American Medical Association Family Medical Guide - American Medical Association [550]
Although the pain may be severe and cause you to double over, it usually subsides quickly without damage to the testicles. Applying an ice pack to your scrotum and taking over-the-counter anti-inflammatory drugs such as aspirin or ibuprofen will usually relieve the pain and swelling.
If the pain and swelling persist for more than an hour or if your scrotum is bruised, see your doctor immediately or go directly to the nearest hospital emergency department. The testicle may have ruptured, or it may have twisted on the spermatic cord. Also, the sperm-producing tubes inside the testicle may have pushed out through a tear in the membrane that covers the testicle. If these problems are not treated promptly, the testicle can be damaged permanently. Surgery may be necessary to stop any bleeding and to prevent blood clots, infertility, or loss of the testicle.
WARNING!
Don’t Give Aspirin to Children or Adolescents
Do not give aspirin to children or adolescents who have a fever; use of aspirin in children has been linked to Reye’s syndrome (see page 411)—a rare but potentially fatal childhood disorder. Carefully check the label before giving any over-the-counter medication to your child.
Treatment
If you have torsion of the testicle, your doctor may try to untwist the testicle with gentle manipulation. If he or she cannot untwist the testicle, or if the testicle does not stay untwisted, prompt surgery to prevent testicular strangulation is required. During the procedure, the surgeon untwists the testicle and fixes it in a position that will help prevent the problem from recurring. He or she will also secure the other testicle in place to prevent torsion. Surgery to remove the affected testicle may be necessary if it has been damaged severely and permanently.
Epididymitis
Epididymitis is inflammation of the epididymis (the coiled tube that lies above and behind each testicle) or the top of the testicle. The condition can result from a bacterial or viral infection that spreads from the urinary tract into the vas deferens (sperm duct) or by the backward flow (reflux) of infected urine from the urethra. In younger men, epididymitis usually results from the sexually transmitted diseases nongonococcal urethritis (see page 481), chlamydia (see page 477), and gonorrhea (see page 480).
Symptoms
Epididymitis often produces severe pain and swelling on the affected side of the scrotum. The swelling develops over the course of a few hours, and the swollen area may feel hot and tender. The affected testicle may feel painful or heavy. You may have a slight fever and chills. You may also have discomfort in your lower abdomen or in the groin area, and pain or burning during urination. In some cases, there may be a discharge from the penis, pain during ejaculation, or blood in the semen. If you have any of these symptoms, see your doctor right away.
Diagnosis
To diagnose epididymitis, a doctor examines the testicle and may order tests of your blood, urine, and prostate fluid to help identify the cause of the infection. To obtain a sample of prostate fluid, a doctor inserts a gloved, lubricated finger into the rectum and massages the prostate, which then releases the fluid through the urethra.
Treatment
If epididymitis results from a bacterial infection, the doctor will prescribe antibiotics. He or she may also recommend bed rest, ice packs applied to the scrotum, elevation and support of the scrotum, and nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen to relieve pain and inflammation. Rarely, in severe or chronic cases, a doctor may recommend surgery to remove the infected epididymis.
If your epididymitis was caused by a sexually transmitted disease, it may also be necessary to treat your sex partner to avoid reinfection and reduce the risk of pelvic inflammatory disease (see page 871) in your female partner.