professional about your symptoms. Sudden groin pain in men with swelling of the scrotum, nausea, vomiting, and abdominal pain are symptoms of testicular torsion, which is a medical emergency. Seek immediate medical care (call 911) if you experience these symptoms.

Groin pain is any discomfort in the groin area. The groin area is where your abdomen ends and your legs begin. The groin is also called the inguinal area and includes your upper inner thigh as well as the front area where your legs attach to your torso.

In men, groin pain may also refer to pain that radiates into or from the scrotum or the testicles within the scrotum. Women may experience groin pain due to a condition of the genitals or reproductive organs. Pain can also radiate into the groin from a condition of the hip, lower spine, pelvis, kidney, bladder, or colon.

Pain is usually a sign of inflammation, disease, or direct injury to a particular area of the groin. The groin may appear swollen, red or tender to the touch. Groin pain can be due to serious infections, inflammation, trauma, malignancy (cancer), and other abnormal processes.

A very common cause of groin pain is a groin pull, a strain of the inner thigh muscles. A groin pull often occurs due to an activity that involves running, skating, jumping or swimming. Groin pulls are a common injury in such sports as football, baseball, hockey, soccer, and track and field.

Depending on the cause, groin pain can begin suddenly and disappear quickly, such as from a pinched nerve associated with a minor injury. Groin pain that develops over time and occurs along with additional symptoms may be a sign of a more serious condition, such as a sexually transmitted disease (STD), inguinal hernia, or testicular cancer.

Groin Pain and Injuries in Men – Consumer Health News

Men are always just one misstep away from groin pain. Even if they manage to avoid serious injury, some aches and pains just come with the territory. It’s important for a man to know which types of pain can be shrugged off and which require medical attention.

Pulled groin muscle (adductor strain)

Groin injuries are common among athletes, especially soccer players. One common type of injury is a “pulled groin muscle,” which doctors would call an adductor strain. Soccer players may be at higher risk for adductor strains because of their constant stop-and-go movements and the long strides they take. The pain may grow gradually, and you may not be able to point to the moment when the trouble started. Eventually, the muscle becomes very painful when it moves or is pressed against.

When your groin muscle starts limiting your game, you should see a doctor. X-rays or ultrasounds may be needed to make sure you don’t have a fracture, tear, or more serious condition. You’ll need to take at least several weeks off from sports to give your groin a chance to heal. Your doctor or physical therapist can suggest stretches and exercises to help strengthen the muscle and speed your recovery. In the meantime, rest and ice may help ease the pain.

Inguinal hernia

If you notice a small bulge in your groin area, there’s a good chance you’re looking at an inguinal hernia, a common condition that occurs when part of an internal organ — usually the intestine — breaks through the abdominal wall and starts intruding into the space that holds the spermatic cord. The bulge can also move into your scrotum (the skin pouch containing the testicles, below the penis). This is what doctors look for when they ask you to turn your head and cough during a checkup.

Inguinal hernias can occur when there is a weakness in the abdominal wall or groin muscles. Some men are born with this weakness. In others it can develop over time due to excessive weight loss or gain, persistent coughing or sneezing, or straining while using the bathroom.

This type of hernia usually doesn’t hurt much, although you might feel some pain when sneezing, coughing, or lifting. For some people, this pain is the only sign of trouble.
If the pain becomes severe — and if the bulge doesn’t disappear when you lie down — a section of the intestine may be pinched. If so, you’ll probably suffer nausea and vomiting, and you won’t be able to have a bowel movement. This is an emergency situation: Without prompt surgery, your life could be at risk.

Most inguinal hernias aren’t dangerous. While they can often be managed by wearing a supportive belt (also called a truss) and avoiding heavy lifting, men generally opt to have corrective surgery to keep the intestines where they belong.

Trauma to the testicles

Every man has a story about a game of catch or a wrestling match that went seriously wrong. It goes without saying that any blow to the testicles will be very painful. If the pain goes away within an hour and there are no other symptoms, it’s safe to chalk it up to a lesson learned. But if you’re still in serious pain one hour or more after the trauma, you need to see a doctor immediately. There’s a chance that the testicle has become twisted, choking off the flow of blood. This is called testicular torsion, and it’s an emergency. If you don’t get help within six hours, there’s a good chance you’ll lose your testicle.

In some cases, you’ll know right away that you need medical help. Any trauma that breaks through the scrotal sac is an obvious emergency. According to the American Urological Association, you should also get prompt treatment if you develop swelling, bruising, or fever after a trauma to the testicles. A doctor will perform a physical examination — possibly including an ultrasound — to check for injuries. If nothing has been damaged, you can get by with painkillers and, for extra protection and support during recovery, a jockstrap. More serious cases may require surgery.

Epididymitis: A common cause of pain and swelling

Sometimes testicular pain seems to come out of nowhere. Even if you haven’t had an injury, one of your testicles may start gradually aching and swelling. This is often the first sign of epididymitis, a bacterial infection in the tubes that store sperm. The pain may spread to your lower back or side, and it may hurt when you urinate. Some men may also have fever or a milky discharge.

Several different kinds of bacteria can cause epididymitis. You might have caught the germs during sex, or they may be bacteria that have spread from the urinary tract. No mater how it starts, epididymitis is easily treated with oral antibiotics. So don’t put up with that achy feeling. Make an urgent appointment with your family doctor or urologist. With the right medication, you’ll feel much better within a few days. If the symptoms don’t get better or if they return, see your doctor promptly.

Other causes of scrotal pain and swelling

There are a few other, less common causes of pain or swelling in a testicle. The testicle itself can become inflamed, a complication of an infection from a bacteria or a virus. This condition, called orchitis, may follow a viral illness such as the mumps. In fact, about one in three males who get the mumps after puberty will develop orchitis in one or both testicles. Treatment for bacterial orchitis is similar to the treatment for epididymitis. A short course of antibiotics should clear up the problem. If a viral infection is to blame, the only treatment is time. The pain will fade and the swelling will recede. In some cases, the testicle may end up smaller than it was to begin with.

If fluid builds up around a testicle, it can start swelling. It is usually painless, even when it grows rather large. This fluid accumulation is called a hydrocele (HI-dro-seel), and it is generally harmless. Hydroceles usually occur in men over age 40 who have experienced injury or infection in the scrotum or who have had radiation therapy. If the scrotum grows large enough to cause discomfort, the hydrocele may have to be surgically removed.

In cases where surgery is especially risky, a needle may be used to remove the fluid instead.

A kidney stone can also cause pain in the groin if it moves into the urinary tract. In addition to pain in the groin, you may feel nausea or the need to vomit. Men are twice as likely as women to form kidney stones. Call your doctor immediately if you have any of these symptoms.

Should I be worried about testicular cancer?

Whenever you notice any changes in your testicles, it’s only natural to wonder about cancer. While cancer is much less common than epididymitis and other testicular problems, it’s always wise to know the symptoms. The most common sign of testicular cancer is a painless lump. Less often, the testicle may swell. There may be a heavy or achy feeling in the scrotum or the lower abdomen, but severe pain is rare. If you’re concerned about testicular cancer, see your doctor.

References

American Urological Association. Testicular trauma. 2008. http://www.urologyhealth.org/

American Cancer Society. Do I have testicular cancer? 2008. http://www.cancer.org/

Morelli, V. and V. Smith. Groin injuries in athletes. American Family Physician. October 15, 2001. 64: 1405-1414. http://www.aafp.org/

Ringdahl, E. and L. Teague. Testicular torsion. American Family Physician. November 15, 2006. 74: 1739-1743.

Cleveland Clinic. Inguinal hernia. 2005. http://www.clevelandclinic.org/health/health-info/docs/1800/1809.asp?index=8099

Inguinal Hernia. Penn State Milton S. Hershey Medical Center College of Medicine. http://www.hmc.psu.edu/healthinfo/i/inguinalhernia.htm

Epididymitis. Sexually Transmitted Diseases Treatment Guidelines 2006. Centers for Disease Control and Prevention. http://www.cdc.gov/std/Treatment/2006/epididymitis.htm

Top Five Soccer Injuries. University of Pittsburgh School of Medicine. http://sportsmedicine.upmc.com/MySportSoccerTop5.htm

Parmar, M. S. Kidney Stones. BMJ 2004;328:1420-1424 (12 June), doi:10.1136/bmj.328.7453.1420 http://bmj.bmjjournals.com/cgi/content/full/328/7453/1420

Common causes of testicular pain – Blog

Medically reviewed by Rosanna Sutherby on November 25, 2019. Written by Kathryn Wall. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

For many men, testicular pain is an anxiety-inducing experience—whether it’s a sharp, pulsing pain or a dull ache that just won’t go away. You might be worried it’s something serious—and wondering what’s causing it.

The good news is that researchers have learned a lot about the potential causes of testicular pain, which means treatment and relief is possible. So keep reading to learn more about some of the common reasons for testicular pain, related health conditions, and more.

Common causes of testicular pain

Here are some of the most common causes of testicle pain.

Sexually transmitted infections (STIs)

Untreated chlamydia in men, as well as gonorrhea, can contribute to symptoms like testicular pain. But, alhough chlamydia and gonorrhea are the most common STIs associated with testicular pain, other STIs can trigger chronic scrotal pain as well. For instance, syphilis and herpes type 2 can lead to the development of genital sores that may cause pain in one or both testicles [1].

A convenient way to test for STIs is with an Everlywell at-home test. The Male STD Test checks for 6 STIs: chlamydia, gonorrhea, hepatitis C, HIV, syphilis and trichomoniasis. Also consider learning more on how to test for STDs from the privacy and convenience of home.

Kidney stones

If you are experiencing severe pain around your testicles, a kidney stone may be to blame.

A kidney stone is a solid crystallized mass composed of salts and minerals that has formed inside a kidney [2]. Many times, the body will work to eliminate them by passing them through the ureter, which is delicate and often far smaller than the stones themselves.

This can cause acute testicular pain, as well as other symptoms including blood in the urine, nausea, and frequent urination. Risk factors for kidney stones include obesity, dehydration, and a diet high in salt and/or sugar [3][4].

Testicular torsion

Testicular torsion occurs when a testicle rotates to restrict blood flow through the spermatic cord [5]—the cord that delivers blood to the scrotum. A twisted testicle can lead to sudden, acute testicular pain, along with symptoms including swelling of the scrotum, a highly positioned testicle, and nausea.

Testicular torsion can trigger severe testicle pain and scrotal swelling when performing any activity such as walking, standing, exercising, or sitting, and is usually considered a medical emergency that requires immediate surgery. If you suspect you have a twisted testicle and are experiencing severe pain, seek medical attention right away.

Medication side effects

Certain medications may also be associated with the onset of testicular pain, including antibiotics [6], chemotherapy drugs, and statins [7]. If you notice that your testicle pain began around the time you started using these or another type of prescription drug, review the medication’s side effects and inform your healthcare provider immediately.

Epididymitis

Epididymitis is an inflammation of the epididymis [8]—the tube at the back of the testes responsible for storing and carrying sperm. Inflammation and swelling of the epididymis can cause chronic testicular pain. Epididymitis is usually caused by chlamydia or gonorrhea. In addition to chronic pain in the testicles, symptoms of epididymitis include pain during urination, discharge from the penis, and blood in the semen [9].

If you suspect you may have chlamydia or gonorrhea, and want a private test to find out, our at-home Chlamydia & Gonorrhea Test is a simple way to screen for these infections. If you test positive, you’ll have the opportunity to connect with our independent physician network—and may be prescribed medication.

Testicular pain may be a side effect of certain health conditions [10]—especially those that affect your nerves or urinary system. Inflammation and blood flow problems in the urinary system can cause right or left testicle pain, while nerve-related health conditions may lead to sore testicles with gradual pain, or sharp pain in the testicles that comes on suddenly.

If you are experiencing pain in the right testicle or left testicle, it may be caused by an underlying health condition. Common health conditions related to testicular pain include the following [11]:

• Diabetes
• Prostatitis (which may include scrotal swelling)
• Henoch-Schonlein purpura
• Orchitis
• Urinary tract infection
• Varicocele
• Mumps
• Hydrocele
• Gangrene
• Inguinal hernia

If you’re suffering from any of the above health conditions and are also experiencing left or right testicle pain, make an appointment with your healthcare provider right away to discuss treatment options. Issues like a hernia will require medical attention and possibly even pain medication of some kind.

Seeking medical care

Make an appointment with your healthcare provider if you’re experiencing testicular pain and/or testicular swelling. The type of medical care you receive for testicular pain depends on the root cause of your pain [12].

Common questions

Can testicle pain be caused by testicular cancer?

Testicular cancer is rare, and usually only affects one testicle. A common symptom of testicular cancer is a small painless lump in the left or right testicle. If you have a “testicle lump” or swelling in your testes and are concerned you may have testicular cancer or a testicular tumor, make an appointment with your healthcare provider to learn more.

Can testicular pain lead to infertility?

Testicular pain by itself usually won’t affect your fertility. However, some testicular pain causes such as varicocele and chronic epididymitis may lead to infertility when left untreated.

Symptoms of testicular cancer | Cancer Research UK

The most common symptom of testicular cancer is a lump or swelling in your testicle.

Testicular symptoms to look out for include:

• a lump or swelling in part of one testicle
• a testicle that gets bigger
• a heavy scrotum
• discomfort or pain in your testicle or scrotum

The scrotum is the sack of skin that surrounds your testicles. These symptoms can be similar to other conditions that affect the testicles, such as infections. But see a doctor if you have:

• any of these symptoms
• symptoms that are unusual for you
• symptoms that don’t go away or don’t improve

Your symptoms are unlikely to be cancer but it is important to get them checked by a doctor. Try not to be embarrassed. Doctors are used to discussing intimate problems and will try to put you at ease.

A lump or swelling in the testicle

A lump or swelling in part of one testicle is the most common symptom of a testicular cancer. It can be as small as a pea, but may be much larger.

Most testicular lumps are not cancer. But do contact your doctor so you can be checked.

Your doctor may shine a strong light through your scrotum. This test is called transillumination. This is useful because:

• light shows through a harmless, fluid filled cyst (for example a hydrocoele)
• light can’t show through a cancer, which is a solid lump

It is usual for some men to have different size testicles. But see your doctor if the size changes, or you notice an unusual difference in size between one testicle and the other. 

A heavy scrotum

Your scrotum may feel heavy. Or you might notice that your scrotum feels firmer or harder.

Discomfort or pain in a testicle or the scrotum

Testicular cancer is not usually painful. But the first symptom for some men is a sharp pain in the testicle or scrotum.

Less common symptoms

If the cancer has spread to lymph nodes (glands)

Sometimes testicular cancer cells can spread into lymph nodes at the back of the tummy (abdomen). This can cause backache or a dull ache in the lower tummy. Your doctor may call these lymph nodes the para aortic or retro peritoneal lymph nodes.

Less often testicular cancer spreads into lymph nodes lower down, such as the pelvic lymph nodes.

If testicular cancer has spread to lymph nodes in other parts of the body you might feel lumps there, such as around the collarbone or in the neck

If the cancer has spread to the lungs

Sometimes testicular cancer spreads to the lungs. It rarely spreads to other organs in the body. If it has spread to the lungs you may have a cough or feel breathless. 

Testicular cancer can usually be cured, even if it has spread when it is diagnosed.

Symptoms due to hormones

Many testicular cancers make hormones that can show up in blood tests. Occasionally, men with testicular cancer have tender or swollen breasts because of these hormones.

The cells can also spread to lymph nodes in the centre of your chest between the lungs – in an area called the mediastinum. If this happens you could have one or more of the following:

• a cough
• difficulty breathing
• difficulty swallowing
• a swelling in your chest

90,000 Pain in the groin, perineum, lower back, testicles – Urology – 05/12/2014

anonymous

Hello. I am a man, 21 years old.
A month ago, my side ached, drawing pains to the left of the navel to the groin. I went to the doctor, was appointed to do a pelvic ultrasound and tests. Nothing but a hypothetical gallbladder and spleen were found at the upper limits of the norm. The kidneys on ultrasound are normal, the prostate is not enlarged. They said most likely a pinched nerve in the spine.
Several days passed, the pains have changed. To the symptoms was added a burning sensation when urinating, and after.I went to get tested for STDs, took a smear. Answer – The smear is calm, nothing was found. The pains changed their character.
Every day I feel unwell, and sometimes the nature of the pain changes.
As a result, today I have the following symptoms:
1) Pain in the perineum, testicles, thighs (inner part), behind the knees, in the lower back and slightly below, and in the side are sharp at the level of the navel and below in the left side of the abdomen. Sometimes pain in the pubic area. Pains are often like burning, as if everything were on fire.
2) Pain when urinating and burning. Frequent urge to pee.The jet seems to be good, not intermittent. The nature of the pain changes, sometimes strongly, sometimes weakly. And there is a burning sensation after urination. And sometimes some kind of itching in the urethra. The tip of the penis is sometimes cold. It seems to me that the head has changed over the past 2 weeks, that is, it began to darken around the hole. Showed to the urologist, he said that the lips were just inflamed, tk. sensitive head.
3) Sometimes there are such symptoms: Dizziness and nausea, headaches, it happened that the left leg went numb.
4) There is a Varicocele.There is a referral for an operation. The operation will definitely be done, only in 3-4 weeks. Because now there is no time to go to the hospital. Session, Gosy, Diploma. I asked the doctor and allowed.
5) My temperature did not rise above 37.2. Usually 36.4-37.2. Mostly good – 36.6
My blood pressure is usually around 140-80. Pulse is small all the time 55-68, I think this interval, in a calm state.
Urine tests are good.

I forgot to write. Yesterday I went to the urologist. We touched the prostate. In conclusion: 2×3 cm, tightly elastic, fairly uniform, clear contours, the groove is preserved.That seems to have written everything. Help me please. What can I have? Any suggestions?

Urologist – andrologist in Tomsk

The First Private Clinic offers you:

• Consultation appointment (urology, andrology, urogynecology)
• Complex conservative treatment for men and women :

– inflammatory diseases of the genitourinary system:

– sexually transmitted infections (Chlamydia, ureaplasma, mycoplasma, gonorrhea, Trichomonas, HPV, genital herpes, candidiasis, etc.)

– benign prostatic hyperplasia (BPH), overactive bladder, urolithiasis, Peyronie’s disease.

– erectile dysfunction (impotence), premature ejaculation, male infertility.

• Diagnostic and therapeutic procedures:

• prostate massage
• ureteroscopy, cystoscopy
• uroflowmetry
• change of nephrost and cystostomy
• Removal and excision of papillomas and genital genitalia genital organs peaked at
• instillation of the bladder
• bougienage of urethral stenosis
• removal of sutures, dressings

• Physiotherapy in the complex treatment of various inflammatory diseases of the genitourinary system in men and women with laser Intromag
• Full complex of ultrasound examinations of the genitourinary system organs (ultrasound)
• Surgical treatment using modern and effective methods:

• phimosis (inability or difficulty in exposing the glans penis due to the narrowness of the foreskin) – circumcisio (circumcision)
• short frenulum of the penis – frenuloplasty
• hydrocele or dropsy (accumulation of serous fluid between the membranes of the testicle, in which it increases in size) – plastic of the membranes of the testicles – according to Winkelmann and Bergman
• cysts of the epididymis and testicles – excision of cysts
• varicocele (dilation of the veins of the spermatic cord of the testicle) – Marmara operation
• removal of contagious molluscs (viral infection caused by one of the smallpox viruses that affects the skin and sometimes mucous membranes)
• resection of genital atheroma (tumor-like formation resulting from blockage of the sebaceous gland duct) and oleogranulomas (presence of any foreign object or substance (gel, balls, rods, etc. ) under the skin of the penis.))

• Possibility of operations under the compulsory medical insurance policy

When to see a urologist

We recommend that you contact the urologist of the First Private Clinic if the following symptoms appear

• burning, pain, itching during urination
• urinary incontinence, frequent urination
• urinary retention
• discoloration of urine, the appearance of blood in it
• pain in the appendages, lower back in women
• pain in the groin, perineum, lower back in men

• Erectile dysfunction

90,031 urination disorders;

• discharge, uncharacteristic of the urethra
• change in the appearance of ejaculate
• accelerated ejaculation

90,031 rashes, sores, etc.changes in the genitals in men 90,034

We also recommend visiting a urologist for examination when preparing a couple for pregnancy, with frequent change of sexual partners.

* The cost of services is given on 01. 09.2021

Groin pain in football players

One of the most unpleasant, difficult and often mysterious problems in football is groin pain (pubalgia).

Hundreds of athletes ended their careers because of them, thousands of athletes were treated for many months and operated on the mythical “groin rings”.

Given the format of the blog, I will not write hard and scientifically about this problem, I will not talk about the international consensus on groin pain, which was adopted in Doha 5 years ago (who wants to easily find it in any of the scientific search engines)

And simply and point by point I will write down the key points related to this problem.

1. If discomfort, and then pain appears gradually and then increases over time and is associated with stress, then it is always either inflamed tendons or swelling of the pubic bone.

In the second case, the treatment can take many months!

2. Most often, problems arise when, during self-preparation, and then during the first training camp, there is a lot of jumping work (hurdles, reindeer running, jumping out) in combination with a large number of hits on the ball.

First, discomfort appears, which they begin to “endure”, then anti-inflammatory drugs are used to reduce pain for a while.

Pauses are given for 3-4 days, which only delay the solution of the problem and, as a result, aggravate.

3. The diagnosis “ARS syndrome” is just an inflammation of the tendons at the point of their attachment to the symphysis – this is an inflammation associated with overload, and there is no need to “clean, scrape” anything there!

4.Dilated inguinal rings should not be an indication for surgery! They are enlarged in most footballers and this is due to the load that they experience during their careers.

5. In the event of inguinal pains, specialists of various kinds begin to “correct the pelvis”, which is “skewed” …

Well, first of all, if the pelvis were tragically skewed, then there would be no talk of playing football!

Secondly, I have not seen a single footballer to whom the manuals would say that his pelvis is perfect)))

Third, does anyone really think that a few sessions in the hands of the most gifted “chiropractor” will remove this imbalance that has been forming over the years?

And, fourthly, in order to accurately determine any imbalance, only a keen eye and unique hands should not be used – there are all instrumental methods, but they are rarely used: after all, when “by eye”, the results are always better – especially when ” by eye “before and after the course of treatment is determined by the healer himself))

6. Diagnosis is based on a detailed history taking! Only a detailed survey and taking into account every detail can make it possible to move in the right direction.

Then there are clinical tests and MRI!

Yes, only a correctly performed MRI can greatly help in solving a seemingly unsolvable problem.

What are his requirements? Minimum 1.5 Tesla, slices at least 3 mm and it is obligatory to perform the STIR sequence in three projections.It would also be very desirable to carry out research in a projection parallel to the linea arcuata of the ischium: this allows the most accurate determination of the involvement of the muscles closest to the symphysis in the pathological process.

Why not ultrasound?

Ultrasound in athletes in our country can be adequately performed by only a few specialists and not everyone who wants to can get to them.

In addition, early stage bone edema, which is often the cause of problems, can only be seen on MRI when performing the STIR sequence, and in many centers it is not done, saving time for research – as a result, the true cause of the pain is not identified.

7. The so-called “sports hernia”, which must be accurately operated (another question is how to adequately operate it in athletes), can be diagnosed only when performing dynamic MRI (in fact, it is not done anywhere) or ultrasound (it can be adequately performed in a very small number of places ).

In addition, “sports hernias” can coexist with other changes in the groin area and be an accidental finding that does not always require intervention.

8.In any adult football player without complaints, when examining the groin and pelvis, one or more of the following findings can be found: arthrosis of any localization, osteophytes, FAI syndrome in the hip joint, 1 degree pubic symphysis divergence, all kinds of enthesopathies …

This is a payment for the opportunity to play – after all, football is played with feet and a huge load falls on the pelvis, causing varying degrees of change

9. What is the most common cause of groin pain?

Bone tissue edema (MRI) – only conservatively.

Tendinitis (MRI, ultrasound) – only conservatively.

Undiagnosed muscle and tendon injuries, against the background of which the load continues (MRI) – only conservatively.

Inguinal hernia (ultrasound, clinical tests) – surgery only.

Inflammation of the muscles around the symphysis (MRI) – only conservatively.

Stress fracture (the first three stages of this pathology are visible only on a correctly performed MRI).

“Sports hernia” (dynamic MRI and ultrasound) – an operation, but only with a precisely established diagnosis, and not on the basis of complaints and the fact that the “rings are expanded”.

Summarizing the above, we can say the following: groin pain in football is a frequent phenomenon and is most often associated with overload.

The main problems are the behavior of athletes (we play through pain) and incorrect diagnostics (we do not see the causes of pain, but what we see is not always them).

I will tell you how and how much to treat “groins” next week.

Volgotransgaz Medical Center

Urology is a field of medicine that deals with diagnostic procedures and treatment of diseases of the urinary tract, bladder, and kidneys. Moreover, these are ailments related to both the male and female genital spheres. At the moment, a science called andrology has emerged in this direction. There are also such highly specialized areas as phthisiurology, urogynecology, oncourology, geriatric urology, and pediatric urology.

Most common symptoms

A urologist in Nizhny Novgorod is faced with a very wide range of symptoms. This is due, among other things, to a large number of urological diseases. Most often, patients report the following body signals:

Various kinds of discharge from the genitals;

Pain, cramps and other unpleasant sensations when urinating;

Blood in the urine.

Urinary incontinence or retention;

Severe back pain;

Pain in the scrotum, in the penis, in the groin, in the lower abdomen;

Itching in the perineum.

Pain during intercourse.

Plaque on the genitals.

Edema of the genitals.

Decreased sex drive.

Very short intercourse.

In the process of carrying out diagnostic manipulations, the symptoms and complaints identified in the patient during the initial examination play an extremely important role. They narrow the search, help to establish the required instrumental and laboratory examinations.This allows the correct diagnosis to be determined. As a result, timely prescribed treatment, which in a short time gives the required effect.

Male diseases

Modern men are increasingly faced with diseases such as prostatitis, erectile dysfunction, cystitis, urethritis, prostate adenoma. Varicocele is also often diagnosed. This pathology is found in more than 40% of men. The disease is characterized by the expansion of the veins of the aciniform spermatic cord. If you do not contact a specialist in time, serious problems can arise.For example, complicated cystitis leads to inflammation of the processes of the prostate gland.

Most ailments are treated with medication. In more serious cases, surgical intervention is performed: dissection of the short frenum, laser urethrotomy, cystoscopy, circular excision of the foreskin, removal of the penile granuloma, opening and drainage of paranephritis, electroresection of the urethral polyp, etc.

Women’s diseases

Women visit a urologist somewhat less often …They usually have the following diseases:

pyelonephritis;

inflammation of the bladder;

kidney stones;

daytime and nighttime urinary incontinence;

inflammation of the urethra;

trophic changes in the mucous membranes of the genital organs.

Illiterate therapy or untimely detected infections are the main reasons due to which problems arise in women. Failure to use protective equipment during sexual intercourse, wearing tight and synthetic clothing, tumor neoplasms of the pelvic organs, deposits of salts and kidney stones, metabolic disorders, defects in the pelvic organs, weakening of the pelvic muscles, lack of hormones, chlamydia, Escherichia coli – all this can lead to urological disease.

Why can’t you do without diagnostics?

Urology in Nizhny is developed at a fairly high level. Specialists who provide services in this area clearly understand that treatment should begin with a diagnosis. It not only allows you to determine the diagnosis, but also to establish the type, stage of the disease. The survey is of a complex individual character. This means that the characteristics of the organism of each individual person are taken into account. Thanks to an integrated approach, a lot of time can be saved.

Do not self-diagnose, let alone self-medicate. In some cases, the clinical symptoms that may accompany urological ailments do not have specific specificity. They can develop with the pathology of other systems and organs. Therefore, deciding to act on your own, you can cause irreparable harm to your health. The urology clinic is exactly the place to which you need to immediately contact even with the slightest suspicion of a urological disease.

Methods of diagnosis and treatment?

In Nizhny Novgorod, the urology clinic provides a wide range of services.A woman or a man can also apply for a comprehensive examination. The following manipulations are carried out:

treatment and diagnosis of prostatitis, urolithiasis, inflammation of the urethra, prostate gland, potency disorders, kidneys, appendages and testicles;

treatment and diagnosis of potency disorders;

ultrasound examination;

rectal examination of the prostate;

the whole range of examinations of sexually transmitted diseases;

taking a swab from the urethra;

urethral bougienage;

blockade of the spermatic cord;

prostate massage;

Bladder catheterization.

Quality help for your health!

If you find at least one symptom from the list above, immediately make an appointment with a urologist. You can visit a specialized medical center or urology department. The main thing is to visit only a competent doctor. Finding a good specialist is not difficult. To this end, you need to study the corresponding rating and read the reviews left by other patients.

When applying for a medical service in a well-established clinic, you can be sure that the problem will be solved competently.In such an institution, you can also get professional advice. Recording is carried out here, which significantly increases the comfort of treatment. You don’t have to queue. With all the advantages, the cost of assistance is reasonable. Anyone who needs it can apply.

Take your health seriously and you will never face a terrible illness!

When to seek help from a urologist?

2020.09.23

When do you need to see a urologist?

Both women and men can and should seek advice or assistance from a urologist in the following cases:

• Women with urinary incontinence, kidney stones or blood in the urine.If you are concerned about problems with the uterus or vagina, infertility, they are more likely to see a gynecologist.
• Men who notice blood in their urine, suspect kidney stones, difficulty emptying the bladder, or an elevated PSA (prostate-specific antigen is a protein found in the blood that can indicate prostate cancer) usually see a urologist.

Many people with bladder or kidney problems consult their healthcare professional first, but if the problem remains unresolved, they should seek professional help.Some of the symptoms of different diseases may overlap or overlap, which requires a multidisciplinary approach in such cases, i.e. the help of several different specialists is required.

Symptoms indicating that you should see a urologist include:

For women and men:

• Blood in urine
• Pain or burning sensation when urinating, which may indicate a urinary tract infection
• Frequent urge to urinate or difficulty urinating
• Urinary incontinence
• Severe constipation
• Pain in the lower abdomen, back or groin

For men only:

• Difficulty getting or maintaining an erection
• Fertility problems
• Increased PSA
• Testicular enlargement or pain in them
• Enlarged prostate gland

The most common reasons for these complaints are:

1.You have a urinary tract infection that doesn’t work and doesn’t go away.

If you experience burning, soreness, and frequent urination that does not clear up with antibiotics, this could be a sign that you have interstitial cystitis, also called painful bladder. To make a diagnosis, the urologist examines the urine and examines the bladder with a cystoscope, and prescribes the appropriate treatment.

2. You urinate a lot and often or do not retain urine.

Urologists work with both men and women to control the symptoms of overactive bladder and urinary incontinence. There are, of course, other serious systemic (non-urological) diseases that cause similar complaints.

3. You suspect you have a kidney stone.

Kidney stones are best characterized by severe pain on one side of the lower back, although other symptoms may occur at the same time: irritating stomach pain, blood in the urine, halitosis, or cloudy urine.The pain from kidney stones can be very severe, and many patients say it is the worst pain they have ever experienced.

4. You are a man with erectile dysfunction.

A urologist is often the first doctor a man turns to if he has problems getting or maintaining an erection. The problem can be psychological, but it is often caused by other health problems. It can be successfully treated with both special recommendations and medication or even surgery.

5. You feel pain in the lower back or pelvis.

Low back or pelvic pain occurs for many reasons, including kidney blockage, inflammation of the prostate, prostate infection, bladder cancer, and kidney cancer.

6. You are a fertility concern.

If you and your partner are unable to have offspring for 6-12 months, a urologist can determine the cause of your infertility based on sperm, blood and ultrasound tests.

90,000 Pain after removal of varicocele – Mingbolatov F.Sh.

To cure varicocele, an accumulation of venous nodules in the testicle, surgical intervention is required in a specialized clinic. The postoperative period can be accompanied by side effects, most of which are natural and gradually disappear. If the testicle hurts after varicocele surgery, you need to consult a urologist and find out the cause of the pain in order to avoid complications.

Do testicles often hurt after varicocele?

The manifestation of pain in the groin in the postoperative period may occur due to various factors:

• Insufficient diagnosis;
• Ligation of the iliac veins instead of the testicular veins, which are located next to each other;
• Non-compliance by the patient with the recommendations of the attending physician during recovery;
• Residual effects after surgery – hematomas, edema;
• Development of complications such as dropsy, soft tissue atrophy, lymphostasis, abscess.

Only a competent urologist or andrologist can determine exactly why the testicles hurt after varicocele – if you experience discomfort, you should immediately contact the clinic.

How to eliminate pain after varicocele surgery?

It is possible to avoid pain if you adhere to the doctor’s instructions for the rehabilitation period:

• Do not take a hot bath;
• Do not have sex;
• Change dressings every day;
• Avoid physical activity;
• Follow a diet;
• Restrict active movement.

If all instructions are followed, but relief does not come, you must go to the doctor. Swelling and bruising disappear in 5-10 days. An increase in body temperature indicates the development of complications. With dropsy, fluid accumulates in the tissues, with lymphostasis – in the lymph. The doctor prescribes the necessary measures after examination. More complex consequences are eliminated on an individual basis, which is established by the urologist.

In Moscow, you can have a varicocele operation or get a specialist’s advice on why a testicle hurts, you can contact Dr. Mingbolatov.