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Testicular problems

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The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Testicle lump

A testicular lump that doesn't hurt may be a sign of cancer. Most cases of testicular cancer occur when men are between ages 15 and 40, although it can happen at older or younger ages.

Call your health care provider right away if you notice any unexplained lumps or any other changes in your testicles.

Your health care provider will perform a physical examination, which may include inspecting and palpating the testicles and scrotum, and ask questions about the lump, such as:

* When did you notice the lump?
* Have you had any previous lumps?
* Does the lump change in size?
* Is there any pain?
* Is only one testicle involved?
* Exactly where on the testicle is the lump?
* Have you had any recent injuries or infections?
* What other symptoms do you have?
* Is there scrotal swelling?
* Do you have abdominal pain?
* Do you have any lumps or swelling elsewhere?
* Have you ever had surgery on your testicles or in the area?
* Were you born with both testicles in the scrotum?

TREATMENT
* For a lump caused by orchitis or epididymitis, your doctor may prescribe antibiotics.
* For a lump caused by mumps, consult your doctor for medication while the disease runs its course.
* For a lump caused by testicular torsion, see your health care provider immediately! This emergency condition is very painful and requires prompt surgical correction.
* For a lump caused by cancer, radiation, and chemotherapy are treatment options.
* For a lump caused by spermatocele, hydrocele, or varicocele, consult your health care provider about medication and surgical options.
* For a lump caused by a herniated loop of bowel, surgery may be recommended.

Starting in puberty, men at risk for testicular cancer should examine their testicles on a regular basis. This includes men with a family history of testicular cancer, men who have had a previous testicular tumor, or men with an undescended testicle. These men should perform a testicular self exam each month, so that a testicular mass can be detected early. A lump on the testicle may be the first sign of testicular cancer.

Orchitis

Orchitis is an inflammation of one or both of the testicles, often caused by infection.

Orchitis may be caused by numerous bacterial and viral organisms. It is usually a consequence of epididymitis, which is inflammation of the epididymis (the tube which connects the vas deferens and the testicle).


The most common viral cause of orchitis is mumps. Approximately 30 % of patients who have mumps will develop orchitis during the course of the illness. It is most common in boys past puberty, rare before the age of 10. It usually manifests 4 to 6 days after the onset of mumps. In one-third of boys who get orchitis caused by mumps, testicular atrophy (shrinking of the testicles) will result.

For the bacterial causes, please refer to the epididymitis article. Of note, brucellosis is a rare disease in which orchitis develops in 2 to 20% of men with the disease.

Orchitis may also occur in conjunction with infections of the prostate or epididymis and, like those conditions, may occur as a manifestation of sexually-transmitted diseases such as gonorrhea or chlamydia. The incidence of sexually-transmitted orchitis or epididymitis is higher in men 19 to 35 years old.

Risk factors for non-sexually-transmitted orchitis include:
* Inadequate immunization against mumps
* Older age (age greater than 45)
* Recurrent urinary tract infections
* Congenital abnormalities of the urinary tract
* Genito-urinary surgery and instrumentation
* Chronic indwelling urethral (Foley) catheter

Risk factors for sexually-transmitted orchitis include:
* Other high risk sexual behaviors.
* Multiple sexual partners
* History of a sexual partner with a previously diagnosed STD
* Personal history of gonorrhea or other STD
* Scrotal swelling
* Tender, swollen, heavy feeling in the testicle
* Tender, swollen groin area on affected side
* Fever
* Discharge from penis
* Pain with intercourse or ejaculation
* Pain with urination (dysuria)
* Groin pain
* Testicle pain aggravated by bowel movement or straining
* Blood in the semen
Physical examination may reveal tender and enlarged lymph nodes in the groin (inguinal)area on the affected side. It may also show a tender and enlarged testicle on the affected side. A rectal examination may reveal an enlarged or tender prostate gland.
Testing may include:
* A urinalysis
* Urine culture (clean catch) (the provider may request several specimens, including initial stream, mid-stream, and after prostate massage.)
* Tests to screen for chlamydia and gonorrhea (urethral smear)
* A CBC (complete blood count)
* Doppler ultrasound (to rule out testicular torsion). It also can confirm the diagnosis of orchitis by demonstrating increased blood flow to the region as well as characteristic finding of hypoechogeneic texture. This study can also detect scrotal abcesses.
* Testicular scan (nuclear medicine scan) may also be obtained to rule out torsion and can confirm the diagnosis of orchitis with increased blood flow.
Treatment;
Medications to treat infection are prescribed if the causative agent is bacterial. Pain medications and anti-inflammatory medications are also commonly prescribed. In the case of gonorrhea or chlamydia, sexual partners must also be treated.

When orchitis is caused by viral agents, only analgesics (pain relievers) are prescribed. Bed rest, with elevation of the scrotum and ice packs applied to the area, is recommended.

Orchitis may cause infertility and atrophy (diminished size) of one or both testicles.

Other potential complications include scrotal abcess, testicular infarction, cutaneous scrotal fistula and chronic epididymitis.

Acute pain in the scrotum or testicles is a surgical emergency. If you experience acute pain in the scrotum or testicles, seek immediate medical attention.

Call the local emergency number (such as 911) or go to the nearest emergency room if you experience an acute onset of testicular pain

Testicle pain;
Testicle pain is discomfort in one or both testicles. The pain sometimes radiates to the lower abdomen.

The testicles, which sit inside the scrotum, are very sensitive. Even a minor injury can cause pain or discomfort. When severe testicle pain begins suddenly, however, it is an emergency.

If a young man has abdominal pain, the scrotum should always be carefully examined. Abdominal pain may occur before testicle pain in some conditions, such as testicular torsion. This is a twisting of the testicles that can cut off their blood supply, causing tissue to die within hours. If tissue does die, then fertility may be affected, and the testicle may have to be removed.

Testicular cancer is usually painless. But any testicle lump should be evaluated by your doctor, whether or not there is pain.

Common causes of testicle pain include:
* Injury
* Infection or inflammation
* Testicular torsion -- most common in young men between 10 and 20 years old
Possible infections include:
* Epididymitis -- inflammation of the ducts through which sperm leaves the testicle. This is often caused by bacteria like chlamydia, a sexually transmitted disease.
* Orchitis -- inflammation of one or both testicles, which may be caused by bacteria or a virus like mumps. Orchitis can occur at the same time as epididymitis or prostatitis (inflammation of the prostate gland).
Fluid in the testicles often causes painless swelling, but may cause
mild discomfort. There are several main types of fluid collection:

* Varicocele -- enlarged veins in the scrotum that carry blood away from the testicles.
* Spermatocele -- fluid in the epididymis that forms a cyst and often contains dead sperm cells.
* Hydrocele -- fluid in the area inside the scrotum, surrounding the testicle; common in newborns.
Pain may also be caused by a hernia or an unrelieved erection.

Home Care:
Some causes of testicle pain can lead to infertility if not treated promptly. Testicular torsion is an emergency, and needs to be treated within a few hours. Infections also should be examined and treated right away as well. If the infection is caused by a bacteria, your doctor will prescribe an antibiotic.

For non-urgent causes of testicle pain, including minor injuries and fluid collection, the following home care steps may reduce discomfort and swelling. These steps will also help if you have an infection.

* Provide support to the scrotum by wearing an athletic supporter.
* Apply ice to the scrotum.
* Take warm baths if there are signs of inflammation.
* While lying down, place a rolled towel under your scrotum.
* Try over-the-counter pain relievers, like acetaminophen or ibuprofen. DO NOT give aspirin to children.

Call your doctor immediately or go to an emergency room if:
* Your pain is severe or sudden.
* You have had an injury or trauma to the scrotum, and you still have pain or swelling after one hour.
* Your pain is accompanied by nausea or vomiting.

Also call your doctor right away if:
* You feel a lump in the scrotum.
* You have a fever.
* Your scrotum is warm, tender to the touch, or red.
* You have been in contact with someone who has the mumps.
Your doctor will perform a physical examination with a focus on the groin, testicles, and abdomen. To help diagnose the cause of the

pain, your doctor will ask medical history questions, such as:
* Is the pain in one testicle or both?
* For how long have you had testicular pain?
* Exactly where does it hurt?
* Is the pain constant or intermittent?
* Did the pain begin suddenly or come on gradually?
* How severe is the pain?
* Is the pain getting worse or better?
* Does the pain extend into your abdomen or back?
* Have you had any recent injuries or infections?
* Have you ever had a sexually transmitted disease?
* What makes the pain worse?
* Does anything help relieve the pain?
* Do you have any other symptoms like swelling, redness, change in the color of your urine, fever, or unintentional weight loss?

The following diagnostic tests may be performed:
* Ultrasound of the testicles
* Urinalysis and urine cultures
* Examination of prostate secretions

Treatment may include:

* Untwisting the testicle, performed by an experienced doctor. If this does not work, a simple surgical procedure will fix testicular torsion.
* Antibiotics may be prescribed for infections.
* Pain medications may be recommended to relieve discomfort.
* Although rare, surgical drainage or removal of an abscess may be necessary if this develops from epididymitis.
* Surgery is needed occasionally for a varicocele, a hydrocele, or spermatocele, particularly if the varicocele is contributing to infertility.

Prevention ;

* Prevent injury by wearing an athletic supporter during physical activity, especially contact sports.
* Prevent sexually transmitted diseases by wearing condoms and following other safe sex procedures.
* Perform testicular self-exams monthly if you are at risk of testicular cancer. See testicular self exam.
* Make sure that children have received the MMR vaccine (a combination vaccine for mumps, measles, and rubella).
If you are diagnosed with chlamydia or another STD, all sexual partners should be notified, examined, and treated if infected.

Testicle ultrasound.

Scrotal ultrasound; Testicular sonogram
The testicles are the male reproductive organs that produce sperm and the hormone testosterone. They are located in the scrotum, the flesh-covered sac that hangs between the legs at the base of the penis.

Testicle ultrasound is an imaging procedure that examines the testicles and other scrotal structures. The ultrasound machine sends out high-frequency sound waves, which reflect off scrotal structures to create a picture.

There is no ionizing radiation exposure with this test. Ionizing radiation procedures such as x-ray carry a small cancer risk and may damage sperm, buYou will lie on your back with your legs spread. The health care provider will drape a cloth or apply wide strips of adhesive tape across your thighs under the scrotum. The scrotal sac will be slightly elevated with the testicles lying side by side.

A clear, water-based conducting gel is applied to the scrotal sac to help with the transmission of the sound waves. The ultrasound transducer (a handheld probe) is then moved over the scrotum.t this test does not.
Children:
The preparation you can provide for this test depends on your child's age, previous experiences, and level of trust. For specific information regarding how you can prepare your teen, see adolescent test or procedure preparation (12 to 18 years). This test is seldom performed on children younger than 12.

The ultrasound is done to help determine the cause of testicular enlargement or the reason for testicular pain.

Abnormal results may indicate a benign cyst (an abnormal sac containing fluid), a testicular tumor (abnormal tissue growth that may or may not be cancerous), an area of infection with or without abscess formation, a testicular torsion, or another problem.

In certain instances the use of Doppler ultrasound may be useful to identify blood flow within scrotal structures. For example, this is very helpful in the assessment of testicular torsion.


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