Can a bad back cause testicle pain

The scrotum is the name for the sac, and the testes and its adjacent structures sit inside the scrotum. The testicle has two functions. It makes testosterone, the male hormone, which is carried from the testis through the blood stream. It also makes sperm.

Sperm travels from the testicle into a series of tubes that form the epididymis. The epididymis sits to the side and in back of the testis. Sperm leaves the epididymis by way of the vas deferens (this is the tube that is divided during a vasectomy) and the vas deferens joins the seminal vesicles and prostate. The vas deferens travels through a structure known as the spermatic cord, which also includes the artery and vein that provide the blood supply to the testis, and the lymphatic vessels that drain the testis. Sperm delivered from the vas deferens, mixes with fluid from the seminal vesicle and prostate to produce the semen, which is the fluid that comes out from the penis at the time of ejaculation.

What can cause a lump in the scrotal contents?

A variety of conditions may cause a lump in the scrotal contents. This lump may be felt by the patient, or may be detected by a healthcare provider during a physical exam.

Conditions that can cause a lump in the scrotal contents include hydrocele (fluid around the testicle), spermatocele (a cyst in the epididymis), nodule or inflammatory change in the epididymis, and varicocele (a dilation of the veins around the testis). As a general rule of thumb, hydrocele, spermatocele and varicocele do not cause scrotal pain.

Testicular tumor is the word used to describe a mass or growth within the testicle itself, which may represent testicular cancer.

When a mass is detected within the scrotal contents, scrotal ultrasound (sonogram) may be carried out to determine if the mass is within the testis itself or in one of the structures adjacent to the testis.

What can cause testicular pain?

A variety of conditions can cause scrotal or testicular pain, including epididymitis (inflammation of the epididymis), orchitis (inflammation of the testis), hernia (weakening of the abdominal wall, with bulge in the inguinal region), torsion (twist of the cord and the blood supply to the testis) and testicular tumor.

There may also be referred pain to the testis, which means there is pain that originates elsewhere, but is felt in the testis. This can occur if there is a pinched nerve in the back or in the groin area.

By far, one of the most common causes for pain in the scrotal contents is inflammatory change in the epididymis or testes. Inflammation can be due to a variety of causes, including urinary infection, viral illness elsewhere in the body, minor physical trauma, or reaction to medication. In many cases, the exact triggering cause of the inflammation cannot be identified.

How is testicular pain treated?

It should be recognized that epididymitis is typically an inflammatory rather than infectious issue. Measures to address inflammation, including sitting in a warm bath for 20 minutes a day, scrotal support with athletic supporter or brief-style underwear, and anti-inflammation medication (Advil 2-3 tablets 3 times a day, taken with food to avoid stomach irritation) can provide relief.

In some cases, antibiotics may be used to address possible infection. It should be noted that if infection is not present, prolonged use of antibiotics is to be avoided to prevent potential overexposure to antibiotics.

At times, scrotal pain can be vexing to treat, and some men may notice it may take 2-4 months until symptoms subside. On some occasions pain can be persistent, and consultation with one of the pain management specialists may be carried out so that additional treatment can be attempted in an effort to achieve pain relief.

Take Home Message

In summary, the primary goal is to make sure there is not underlying disorder, such as testicular cancer, hernia, or testicular torsion which would put the patient’s health at risk. Once those conditions have been excluded, then an effort is made to achieve symptom relief as best as able.

1. Developing testicular pain might be an emergency, especially if you’ve never had it before. Go to your medical provider, walk-in clinic, or emergency room if the pain is severe. One of the potential culprits of new onset testicle pain is testicular torsion, in which the cord that travels from your lower abdomen to the scrotum is twisted. This twist, or torsion, can cut off blood supply to your testicle and that is why quick intervention is needed. Oftentimes, a simple procedure such as an ultrasound is all that is needed to find out if this is the cause.

2. Even if not an emergency, testicular pain could be an infection or a mass, so making sure that all is well can ease your mind and help keep you healthy. It is also helpful to ease your mind so that you don’t worry too much about your symptoms. Some men find that worrying increases their testicular pain, and it is possible to create testicular pain by constantly squeezing your testicles to see if there is a lump! Doing self-exams is important, but you want to avoid over-doing the checking, and always apply a gentle pressure as the testicles are sensitive structures. 

3. Getting a blow or kick to your groin is not an uncommon way to feel temporary pain in the testicles. Once the initial injury has calmed down, if pain persists, follow-up with a medical provider to make sure everything is healthy, and you will likely be advised to use conservative strategies such as a cold pack, rest, and maybe lightly compressive shorts to give a lift and support to your scrotum. 

4. Sometimes the nervous system gets a bit overactive and can tell the smooth muscles around the testicles and scrotum to pull up, and up, and up. So much so that the testicle can even retract into the lower abdomen. Although it’s not always the case, for some men this can be very painful. Learning to identify the triggers for this such as cold, stress, low back pain and then identifying strategies to avoid or alleviate this issue can be accomplished in pelvic rehabilitation.

5. Because the testicles are supplied by nerves that branch off of your spine at the level of the low back, even a bout of low back pain may be related to developing pain in the scrotal area. Don’t be surprised if your therapist wants to examine your thoracic and lumbar spine, your abdomen, pelvis, or another nearby region. Many men who sit for really long periods of time every day have symptom improvement when they include more movement and less sitting into their day.

6. While having a vasectomy often involves a simple recovery with short-term discomfort only, sometimes pain develops after this procedure. In some men, a small granuloma forms at the surgery site, or a nerve that travels along with the vas deferens gets irritated. Rehabilitation providers have a lot of techniques and tools to help you recover from this discomfort. 

7. A great way to develop new testicular pain is to start doing 300 sit-ups a day, especially if you haven’t been exercising AT ALL. I lost count of the number of men I’ve examined who decided, for some unreasonable reason, to start off a new exercise regimen with 200, 300, or maybe even 500 sit-ups per day, every day. That amount of effort on the abdominal wall can really annoy structures such as the nerves that travel from your low back to the scrotal area. Remember this when you start planning, give your body a chance to gradually adjust and remember to stretch related areas like the hip flexors. 

8. Some authors and healers have found a relationship between testicular pain and being worried about such things as your job, your marriage or relationships, and other important topics related to your emotional well-being. Fortunately, some men find relief from their pain when they are able to share with a mental health provider any worries or fears, anger that may be carried in the body. 

9. No matter where your pain is, strategies such as deep breathing, focusing on what you can do to help yourself (and them doing them), visualization, gentle movement such as walking, or even a hot bath can be helpful. Just knowing that there are providers who are trained to help recover from testicular pain can ease symptoms by providing some hope and relief. 

10. Most importantly, physical therapists and other pelvic health providers are trained to treat testicular pain, and much of the time, this treatment is simple and effective. Before you let anyone convince you to have a painful testicle removed (which might not even fix the pain!), be sure to find a pelvic health provider to sort out how your body may be influenced by all the amazing structures involved.  

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