• Dr Andy Raffles

Scrotal and Testicular Pain in Childhood

It is always worrying for parents when your child complains of pain, swelling, or a lump in the testicle. The good news is when caught early, many scrotal and testicular problems and injuries can be sorted out.


The first problem for some children and young boys is telling anyone they are experiencing pain or have found a lump. It may feel embarrassing for a child or teen to talk about testicle health, but as a parent, you should emphasize the importance of communicating any concerns, pain, or changes, and then seek advice from your doctor or attend a local emergency department if the pain is significant. The pain may be a warning sign of a serious condition that will need treatment. Without immediate care, your child may be at increased risk of losing a testicle.


Some babies are noted to have an undescended or absent testicle at birth. Usually, the testicle hasn’t finished descending from the abdominal cavity where it starts life in the unborn baby. However, sometimes the testicle gets “lost” on its way down into the scrotum or sometimes gets twisted (a neonatal torsion) and as a result, the boy may only have one testicle at birth. Babies with undescended or absent testicles need further examination with ultrasound scans and a review by a specialist urologist.


What causes testicular pain and swelling?


Many testicular problems cause both pain and swelling. Sometimes, the pain can be a dull ache and worsen over time. Testicular pain can also be sudden and severe and can make your child vomit.


Causes of severe testicular pain can include:

  • Torsion ( Twisting) of the Testicle – A serious condition that happens when the spermatic cord twists and cuts off blood supply to the testicle. This is diagnosed either clinically or with an ultrasound scan. Treatment is surgical to untwist the testicle and fix it from twisting again.

  • Torsion of a cyst of Morgagni – A problem that occurs when a small piece of tissue on top of the testes twists and causes swelling and pain. This can be left to heal itself if the pain and discomfort are not too severe.


Other conditions that cause testicular pain and swelling include:


  • Infection (epididymitis) – A condition that can cause swelling in the epididymis, a tube behind the testicles that helps activate sperm.

  • Hernia- You may notice a hernia as a bulge above the testicle. The bulge can sometimes extend into the scrotum and cause mild, moderate, or severe pain.

  • Varicocele– A condition that occurs when there is swelling in the vein that drains blood from the testicles. It can cause a dull ache and swelling and may feel like a bag of worms above the testicle.

  • Hydrocoele – A condition where fluid gathers around the testicle. While it may not cause serious problems, it can result in uncomfortable swelling. Lots of babies have hydroceles at birth which go away by themselves over the first few months after birth. Sometimes there is an associated hernia that may need treatment at some time.

  • Idiopathic Scrotal Oedema – A common summertime condition that causes the skin around the scrotum or penis to become red, swollen, itchy, and painful. It may look and feel like an allergic reaction or a bad bug bite. Treatment is with local antihistamine cream and sometimes oral antihistamine and steroid tablets.

  • Orchitis – An uncommon condition that causes the testicles to swell.

  • The treatment for testicular pain and swelling depends on the type of condition you have. Treatments can include antibiotics, surgery, and careful monitoring.


What causes testicular lumps?


There are different types of testicular lumps. Non-cancerous (benign) lumps in the testicle are usually cysts. These are small lumps are typically the size of a marble, smooth and round, and may feel like fluid. Cysts can stick around for a while, but they usually don't need treatment. Cancerous (malignant) lumps in the testicles are usually hard and feel very different from the surrounding testicle. These lumps can also be painful.

It is important that your child is examined by a doctor. Any changes in the scrotum or testicles require an examination and usually an ultrasound to help decide if the problem needs further investigation or treatment.


Testicular injury and trauma


Although testicular trauma is rare, it most often affects athletes. In many cases, testicular trauma causes bruising and swelling around the scrotum. While painful, this bruising usually resolves on its own with time. However, serious trauma to the testicles can sometimes occur and these more severe injuries may require surgery to help relieve pain and limit damage to the testicle.


If a testicular injury occurs and results in bruising, consult a doctor. If an injury results in no significant swelling, bruising, nausea or vomiting, the injury can be treated with ice and rest. If there is extensive swelling or moderate to severe pain you should attend a local emergency department.


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