Pain in the testis on one or both sides is a common presentation amongst young boys and men. It may be arising from the testis itself or at times referred to the testis from a problem such as inflammation within the prostate or indeed a stone lodged in the lower end of the tube (ureter) draining the kidney.
Pain arising from the testis itself is most commonly due to inflammation of the testis caused by either viral or bacterial infection which may lead to testicular pain and swelling (orchitis) or inflammation of the epididymis leading to pain and swelling of the epididymis (epididymitis) or not infrequently a combination of both (epididymo-orchitis). This is a clinical diagnosis confirmed by an ultrasound scan (USS) and requires long-term treatment with appropriate antibiotics as well as anti-inflammatory agents.
Pain referred from other sources requires further investigations to confirm the diagnosis, as the testis itself on examination is non tender and has no obvious swelling.
Acute onset testicular pain that develops over few hours for no obvious reason and does not respond to painkillers raises the possibility of twisted testicle irrespective of patient's age, although it is generally most common in teenage boys and young men. In this situation, an accurate clinical diagnosis is paramount as it justifies giving patient the benefit of doubt and offer surgical intervention.
Lump or swelling of the testis without associated pain may indicate more sinister problem and must be investigated promptly with an ultrasound scan (USS) in addition to clinical examination by Urologist.
This is one of the commoner types of cancers amongst young men and deserves urgent attention with a view to remove the afflicted testis. It presents as a painless hard lump arising from the testis and noticed accidently by the patient or his partner. With increased awareness of this condition, it also manifests when boys/men conduct self-examination to find a painless lump on one of their routine checks. After appropriate tests, the involved testis needs to be removed surgically and the patient given the option of insertion of a testicular prosthesis at the same sitting. Further management depends upon the results of staging scans.
There are several non-sinister reasons that would account for swellings within or on the surface of the scrotum, which may or may not require surgical intervention after initial assessment and scanning but it is important that men with such problems are appropriately investigated to rule out any sinister causes such as cancer.