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When the scrotum gets hurt

When the scrotum gets hurt

Doctors advise wearing protective gear while playing sports and caution while riding two-wheelers to prevent testicular injuries


Taking care of the men’s reproductive system and protecting them is as crucial as wearing a helmet to protect the skull while riding a bike or playing an outdoor sport. Unlike the skull, which is made up of bones, the scrotum (testes) is made up of tissue. So, it doesn’t have any protection from either bones or muscles.

Scrotum produces and stores sperms and hormones required for reproduction. Testicular injury can potentially damage its functions as well as interfere with blood flow.

Common causes of testicular injuries

Our daily lives are full of varied activities. Right from waking up until going back to bed, they involve household chores, personal hygiene care, exercising, commuting in public transport or driving or riding bicycles, etc. Just like the way the ankle can get sprained accidently, an injury can happen to the testicles.

“Testicular injuries are caused commonly during sports activities like cricket, gymnastics, motorsports and cycling,” says Dr KC Mallik, consultant urologist, Manipal Hospital Salt Lake, Kolkata. “Other causes can be penetrating forces such as stab wounds or gunshot wounds, or blunt forces such as a kick to the scrotum or [being hit by a] baseball, machinery or industrial injuries, and road traffic accidents. These can cause all or part of the testicle to rip or permanently damage the testicle. An injury from a penetrating object, such as a knife or bullet that punctures the scrotum, may cause a minor scrape to the skin or major damage to the blood vessels in the testicle.”

The incidence of scrotal or testicular injury in trauma is less than 1 per cent. While such injuries are generally not life threatening, prompt diagnosis and appropriate management are critical to prevent morbidity.

The American Urological Association recommends early scrotal exploration in all cases of suspected testicular rupture to prevent testicular loss, infection, chronic pain, infertility and altered self-image. Common blunt mechanisms of injury in scrotal trauma include motor vehicle, motorcycle and bicycle accidents.

How hurting your scrotum can be avoided

Though there is no fool proof way of avoiding testicular injuries, it’s advisable to wear tight briefs or jockstraps during while playing sports or exercising and protective gear when playing sports involving contact or a hard ball (like cricket or hockey). Exercising caution while riding on motorbikes and bicycles is extremely important to prevent such an injury. One should also stay hydrated.

“In the case of cycling or motorcycles, padded seats are essential,” says Dr Mallik. “Lastly, the opinion of a doctor is very crucial if something is bothering the person with the injury.”

And at the first sign of pain or swelling, do consult the nearest urologist and get the condition diagnosed and treated.

Types of testicular injuries

According to Dr Shakir Tabrez, consultant, urology, uro-oncology, andrology, kidney transplant and robotic surgery at Fortis Hospital, Cunningham Road, Bengaluru, testicular injuries or acute pain could occur due to:

  • External trauma: The location of the testes in the scrotum makes them prone to various injuries — like after getting kicked or getting hit by a ball, or bike accidents. Blunt trauma is responsible for 85 per cent of testicular injuries.
  • Torsion testis: The testis receives blood through blood vessels, which are part of a tube called spermatic cord. Sometimes there can be a twist in the cord, leading to a sudden cut-off of the blood supply which, in turn, causes acute agonising pain.
  • Epididymitis or orchitis: An inflammation of the testis or the epididymis (a coiled tubular structure on the testis which holds the sperms) with or without infection is called epididymitis or orchitis.
  • Infection: Bacterial or viral infection of the testis
  • Varicocele: An enlargement of the veins on the testis because of the pooling of blood in these veins is called a varicocele. Varicocele is different in its presentation as it presents with a dull aching pain or discomfort. It also may cause a change in the sperm quality, which may affect fertility.

Often there is heightened concern about these symptoms arising because of a tumour in the testis. One should be aware that commonly testicular tumours present with a painless swelling and, importantly, are hard when felt. Hence it is advised to regularly palpate both testes to ensure there is no change in consistency.

“The commonest presentation of the above conditions is a sudden and severe pain in the testis which may be accompanied with fever in case there is additional infection,” says Dr Tabrez. “In case of torsion [or twisting], the pain is extreme, and the patient has to be taken to the emergency at the earliest.”

Diagnosis, treatment of scortum injuries

A doctor will first try to understand the cause and nature of the injury by asking basic questions. Then, after a detailed physical examination, and depending upon the answers to the questions asked, the doctor may ask for an ultrasound test. This will provide the doctor a picture of the extent of the injury. In cases that are more severe from the beginning or that haven’t improved after 48 hours, a surgery may be needed to fully diagnose the injury.

“Usually, testicular inflammatory conditions like epididymitis or orchitis are diagnosed on an ultrasound and can be treated medically with antibiotics and anti-inflammatory medication,” says Dr Tabrez.

A torsion of the scrotum is also diagnosed on ultrasound and requires immediate and urgent surgical exploration and correcting the blood supply, as any delays could lead to removal of the testis.

On the other hand, varicocele is usually managed conservatively, but when it is symptomatic or causing an alteration of sperm quality or significantly dilated veins, it needs a micro-surgical correction.

Scrotum injuries: healing, short- and long-term effects

Testicular injuries can be divided into major and minor. In case of minor injuries, a visit to a urologist can be helpful. “However, for any major injury, a proper and timely diagnosis is required for complete treatment, while the healing process depends upon the cause and the degree of the injury,” says Dr Mallik.

The impact of testicular injury depends on the grade or degree of the injury. Thankfully, most sports injuries are minor, and the effects are short-term.

Injuries caused by road traffic accidents or from gunshots or sharp objects are usually more extensive and can affect other organs around the testicles. The other life-long impact, depending on the nature of the injury, could even be erectile dysfunction, especially if medical help isn’t sought.

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