Diagnosis and treatment of testicular pain, pain relief measures, and early warning and prevention of testicular cancer

Testicular pain can be categorized into two types: acute, persistent pain and chronic, recurring pain. ① Acute pain. This is commonly seen in orchitis and injury. Besides hematogenous infection, orchitis is more often caused by bacteria ascending from the urethra to the epididymis and testis, resulting in epididymitis and orchitis. Clinically, swelling and pain in the epididymis and testis are observed. Testicular injury is characterized by a history of trauma and local swelling and bruising. Strenuous exercise, sexual activity, or violence can sometimes cause strong contractions of the cremaster muscle, leading to torsion of the testis with an excessively long spermatic cord and causing severe testicular pain. Because testicular torsion blocks the blood supply to the testis, in addition to severe pain, there is scrotal swelling and skin edema. Acute pain is relatively easy to diagnose. ② Chronic pain. In mild cases, it can persist for a long time. The pain is milder, more diffuse, and radiating, making it difficult to pinpoint the exact location of the inflammation. Testicular pain is not necessarily proportional to the severity of inflammation. Some people have highly sensitive nerves, and even mild inflammation can cause severe pain; while others are less sensitive and experience less pain. Some pain occurs after sexual activity, possibly due to increased blood flow to the genitals and gonads during sexual arousal. Other pain may radiate from varicocele or other areas, such as radiating testicular pain caused by ureteral stones. In these cases, careful identification of the true cause is crucial for effective treatment.

Treatment for testicular pain: Treatment should be based on identifying the underlying cause. If the cause cannot be found immediately, symptomatic treatment with sedatives and analgesics can be administered. If necessary, procaine can be used to block the spermatic cord, thus interrupting the vicious cycle between the source of nerve pain and the brain's pain center. Some people experience testicular pain even with slight discomfort or no discomfort at all; in these cases, it's entirely psychological. Some people associate the pain with masturbation, carrying a heavy burden of guilt. However, excessive anxiety and focusing too much on sexual performance can lead to psychogenic erectile dysfunction and other sexual dysfunctions. In short, there are many causes of testicular pain, making self-diagnosis difficult. Do not self-medicate; it is best to consult a specialist as soon as possible to avoid delaying treatment.

Five ways to relieve testicular pain: (1) Elevate the scrotum: When lying down, place a pillow under your hips to elevate the swollen scrotum. This will relieve pain if there are symptoms of infection, such as epididymitis. At the same time, try wearing a compression garment or men's briefs for more protection, which will have the same effect. Note that if it is a torsion, the above will only worsen the pain. (2) Ice therapy: Try pressing a piece of ice gently on the swollen testicle, which can relieve pain and reduce swelling. However, be aware that ice may also worsen the pain caused by a torsion. If the pain suddenly intensifies when you press an ice on the testicle, it is obviously a torsion. Try small cubes of ice in a plastic bag, wrapping the bag in a towel, as applying ice directly to the delicate scrotal skin may cause damage. (3) Heat therapy: Place a hot pad or warm compress wrapped in a towel on the painful genital area. This may feel better, but you still need to seek medical attention promptly. (4) Anti-inflammatory treatment: Adults can take anti-inflammatory drugs, such as aspirin or ibuprofen, to stop swelling and pain. (5) Use a condom: Because sexually transmitted infections are a common cause of testicular pain, common sense dictates that using a condom during intercourse is probably the simplest way to prevent testicular pain.

Testicular cancer is one of the most common cancers in men, accounting for 1% to 2% of all male malignant tumors. It has an insidious onset, with few or no obvious early symptoms; by the time obvious symptoms appear, it is often in the middle or late stages. Early detection greatly increases the chances of a cure. If not detected in time, it often metastasizes rapidly, endangering life. According to clinical statistics, the following conditions increase the risk of testicular cancer: ① One or both testes failed to descend into the scrotum at birth. If one testis fails to descend, the risk increases 4 to 5 times; if both fail to descend, the risk increases 10 times. However, if this problem is corrected before age 10, the risk is not increased. ② A father's or brother's history of testicular cancer increases the incidence by 50 times. ③ Early cessation of puberty may also increase the incidence of testicular cancer. ④ Orchitis following viral or bacterial infections. ⑤ Long-term exposure to certain chemicals and radiation.

Early signs of testicular cancer include: ① Significant swelling of one testicle, with an uneven and sometimes irregular shape. ② A pea-sized lump that can be felt in the front or side of the testicle. ③ Painless enlargement of the testicle. About 80% of patients experience significant testicular swelling in the early stages, but without pain, even when pressure is applied. Sometimes there may be a feeling of heaviness, caused by the increased weight of the testicle due to tumor growth. ④ Hardening of the testicle. As the testicle enlarges, it often hardens and becomes less rounded, losing its elasticity and feeling like a pebble, but without pain upon pressure. ⑤ A mass in the groin or abdomen, accompanied by symptoms such as lower back pain, frequent urination, and urgency. ⑥ Acute testicular pain that does not improve significantly or continues to progress after more than two weeks of antibiotic treatment and bed rest. ⑦ Negative transillumination test. A negative transillumination test using a flashlight suggests the possibility of a tumor. This is because testicular tumors grow densely and firmly without fluid inside. Even if some testicular tumors are accompanied by a small amount of hydrocele, the transillumination test will be negative due to the small amount of fluid. ⑧ Unexplained male breast enlargement. This may be because testicular tumors can reflexively increase estrogen levels, stimulating the breasts and causing them to enlarge.

To detect testicular cancer early, men should examine their testicles monthly, just like women examine their breasts, starting from puberty. The method is as follows: (1) Examine once a month, preferably during or after bathing. Under normal circumstances, the scrotum is relatively relaxed. (2) Support the scrotum with the palm of your hand and use your fingers to check the approximate weight and size of your testicles. Normally, one testicle is slightly larger than the other and hangs slightly lower. (3) Gently rub the testicles with your fingers to make them roll. There is a soft tube called the epididymis at the top and bottom of each testicle. This is not an abnormal lump. If there is no lump or swelling, the testicle should be smooth and firm. (4) If the two testicles are significantly different in size or weight, be alert and go to the hospital for further examination as soon as possible.

Because testicular tumors are closely related to cryptorchidism, early detection and treatment of cryptorchidism are crucial for preventing testicular tumors. A British study showed that men who exercise 15 hours or more per week significantly reduce their risk of testicular cancer compared to men who do not exercise at all. Men who sit for more than 10 hours a day have a 71% higher risk of developing the disease compared to men who sit for no more than 3 hours a day. Additionally, exposure to chemicals and radiation should be minimized. Of course, once a testicular tumor is diagnosed, the testis should be removed as soon as possible. During surgery, the spermatic cord vessels and vas deferens are ligated at the internal ring, and the spermatic cord and tunica vaginalis are removed en bloc. Orchiectomy is relatively simple and can clearly identify the pathological type, providing a reliable basis for future treatment. Seminomas are very sensitive to radiotherapy; therefore, radiotherapy is an important adjunct therapy to surgical treatment. It has been confirmed that if seminomas have no clinical metastasis, prophylactic radiotherapy should be given to the para-aortic, para-iliac, and sometimes mediastinal and cervical lymph nodes after orchiectomy. If retroperitoneal lymph node metastasis is clinically detected, orchiectomy followed by radiotherapy and adjuvant chemotherapy is performed. If extensive clinical metastasis is present, chemotherapy can be administered after orchiectomy. For embryonal tumors, teratomas, teratomas, and choriocarcinomas, retroperitoneal lymph node dissection should be performed after orchiectomy. Non-germ cell tumors of the testis can originate from fibrous tissue, smooth muscle, striated muscle, blood vessels, and lymphatic tissue, but these tumors are rare. Most are benign and can be cured by orchiectomy.