Concerned about 'below the belt' issues?

6/22/2017 by Dr. Chris Boswell

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"Below the belt" issues like testicular or scrotal symptoms often are difficult for men to discuss, but they lead to a lot of worry and fear. Knowing the causes for pain, lumps or masses can relieve some of that anxiety, but also alert you to when to see your health care provider. 

Experiencing pain? It could be:

Testicular torsion

  • More often occurs in those going through puberty, but can happen to any male, even infants
  • Testicle rotates, partially reducing its blood supply
  • Causes sudden severe pain in testicle, groin and up into the abdomen
  • Requires emergency surgery to avoid permanent damage

Epididymitis

  • Epididymis: Coil carrying and storing sperm at back of each testicle
  • Can become infected (often by bacteria such as chlamydia) or inflamed
  • Causes swollen, red, warm hemiscrotum, painful urination or intercourse, sometimes blood in the semen
  • Usually requires antibiotics

Orchitis

  • Inflammation or infection of one or both testicles
  • Usually caused by bacterial infection or mumps virus
  • Symptoms: Fever, nausea and vomiting, pain and swelling in a testicle
  • May take several weeks to completely disappear, even after appropriate medical treatment
  • Can affect fertility, so be evaluated early

Finding a lump or mass? It could be:

Spermatocele/epididymal cyst

  • Often causes painless lumps in the scrotum, usually above the testicle
  • Physical exam may be enough to determine if cyst is separate from testicle
  • Should be evaluated, ultrasound may be required
  • Usually does not need treatment, unless it becomes large or painful

Cancer

  • Lump in testicle itself
  • Should be evaluated with an ultrasound examination
  • Monthly testicular self-exams recommended for men with increased risk of testicular cancer
  • Risk factors: History of undescended testicle or family members who have had testicular cancer

Hydrocele

  • Excessive fluid between layers of the sac surrounding each testicle
  • Common in infants, but can happen in adults
  • In adults, usually the result of an injury or infection
  • Some, but not all, require surgical repair

Varicocele

  • Engorged collection of veins in scrotum
  • Usually occurs on left side
  • Often described as looking or feeling like "a bag of worms"
  • Larger varicoceles can contribute to infertility
  • Many do not require intervention. However, if you or your provider have concerns about its size or your future fertility, or if it causes discomfort, a referral to a urologic surgeon is appropriate. 

Inguinal hernia 

  • Small amount of abdominal contents, such as fat or intestine, pushes through a weak area in the wall between abdomen and groin
  • Usually a mass in the scrotum or higher in the groin
  • Requires surgical repair if causing discomfort or can't be pushed back in

The bottom line is to see your provider right away if you experience pain or swelling in your scrotum or testicle, especially if the pain comes on suddenly.  A painless lump or mass should be evaluated within a few weeks, but usually is not a medical emergency. 

Dr. Chris Boswell is a graduate of Mayo Medical School and the Mayo Family Medicine Residency Program. He practices full-spectrum Family Medicine, including obstetrics, at Mayo Family Clinic Northwest.