PAINFUL BALLS. Swelling in your scrotum

The scrotum.

The scrotum is an external sac that is located under the penis and is composed of skin and smooth muscles. The sac is divided into two compartments by the scrotal septum.

The structures contained in the sac are

1. Testes

2. Epididymis

3. Spermatic cod

Functions of the scrotum

The scrotum is responsible for protecting the testes. It helps in regulating temperature of the testicles. It keeps the temperature of the testis several degrees below the average body temperature which is an essential factor for sperm production.

The testes

The testes are oval shaped reproductive structures that are found in the scrotum and separated by the scrotal septum.

The structure of the testis and epididymis.

The spermatic cord suspends the upper aspect of the testis while the lower end of the testes is attached to the scrotum the scrotal ligament.

The left testis is affixed slightly lower than the right testis. The testis is responsible for the production of sperms.

Scrotal pain

Scrotal pain is a common complaint in men. Its treatment requires judicious examination and evaluation by a competent doctor. Pain in the scrotum can be acute i.e., of sudden onset or it can be of gradual progression over a long period of time.

In this blog post, I am sharing simplified information about the causes of pain or swelling in the scrotum.

Testicular torsion

This is acute pain in one testicle that is common in patients under the age of 26 and it is considered a surgical emergency. Failure to correct this torsion leads to loss of testicular function and shrinkage of the testicle.

Testicular torsion: A testicle rotates, twisting the spermatic cord that supplies blood to the scrotum causing severe pain and swelling.

What happens?

The testicle twists around the spermatic cord, this leads to compromised flow of blood causing congestion and death of testicular tissues.

Signs and symptoms

The pain is acute of abrupt onset.

The pain is located in one testicle.

There may be intense pain around the groin area.

The testicles may be swollen because of congestion.

Treatment

Once you experience testicular torsion, the solution is to seek immediate surgical attention. If no surgical attention is given, the testicles can shrink, deform or die leading to infertility.

Orchitis

Orchitis is the inflammation of one or both testicles. It is most often as a result of bacterial infection e.g. sexually transmitted infections or caused by viral infections.

The bacterial and viral organisms can travel in blood to find their way into the testicles to cause inflammation.

In children and teenagers, orchitis is mostly caused by virus which causes measles and mumps and another viral disease called rubella or German measles.

Bacterial infection of the prostate or in the urinary system can also travel to the testicles to cause orchitis.

Any infection of the epididymis will spread to the testicles to cause orchitis. The combination of orchitis and epididymis is called epididymo-orchitis.

Orchitis is also accompanied by another testicular condition known as epididymitis which is the inflammation of epididymis. it is in this epididymis where maturation of sperms occur.

Any man with epididymo-orchitis will complain of:

Intense pain in the scrotum

A swollen scrotum

Both orchitis and epididymis can lead to serious fertility complications if not treated. They are both treated after a thorough investigation and diagnosis by a doctor.

Hydrocele

A hydrocele is the accumulation of fluid in testicular compartment known as tunica vaginalis.

This tunica vaginalis surrounds the testis and the spermatic cord.

Hydrocele: The fluid that accumulates in this compartment comes from the abdomen and it is called peritoneal fluid.

There are two types of hydrocele.

Primary hydrocele which occurs as a result of birth defects when the spermatic codes fail to fuse creating a potential space where fluid accumulation within it can lead to hydrocele formation.

Secondary hydrocele usually occurs later in life due to underlying conditions such as infections like tuberculosis of the testis, filariasis, testicular injury or cancer of the testicles.

A hydrocele occurs when;

There is connection between the testicles and the abdomen through an open space.

There is excessive production of fluid in the testicles to drain this excessive fluid.

There is interference of the lymphatic system in the testicles. The lymphatic channels drain lymph fluids from the scrotal structures.

The treatment of choice for hydrocele is surgery. This surgical treatment is known as hydrocelectomy.

The other method of treatment is known as aspiration particularly for patients who cannot tolerate surgery. In this method fluid is aspirated from the testicular compartment however there is risk for re-accumulation after a week.

Hernia

An inguinal hernia is a lump located in the scrotum or groin region. It is an emergency that requires prompt surgical intervention.

Hernia: An inguinal hernia that is not repaired can strangulate the intestine and cause malfunction at the part of the intestines.

Causes of inguinal hernia

Anatomical weakness of the groin muscles.

Congenital defect i.e, a baby or man born with scrotal weakness or defects.

Predisposing factors to an inguinal hernia;

Obesity

Heavy lifting/straining.

Decreased muscle strength due to old age.

Prematurity births.

Smokers.

A chronic cough.

Sedentarism lack of experience causing weak abdominal exercise.

Difficulty urinating due to blockage e.g., enlarged prostate gland.

An inguinal hernia is common in men especially among men 35 to 59 years of age.

The symptoms of inguinal hernia may not be identifiable but may appear gradually overtime or in emergency cases the symptoms may develop suddenly.

Pain in the groin area especially when exercising or walking or lifting.

Severe pain in the right testes.

Pain in the testes when coughing, straining or lifting.

It is easy to suspect an inguinal hernia. If you suspect a lump in your groin, simply do the following,

Locate the groin pain.

Grasp this area where the pain is located.

Cough.

If the bulge of the hernia gradually increases in size during coughing, then it disappears when you stop coughing or you lie down, then suspect an inguinal hernia.

An inguinal hernia can also strangulate the testes leading to testicular torsion.

Varicocele

A varicocele of the scrotum is an abnormal enlargement of the blood vessels in the scrotum. These blood vessels are called spermatic cord veins and they drain blood from the testes.

Varicocele of scrotum is common in male adolescents and young adults between 15 – 26years of age but can also affect men above 27years.

Predisposing factors

Blood clot in the veins of kidneys.

Injury to the scrotum and testis.

In your basic biology classes, you learned that veins are responsible for carrying deoxygenated blood from tissues back to the heart for oxygenation. You also learned that veins have valves that prevent backflow of blood.

In the varicocele of scrotum, there is a defect in valves that lead to backflow of blood into the blood vessels hence increasing pressure in the veins. This pressure causes veins to dilate, thereby damaging the testis.

Symptoms of a varicocele

A dull pain in the scrotum.

Visible enlarging veins.

A “Bag of worms” feeling in the scrotum.

Decreased sperm count and sperm motility, leading to infertility.

The effective treatment of varicocele scrotum is through surgical intervention.

The abnormal vein is removed through a procedure known as varicocelectomy. This allows blood to flow through the remaining normal veins.

A surgeon may also introduce a coil into the abnormal veins. This coil prevents backflow of blood. This procedure is known as varicocele embolization.

Spermatocele

A spermatocele is an abnormal sac of fluid which develops in the epididymis. A spermatocele usually is filled with milky or clear fluid that might contain sperm.

Spermatocele: masses are not painful and cannot turn cancerous but they can be a nuisance.

In extreme cases of spermatocele, a man will feel a numb pain in the affected testicle. Other symptoms of large spermatocele masses are:

Pain in the affected testicle.

Heaviness in the testicle with the spermatocele cyst.

If they continue being unbearable, a surgeon my perform a procedure known as spermatocelectomy.

Finally, let me talk about Blue balls.

Blue balls.

Have you ever had an erection but failed to have sex or an orgasm till your scrotum felt full with a dull boring deep pain that radiated deep into the pelvic cavity?

Yes! Blue balls. Every man has experienced this tension in the scrotum.

Blue balls are medically known as Epididymal Hypertension. It is not a serious testicular condition that can call for emergency medical intervention, but it can cause testicular pain.

During an erection, the blood vessels to the penis and testicles dilate to allow a greater volume of blood flow. This blood makes the penis to expand and stiffen, leading to an erection. The testicles also grow in size, causing them to become heavier.

During an orgasm, this blood is released. However, if the blood remains in the scrotum without an orgasm or release, this will cause pain and discomfort. The testicles may turn blue due to the excess blood and increase in the scrotal blood pressure, but you won't see them turning blue!

The testicles may turn blue due to the excess blood and increase in the scrotal blood pressure.

The best management of 'Blue Balls'

A cold shower.

A distraction e.g. a domestic chore.

A workout e.g. running or resistance training.

There you have it. If you are experiencing scrotal pain or swelling and you don't know where to begin from with medical attention, reach out to me through this link ( https://dennismasinde2018.wixsite.com/healthandwellnesspla.), you can also send an email to dennismasinde2018@gmail.com.

Thank you for reading!