SCROTAL PAIN

Scrotal pain :
- Pathology within the scrotum
Torsion of the testicles
Torsion of testicular appendages
Epididymo-orchitis
Testicular tumour
- Referred pain
Ureteric colic

Testicular torsion: ischaemic pain is severe (e.g. myocardial infarction, ischaemic leg, ischaemic testis). Torsion presents with sudden onset of pain in the hemiscrotum, sometimes waking the patient from sleep. May radiate to the groin and/or loin. There is sometimes a history of mild trauma to the testis in the hours before the acute onset of pain. Similar episodes may have occurred in the past, with spontaneous resolution of the pain (suggesting torsion/spontaneous detorsion). The testis is very tender. It may be high-riding (lying at a higher than normal position in the testis) and may lie horizontally due to twisting of the cord. There may be scrotal erythema.

Epididymo-orchitis: similar presenting symptoms as testicular torsion. Tenderness is usually localized to the epididymis (absence of testicular tenderness may help to distinguish epididymo-orchitis from testicular torsion, but in many cases it is difficult to distinguish between the two).

Testicular tumour: 20% present with testicular pain.