Testicle injuries and conditions

Several non-cancerous conditions can affect the testicles. The testicles are also prone to injury because they are not protected by muscle or bone. It is important to seek prompt medical attention for any testicular complaint.

About the testicles#

Testicles are also known as testes (a single one is a testis), or ‘balls’. They are two small, oval-shaped male sex glands that produce sex hormones and sperm. Each testicle is enclosed in a fibrous outer covering called the tunica albuginea, which sits inside a sac of skin called the scrotum.

Sperm production needs a temperature that is around 2°C (35.6°F) lower than the rest of the body, which is why the testicles are located outside the body in the scrotum. The spermatic cord attaches the testicle to the body.

Testicular torsion#

Testicular torsion occurs when the spermatic cord twists and cuts off the blood supply to the testicle. It can happen at any age but tends to be more common between the onset of puberty and the mid-20s. It is a medical emergency that requires urgent attention.

your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia)

Hard physical activity can cause the cord to twist. In most cases, however, it is caused by differences in a person’s anatomy that make it easier for the testicle to rotate around the cord.

Symptoms of testicular torsion include severe pain, scrotal swelling, nausea, and vomiting. These can be confused with an infection of the testicles, but an infection should not be assumed until torsion has been ruled out.

A doctor uses physical examination and ultrasound scans to make the diagnosis. Sometimes a conclusive diagnosis can only be made during surgical exploration.

Urgent surgery is needed to untwist the spermatic cord and restore blood flow. The survival of the affected testicle is poor unless surgery is performed within four to six hours of the onset. Unnecessary investigations should be avoided when torsion is suspected, because delays can affect whether the testis can be saved. If the blood supply has been cut off for too long, the testis may not be salvageable and may need to be removed.

In many cases the surgeon will also secure the spermatic cord on the unaffected side, to prevent future torsion of the other testicle. If a twisted testicle has to be removed, a surgeon can later place a prosthesis (a silicone testis) into the scrotum for cosmetic reasons.

Torsion of the appendix testicle#

The appendix testicle is a small tissue structure at the upper third of the testicle. It does not appear to have any particular function. Torsion of the appendix testicle means this structure has twisted and cut off its own blood supply.

This condition is easily confused with testicular torsion because the symptoms are so similar. However, the pain tends to come on more slowly, and the condition often shows a noticeable blue dot on the surface of the scrotum – this is the darkened appendix testicle. Surgery is used to correct the problem, but the testicle itself is not at risk.

Testicular cancer#

Testicular cancer is an abnormal growth or tumour that usually appears as a hard, painless lump in either testicle. In most cases it can be cured if a person seeks medical treatment early. Surgical removal of the affected testicle (orchidectomy) is usually the first treatment for all testicular cancers.

Other testicular conditions#

• Epididymitis – the epididymis is a collection of small tubes at the back of each testicle that collects and stores sperm. Epididymitis is infection and inflammation of these tubes. Causes include urinary tract infections and sexually transmissible infections (STIs). Treatment is usually antibiotics.
• Epididymo-orchitis – infection of the epididymis, testicle, or both, causing inflammation and pain. Treatment is usually antibiotics.
• Varicocele – occurs where the veins that drain blood from the testicle become enlarged. When a person stands, blood in these veins must move against gravity to return to the heart, and valves help this process. If the valves do not work well, blood pools and swells the veins, giving the appearance of ‘varicose veins’. Around 10 to 15 per cent of men have a varicocele. Varicoceles usually do not need treatment unless they are severe enough to cause discomfort or impair fertility. The link between varicocele and infertility is not fully understood and research is ongoing. Treatment may involve surgery or radiological techniques that block the affected veins and redirect blood into unaffected ones.
• Haematocele – a blood clot caused by trauma or injury to the testicles or scrotum. In some cases the body reabsorbs the blood; if not, surgery is needed to remove the clot.
• Hydrocele – an abnormal build-up of fluid that causes the affected testicle to swell. The body can sometimes reabsorb the fluid. Although it is painless, a hydrocele may become so large that surgery is needed to remove it.
• Spermatocele – an abnormal build-up of sperm-filled fluid next to the epididymis, which feels like a separate lump on the testicle. It is harmless but can be removed surgically if it becomes large or bothersome. It is more common after a vasectomy.
• Undescended testicles – one or both testicles are missing from the scrotum and remain in the lower abdomen. Premature and low-birth-weight newborn boys are most prone to this. It is a known risk factor for testicular cancer and is strongly linked to infertility. Unless the testicle is brought down into the scrotum by 12 months of age, there is a high risk of damage to sperm production later in life.

Trauma to the testicles#

Testicles are easily injured because they are not protected by muscle or bone. The main types of injury include:

• Impact from a moving object, such as a kick to the testicles
• Impact from hitting an immovable object
• Penetrating injury, such as a bite or stab wound

If the testicles seem normal, a doctor may prescribe pain-relieving medication. Even without an ultrasound, a surgeon may choose to surgically explore the testicle, particularly when testicular torsion is possible. Surgery is usually performed under general anaesthetic. Significant injury may require surgical exploration and repair, or possibly removal of the affected testis. A person’s fertility is not affected as long as one functioning testicle remains.

Reducing the risk of testicular problems#

• Take all reasonable precautions to prevent accidents – for example, drive safely and always wear a seatbelt.
• Protect yourself from sexually transmissible infections (STIs) by wearing a condom.
• Always use protective equipment, such as a jockstrap or hard cup, when playing sports.
• If you injure your testicles, always seek urgent medical advice.
• Perform testicular self-examination (TSE) regularly. See your doctor for advice on how to do this.

Always see your doctor if you have any scrotal or testicular pain or unusual symptoms, or if you find a lump or swelling.

Key points#

• The testicles are prone to injury because they are not protected by muscle or bone.
• Seek prompt medical attention for any testicular complaint.
• Testicular torsion can occur at any age but is more common between puberty and the mid-20s, and is a medical emergency.
• Symptoms of testicular torsion include severe pain, scrotal swelling, nausea, and vomiting.
• Perform testicular self-examination regularly and see your doctor if you notice a lump, swelling, or unusual symptoms.

Where to get help#