People respond to pain in different ways. Some ignore it and hope the discomfort will disappear of its own accord; others will swiftly seek medical attention. It can sometimes be difficult to know what to do when pain is experienced. For those people who feel they just do not have the time to see their General Practitioner, they are likely to at least postpone a visit to their doctor, until the pain becomes less bearable, or simply wait in the hope the pain will disappear without intervention.
However, there are some instances when immediate action and a visit to the GP is essential, to avoid irreversible harm. One such example is pain in the testes.The testes are the male sex gland, which is found behind the penis in what can be described as a pouch, called the scrotum. The testes produce and store sperm, thus being the reproductive organ. The testes are also the source of male hormones. The loss of a testicle may have a detrimental impact on a man’s fertility.
The health of the testes can be put in jeopardy by a condition that starts with pain. A sudden and painful swelling in a male’s testicles can be the sign of a condition called testicular torsion. This is where the blood supply to a testicle is interrupted.
It is most likely to affect boys, teenagers and young men. Due to the consequences of inaction it is important this group are aware of the consequences of delaying action and for parents to make their sons aware of the importance of responding to pain in the testicle region.
The advice from the NHS is that if a boy or young man experiences sudden pain in his testicles then he should see his GP immediately, or attend the local accident and emergency department of a hospital. Time is of the essence.
A full history and examination will be conducted, to make a diagnosis and where the first visit is to the GP, the GP should make a referral to the hospital if there are concerns about the testes. Guidance from the National Institute for Clinical Excellence states that if testicular torsion is suspected the individual should be admitted immediately to hospital for urology or paediatric surgery. The basis of this statement is the best practice guides from the British Medical Journal, which states testicular torsion requires surgical intervention, ie detorsion, as soon as possible, to prevent damage.
When the boy or man is first presented for examination, with acute, painful scrotal swelling, particularly if he is younger than 30 years of age, Guidance from the National Institute for Clinical Excellence states a history and physical examination alone cannot always rule out testicular torsion. An ultrasound scan and or surgical intervention may be necessary. The examining doctor should ask about the presence of pain- painful scrotal swellings are more likely to need urgent intervention. If pain is present, the health professional should ask about its duration and severity, as well as speed of onset of pain and swelling.
The examination of the testes will be of the position of the swelling in relation to the testes, the testicular lie, size of the testes (may be enlarged), symmetry of the testes and tenderness.
Research has focused on the time that may be available to save the testes. The results vary but it is clear the risks of salvaging the testicle diminish over time. The recommendation from the British Medical Journal is that surgery is carried out within 4-8 hours of the onset of pain. The risks of salvage of the testicle decrease from 90% at 6 hours, to less than 10% at 24 hours.
Therefore, it is absolutely essential that on experiencing sudden pain the boy or young man attends upon his GP, but probably should go directly to his local hospital, to save time and improve the prospects of salvaging the testicle. If surgery can be carried out promptly, blood flow can be restored to the affected testicle. The Guidance from the National Institute for Clinical Excellence states quite bluntly that testicular torsion is a surgical emergency. If history and physical examination suggest testicular torsion, immediate surgical consultation and exploration should take precedence over diagnostic tests.
If testicular torsion does result in the testicle dying, the testicle will be removed.
The loss of a testicle in a boy or young man is likely to cause distress, anxiety and embarrassment, particularly around their friends and future partners.
There is also a possibility of infertility arising from the loss of the testes, although the evidence is conflicting. The reality is that there is little information in this area. A detailed study does not appear to have been undertaken.
For those young men who wish to have the appearance of both testes, it is possible to have a prosthesis (a false testes), although where the loss occurs in a boy, the provision of a prosthesis will probably wait until they have physically matured.