What Causes Sore And Tender Testicles After Injury?

Posted on Fri, 13 Jun 2014

Question: Three or four years ago I had a testicular trauma. The left testicle would get sore from time to time and sometimes I would hear gurgling and see sperm come out with urine when I urinated. The testi hangs lower then the other and is a little smaller than the other. I had a physical three days ago and the PA said everything seemed fine except for tenderness in the left testicle. He scheduled me to see a urologist in two weeks from when i saw him. Is there something wrong or am i worried for nothing? Also if the testicle was torn or dead wouldn't i have bigger problems right now and wouldn't the physical I had have shown anything? What does it mean when one testicle is tender and feels loose in the scrotum? Would a person know if they suffer from atrophy and how long does atrophy last?

Answered by Dr. Hardik Thakker (5 hours later)

Brief Answer:
Please read detailed response

Detailed Answer:
Dear Sir,

I am Dr Thakker and I shall be answering your question.

I can very well understand your anxiety with regards to the tender testicle. I will try my best to help you out. Can you please provide me the following relevant details:
- Nature of trauma 3 years back?
- Any history of fever?
- Are you sexually active currently?
- Did you engage in vigorous and rough sex in last few days?
- Colour of your urine? Any turbidity in the urine?
- Any swelling in the groin region?
- History of mumps in the past?

Your answers will help me narrow down to a list of differential diagnosis.

Currently the differentials would be:
1. Spermatocele
2. Epididymo-orchitis
3. Torsion of testis
4. Varicocele of left side.
5. Left inguinal hernia with incarceration.

It doesn't look like dead testicles. So don't be worried. I would recommend you to have a Doppler plus ultrasound of the scrotum to help us differentiate between them. It will also reveal if there is any testicular atrophy. You can get these done after urologist consultation.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Hardik Thakker (26 minutes later)

Handled testicle to rough when examining myself. (biological knowledge at that time was low). I don't remember noticing any swelling. But I didn't know to check for it then. I have had fever in the past when sick but i don't remember if i had one shortly after trauma. there were instances after trauma where it hurt to stand and it felt like the testicle was gurgling or tingling. I have had still do at times have cloudy urine or dark urine but i don't remember seeing bloody urine.
I am not and haven't been sexually active. I have never had the mumps.

Answered by Dr. Hardik Thakker (1 hour later)

Brief Answer:
urgent ultrasound and doppler of scrotum

Detailed Answer:
Dear Sir,

Thank you for your response to my questions.

Going by your history, you seem have sustained an injury to the testicles / spermatic cord. This could be in the form of a hematoma or a fistula formation. We need to keep in mind the other differentials I have mentioned in the reply above.

It is good that you been examined by an expert. But I recommend you get the next set of tests done at the earliest. If it hurts more, ER visit is worthwhile.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Hardik Thakker (55 minutes later)

I am scheduled to see a urologist on Tuesday. I have consulted other doctors on-line and I have received answers like yours and some who say don't worry. i have already waited three years. Will Tuesday be too long? Is the other testicle in danger?
can testicular atrophy spread?
I sometimes feel tingling in left testicle and i've noticed that more recently i will feel it in the right one. Does atrophy spread and if so, how long does it last? Can it be stopped?

Answered by Dr. Hardik Thakker (5 hours later)

Brief Answer:
Please read the detailed response

Detailed Answer:
Dear Sir,

Your question reminds me of the proverb " Stich in time saves nine". However it is never too late to mend.

I have already made my opinion very clear about the urgency of the ultrasound and Doppler. I do not believe that there is a real shortage of ER ultrasound or man power which would mandate you to wait till tuesday. You are mature enough to take a right decision regarding the same.

With regards to the atrophy, it is an irreversible process. The affected testis get irreversibly non-functional. This does not spread as it is not infectious. The other normal testis tries to take over the function of the lost testis. The only way to stop atrophy is to act promptly and reverse the pathology so that the irreversible changes don't set in.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Hardik Thakker (24 hours later)

Hello Sir,
I have one more question that I thought of a little late. I didn't draw attention to this when I had the physical two weeks ago because I didn't think it was anything. But what I've noticed is that I now have two light brown spots on the the head of my penis. Could this be penile cancer? I don't know if the doctor i saw noticed or not. I don't mean to sound paranoid but these subjects I speak of are true.

Answered by Dr. Hardik Thakker (31 minutes later)

Brief Answer:
Do not worry

Detailed Answer:
Dear Sir,

Penile cancer usually presents like a cauliflower like growth over the corona of the penis. It does not manifest usually like light brown spots in 2weeks as you described. you should not worry about the penile cancer. I am assuming you have a cut penis and this is a very low risk state for penile CA.

We just need to make sure that it is not some sexually transmitted disease and a local examination is very important for that.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Hardik Thakker (21 minutes later)

Well, the spots have been there for more than two weeks. What I meant to say is that two weeks ago at the physical exam I did not draw attention to it because I didn't think it was anything.
It couldn't be sexually transmitted because I am not sexually active.
I appreciate your time Dr.

Answered by Dr. Hardik Thakker (6 minutes later)

Brief Answer:
please read the response

Detailed Answer:
Dear Sir,

What you have described doesn't seem to be a penile CA. The best you can do is to take a clinical picture of the same and share it here to make sure. I know it sounds emberassing but that helps a proper diagnosis. A local exam by a doctor however is the best way out.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

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Above answer was peer-reviewed by : Dr. Vaishalee Punj