Treat Pain and Swelling in the Testicles

Pain and swelling in the testicles can occur due to a number of causes, from viral or bacterial infection to trauma. The cause is important because the treatment varies depending on the cause. Testicle pain usually comes in the form of testicular torsion from trauma, viral infection from mumps orchitis, or bacterial infection with epididymis or epididymo-orchitis. It is likely not cancer, since testicular cancer is typically painless. When pain occurs, there are some things you can do to treat testicular pain.

Steps

Finding Fast Relief

1. Take over-the-counter pain medications. Over-the-counter painkillers such as Ibuprofen, paracetamol, or aspirin can be used to relieve pain and swelling. All of these medications work by inhibiting the production of chemicals called prostaglandins, which cause inflammation. The recommended dosage for each of these drugs is as follows:
   • Ibuprofen (or similar generic drug), 200 – 400 mg tablets, with or just after food, up to three times a day
   • Aspirin, 300 mg tablets up to four times a day
   • Paracetamol, 500 mg tablets up to three times a day
   • Do not mix these medications. Overdose can lead to serious side-effects.
2. Lie down on your back. Until professional medical assistance is obtained, lying on your back and supporting the testes in whatever way feels comfortable can help to relieve physical stress and discomfort.
   • You can also enhance your scrotal support, such as a jock strap. This can aid in relieving testicular pain by protecting the region against contact friction between your legs, painful movement of the scrotum, and external contact that can lead to irritation.
3. Apply an ice pack to the area. In case there is a sudden onset of swelling and pain, gently apply an ice pack or a bag of frozen vegetables to your testicles to help relieve pain and swelling.
   • Applying an ice-pack is an important measure since, if the cause of the swelling is serious, it can increase the amount of time the testicles can survive without a blood supply.
   • Wrap the frozen ice or bag of vegetables in a dry cloth before applying to protect from frostbite.
4. Rest and avoid strenuous activities. Allow time for the testicles to naturally heal by avoiding activities that could aggravate the pain and swelling. Avoid heavy lifting, running and other vigorous exercises.
   • If total rest is not possible, then wearing supportive undergarments and/or a truss can be beneficial.

Looking for Symptoms

1. Recognize the risk factors. There are some common risk factors for both bacteria and viral infections that cause testicular pain. These risk factors include:
   • Sexual activity
   • Strenuous physical activity, such as frequent bicycle or motorcycle riding
   • Prolonged sitting, such as frequent travel or truck driving
   • History of prostate or urinary tract infection
   • Benign enlarged prostate or prostate surgery, typical in older men
   • Anatomic defects such as a posterior urethral meatus, which occur in prepubescent boys
2. Check for trauma. Testicular pain from trauma, called testicular torsion, includes pain of the testicles and of the epididymis, which is the tube that runs on the underside of the testicles. To evaluate this, it requires a meticulous physical exam. If you have experienced any testicular trauma at all, especially testicular torsion caused by a twisting of the testicles, have it checked because it is a testicle-threatening problem.
   • Your doctor may check your Cremasteric reflex, which is absent in cases of trauma. This is done by running a reflex hammer along the inner thigh, which will cause the testicle to rise up protectively into the scrotal sac in healthy testicles.
   • Testicular torsion usually represents itself as an abrupt pain.
3. Diagnose pain due to infection. Age plays a major factor in the determination of infection. Infectious causes of testicular pain include bacterial infection of the testicles and epididymis. This is due to bacteria that make their way up from the rectum, usually in men older than 35 and younger than 14. For young men between 15 and 35, the most common reason for infections of the testicles are sexually transmitted bacteria, such as Chlamydia and Gonorrhea. You will have pain when the area is touched during examination. Your doctor may check to see if elevating the testicles will ease your pain, which is referred to as Prehn’s sign.
   • Treatment of the infection will help with pain relief and combat any worsening of the infection and potential sepsis.
   • The Cremasteric reflex will still occur with pain due to infections.
4. Look for orchitis. Orchitis is due to viral infection, which causes pain and swelling in the testicle to come on abruptly. There is acute pain and swelling of the testicle. Orchitis occurs due to mumps orchitis, a viral infection seen with more prevalence as we see a lack of the MMR vaccine being given in early childhood, around 11 months. Approximately 20 to 30 % of kids with mumps will get mumps orchitis. It usually begins one week after the onset of parotitis, which is the swelling of the parotid glands beneath the jaw.
   • There is no treatment for viral mumps orchitis and it may cause infertility. The only way to help is with supportive care, such as pain medications and ice packs.
5. Check for sexually transmitted infections (STIs). For STIs, the symptoms will likely be pain in the testicles, which may be accompanied by burning during urination. The onset of the symptoms is gradual and can take weeks for them to show up. The testicular pain may also be associated with nausea and vomiting as well as abdominal pain. You will have a normal Cremasteric reflex.
   • An ultrasound will show increased vascularity, pockets of infection, or abscess formations.
   • You may also suffer from other symptoms, such as discharge or blood in the urine.
6. Look for signs of epididymo-orchitis. The pain caused by this bacterial infection develop quickly, over a day or so. Your epididymis and testicles will swell rapidly and become enlarged, red, and tender. It will also cause great pain.
   • You may also have a different infection, such as a urinary tract infection or urethral infection.
7. Have lab tests done. Lab tests are helpful in detecting infection. Your doctor may test your urine for bacteria, such as E coli. If you are a sexually active young man, your doctor may run a urine multiplex polymerase chain reaction (M-PCR), which will show if you have chlamydia or gonorrhea.
   • An ultrasound is routinely performed for all scrotal pain and swelling, in order to check for more complicated problems.

Treating Continual Pain

1. Deal with bacterial infections. Men of any age can suffer from infections that cause testicle pain, which can be caused by E. Coli or other bacteria. For older men, benign enlarged prostates can play a major role in developing these infections. The bacteria accumulates when the enlarged prostate prevents the bladder from draining properly. Because of this, E.coli or other gastrointestinal bacterial can back up and cause infection.
   • Medical treatment for this includes Bactrim DS or a quinolone antibiotic. The course of treatment is around 10 days, unless the prostate is involved, which may be treated longer.
   • Often, the Prehn’s sign will ease symptoms. Ice packs are also helpful.
   • You can reduce pain with Tylenol, Motrin, or even stronger narcotic pain medication for the first few days.
2. Treat sexually transmitted infections. Treatment for STIs is antibiotics. Your doctor may prescribe Rocephin followed by a course of zithromax or doxycycline. Improvement in pain should begin in 24 to 48 hours. Ice packs as well as testicular elevation can bring relief while you wait for the antibiotics to work. You can also take over the counter pain medications to help as well, especially during the first few days.
3. Deal with testicular trauma. Testicular trauma is caused by a twisted testicle not getting enough blood. This typically occurs after many different kinds of trauma, such as slipping off of a bicycle and hitting the groin. Extreme testicular trauma can twist the spermatic cord, which calls for surgical intervention. This condition affects 3.8% of every 100,000 males under the age of 18 every year.
   • Early recognition of a high-riding testicle and no Cremasteric reflex is sufficient to warrant surgical exploration. This can help prevent an orchiectomy, which is the surgical removal of the testicle.
   • Even trauma that is not severe can cause swelling, tenderness, high fevers, and frequent and urgent need to urinate.
   • The window from injury to surgery is approximately four to eight hours. This will prevent too much damage to the spermatic cord, which has to be untwisted quickly to avoid removal. Despite this rush to take care of it, orchiectomy rates average 42%. Delay in diagnosis may result in orchiectomy and possibly infertility.

Sources and Citations

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