Testicular Disorders and Treatment: A Comprehensive Guide to Pain, Swelling and Lumps

What causes testicular pain? Expert information on testicular cancer symptoms, varicocele, hydrocele and testicular torsion treatment. How to perform a self-examination?

Don’t Let Shame Get in the Way of Your Health

Testicular diseases can affect every group, from newborn babies to older men. They sometimes present as an insidious swelling, sometimes as unbearable pain, and sometimes as infertility issues.

When someone searches online for ‘My testicle hurts, why?’, they may find results ranging from a simple infection to a condition requiring urgent surgery. That’s why accessing accurate information is vital. This article has been prepared as a roadmap to help you understand your symptoms and learn about treatment options.

The Function and Structure of the Testicles

The testicles are two oval organs located inside a skin sac called the scrotum, one on the right and one on the left.

Sperm Production: With puberty, they produce millions of reproductive cells.

Hormone Production: They are the main source of testosterone, which provides male characteristics (muscle structure, voice pitch, hair growth, sexual desire).

The reason the testicles are located outside the body is that sperm production requires an environment that is 1-2 degrees cooler than body temperature.

The Most Common Testicular Diseases and Their Treatments

We can categorise testicular diseases as vascular, fluid accumulation, infection, emergencies and tumours.

A. Varicocele (Varicose Veins)

It is the dilation of the testicular veins, similar to varicose veins in the legs. It is most commonly seen on the left side.

Symptoms: Pain in the testicle, a ‘worm-like’ appearance of veins in the scrotum, infertility.

Risk: It damages sperm quality by heating the testicle and may cause testicular shrinkage.

Treatment: If it does not cause pain or infertility, it is monitored. However, if sperm values are impaired, the dilated veins are ligated using microsurgical varicocelectomy.

B. Hydrocele (Accumulation of Fluid)It is an accumulation of excess fluid between the membranes surrounding the testicle.

Symptoms: Swelling and enlargement of one side of the scrotum. It is usually painless but causes a feeling of heaviness. When light is shone on it, it glows like a water-filled balloon.

Treatment: In infants, it is expected to resolve spontaneously by the age of 1. In adults or infants where it does not resolve, the fluid is drained and the membrane producing the fluid is removed via hydrocelectomy surgery. Draining with a needle (aspiration) is not recommended because the fluid quickly accumulates again.

C. Testicular Torsion – EMERGENCY

It is the twisting of the testicle around its own cord (the structure through which blood vessels pass), causing it to become constricted. Blood flow is cut off.

Symptoms: Sudden onset of severe testicular pain, nausea, vomiting, and the testicle being pulled upwards. It usually occurs during sleep or after trauma.

Treatment: Time is of the essence. If not treated within the first 4-6 hours, the testicle will become gangrenous and die. Emergency surgery is performed to return the testicle to its original position and secure it with stitches to prevent it from twisting again.

Warning: Do not wait for sudden testicular pain to ‘go away’; go to the emergency room immediately.

D. Orchitis and Epididymitis (Inflammation)

Orchitis: Inflammation of the testicle. It is commonly seen in children or young adults, usually associated with the mumps virus. The testicle becomes swollen, reddened, and extremely painful.
Epididymitis: Inflammation of the sperm ducts (epididymis) on the testicle. It is usually caused by urinary tract infections or sexually transmitted bacteria (Chlamydia, Gonorrhoea).
Treatment: It is treated with appropriate antibiotics, rest, ice application, and a scrotal sling (lifting the testicle).

E. Undescended Testicle (Cryptorchidism)

The absence of the testicle in the scrotum at birth, where it remains in the inguinal canal or within the abdomen.

Treatment: Wait for the first 6 months. If it does not descend, it must be surgically corrected (orchidopexy) between 6 months and 1 year of age.
Importance: Delaying treatment significantly increases the risk of infertility and testicular cancer.

F. Spermatocele (Sperm Cyst)

These are benign cysts that form in the epididymis, filled with dead sperm. They are usually painless and can be felt as a small lump. They do not require treatment unless they grow very large (and cause pain).

Testicular Cancer: The Nightmare of Young Men

Testicular cancer is the most common type of cancer in young men aged 15 to 35. However, despite its frightening name, it is one of the cancers with the highest success rate (survival rate) in treatment (over 95%).

What are the symptoms?

The most important and typical symptom: A palpable, hard, irregular and usually PAINLESS lump on the testicle.

Heaviness in the testicles.
Breast enlargement or tenderness (in hormone-secreting tumours).
Abdominal or back pain (in advanced stages).

Warning: Do not say, ‘I have no pain, so it is not important.’ Testicular cancer usually does not cause pain. A lump that can be felt is the most important sign.

Treatment

Orchiectomy (Removal of the Testicle): The cancerous testicle is removed through an incision made in the groin area. It is sent for pathology.
Additional Treatments: Chemotherapy or radiotherapy may be administered depending on the pathology results and the extent of spread.
Prosthesis: A silicone testicle prosthesis may be fitted in place of the removed testicle to address aesthetic concerns.

Diagnostic Methods

After examining you, your doctor may request the following tests:

Scrotal Colour Doppler Ultrasound: This is the gold standard for diagnosing testicular diseases. It clearly shows the contents of the swelling (fluid, mass, inflammation) and blood flow (torsion).
Tumour Markers (Blood Test): Beta-HCG, AFP and LDH values are checked when testicular cancer is suspected.
Urinalysis: Investigates the presence of infection.

Self-Testis Examination (STE)

As with breast cancer, early diagnosis of testicular cancer is in the individual’s own hands. Every man should examine himself once a month from puberty onwards.

How is it done?

Time: The best time is after a warm shower or bath. The scrotum skin will be relaxed.
Position: Stand in front of a mirror.
Method: Gently hold each testicle with both hands. Roll the testicle gently with your thumb on top and your other fingers underneath.
What to look for?
A hard lump on the surface of the testicle, about the size of a grain of rice or a pea.
A change in shape or size.
Swelling.

What is Normal? The soft, cord-like structure felt behind the testicle is the epididymis. Do not mistake this for a lump. It is also normal for one testicle to be slightly lower or larger than the other.

What Causes Testicular Pain (Orchialgia)?

Sometimes no disease can be found, but the testicular pain persists (chronic testicular pain). The causes may include:

Yansıyan Ağrı: Böbrek taşı düşürmek, kasık fıtığı veya bel fıtığı ağrısı testise vurabilir.
Travma: Darbe almak.
Cinsel Uyarılma: Uzun süre ereksiyonda kalıp boşalamamak (“Blue Balls”) kasıklarda ve testislerde ağrı yapabilir.
Stres: Pelvik taban kaslarının gerilmesi.

Frequently Asked Questions (FAQ)

Question: If one testicle is removed, will I still be able to have children? Answer: Yes. If the remaining testicle is healthy, it can produce sufficient testosterone and sperm on its own. Your sex life and reproductive ability will continue as normal.

Question: How long does it take for testicular cancer to spread? Answer: Testicular tumours are fast-growing tumours. You should see a doctor within weeks of noticing a lump. If caught early, it is possible to be cured with surgery alone, without even needing chemotherapy.

Question: Does wearing tight trousers damage the testicles? Answer: Yes. Constantly wearing very tight trousers or underwear presses the testicles against the body, increasing their temperature. This can reduce sperm quality. It can also impair blood circulation.

Question: Does cycling damage the testicles? Answer: Professional and long-term cycling can cause numbness or microtrauma in the testicle and prostate area due to saddle pressure. Choosing the right saddle and clothing is important.