Testicular pain and injuries are an unusual but important first aid presentation to consider. Many individuals presenting with this complaint may feel uncomfortable discussing this with a stranger or even close family member.

There are several key possibilities to consider when a patient presents with testicular pain. We’ll take a look at some of these in this first aid blog post.

Firstly in terms of your questioning when taking your history it is important to ask the patient the following:

Site – Is it one testicle, both or the whole scrotum?

Onset – When did it start?

Character – Is it a burning or stinging pain?

Radiation – Does the pain spread down the penis or into the groin?

Alleviating factors – Anything make the pain better or worse?

Timing – Is this following trauma, has it been like this for a couple of weeks?

Exacerbating factors – Is it worse when walking or sitting?

Severity – On a scale of 1-10 (10 being the worst pain imaginable), how bad would you say  the pain is?

Other important questions to ask include:

• Do you check your testicles regularly? Have you noticed anything unusual?
• Do you see a urologist regularly?
• Do you have any difficulty normally passing water?
• Have you recently been treated for an infection?

Possible Causes of Testicular Pain

Trauma – If the patient has recently received a blow to the genital area this could cause rupture of the testicle or structures in the scrotum causing bleeding in the scrotum. This is a time-critical surgical emergency and urgent medical attention should be sought.

Testicular Torsion – The testes are held in position via a rich network of vessels and tubes. In testicular torsion, the testicle twists around on itself cutting off its blood supply. This is a time-critical surgical emergency requiring urgent surgical intervention.

Infection (Epididymal-Orchitis) – A painful infection, the epidydimus (the structure that helps transport semen out of the testicle) and the testicles (orchitis) become inflamed due to a bacterial or viral infection. This can be a gradual onset and often sometimes goes hand in hand with other urinary symptoms such as difficulty passing water. These patients should still seek urgent medical attention to rule out testicular torsion, which to the untrained eye is near impossible to differentiate between.

Testicular Lumps

A worry for any individual, the majority of masses felt in the testicle are often non-sinister structures such as cysts (fluid collection). However, without specialist knowledge and scanning, it is impossible to know for certain what it is and therefore you should encourage the patient to see their family doctor or urologist as soon as possible for investigations in the event that it could be something more serious such cancer.