Why does my left testicle hurt and what to do?

The left testicle hurts - men often turn to a urologist with this complaint, experiencing real panic, since the pain symptom is quite strong, and its cause has no objective, visible reason.

The testicles are small organs that should be evenly distributed in the scrotum on both sides. The upper part of each testicle has a cord, which in turn is quite complex in structure - it has an artery, veins and a vas deferens. Each testicle is embraced by appendages, which connect at the bottom, pass into the vas deferens. The testicles are responsible for the production of an important male hormone - testosterone, and also contribute to the production of sperm, without which the process of reproduction, fertilization, is impossible. [ 1 ]

Why does my left testicle hurt?

Testicular pain can occur in men of any age – from childhood to old age. When the left testicle hurts, the cause of such symptoms can be chronic prostatitis, which manifests itself in this way for the first time, and sexually transmitted diseases – STDs, and trauma, and orchitis – an inflammatory process as a complication after a venereal or infectious disease, and epididymitis – an inflammatory process in the scrotum caused by bacteria or gonococci.

There are frequent cases when the pain on the left side increases and becomes acute, unbearable, which may indicate testicular torsion. This is not a pathology, but a physiological feature, quite rare, when the left testicle changes its position and blocks the blood flow going through the vessels to the scrotum. Such a displacement is not an independent disease, but requires immediate assistance, since without blood supply the testicle can atrophy.

If the left testicle hurts, this is a clear sign of a disorder in the structure of the scrotum organs, or a symptom indicating a pathological process inside the scrotum. The most common causes of such pain that occur in clinical urological practice are the following: [ 2 ]

• Trauma (bruise, blow) of the testicle;
• Inflammation of the testicle caused by urological infection, inflammation of the appendages, seminal vessels;
• Underwear that puts pressure on the testicle;
• Thermal exposure, severe hypothermia;
• Lack of regular intimate life;
• Torsion of the seminal ducts, testicular torsion; [ 3 ]
• Cyst of the seminal duct, cyst of the epididymis (or both testicles);
• Varicose veins of a nearby vein or varicose veins of the spermatic cord - varicocele;
• Scrotal tumor - tumor of the testicles or their appendages, tumor of the seminal ducts;
• Hernia in the groin; [ 4 ]
• Dropsy, an increase in serous fluid between the plates of the testicular membrane - hydrocele;
• Oncological pathology, cancer. Oncologic process in the testicles, seminal vessels, appendages; [ 5 ]
• Impaired nerve conduction due to injury to the lumbar spine, sacrum or coccyx.
• Chronic orchialgia (chronic pain in the scrotum). [ 6 ]

The left testicle hurts most often as a result of an inflammatory process in the appendages. The appendage or epididymis is an important organ that ensures the development and motility of spermatozoa. This is a paired organ that surrounds the testicle, starting from the back and ending with its surface.

Epididymitis is an inflammatory process in the appendage of the left or right testicle, which is characterized by an increase in the size of the appendage itself. As it increases, the epididymis causes painful sensations in the groin, since the appendage encircles the testicle, pain also occurs in it. [ 7 ]

Differential diagnostics

Radionuclide scanning in patients allows diagnosing acute and chronic persistent pain in the testicles, including:

• testicular torsion (negative predictive value 96 to 100%; positive predictive value 75%). False positives (cold scans) may be caused by hydrocele, hematomas, and hernias with trapped bowel;
• testicular abscess;
• testicular rupture or torsion from trauma;
• epididymo-orchitis ("hot" scanning);
• distinguish testicular torsion from testicular abscess.

Also, evaluate the testicle in patients with a normal physical examination and associated emotional problems. Nuclear scans may show no lesions as small as 1 to 1.5 cm

Modern ultrasound examinations have better resolution and can detect lesions smaller than 1 to 1.5 cm. Thus, radionuclide angiography can detect cases of torsion (cold scan) or epididymo-orchitis (hot scan). Hydrocele, hematoma or hernia can cause decreased isotope uptake and mimic testicular torsion.[ 8 ]

If your left testicle hurts, when should you see a urologist?

Ideally, any painful sensations in the groin, whether it is the scrotum or penis, or the perineal area, should be seen by a urologist. Particularly alarming signs, not only when the left testicle hurts, are the following: [ 9 ]

• Painful sensations when touching the testicles, both left and right;
• Enlargement of the left or right testicle;
• Changes in the shape of the left or right testicle;
• A change in the texture of the testicle, where it feels softer than usual;
• Acute pain in the left testicle that occurs suddenly, without apparent cause (trauma, bruise);
• The left testicle hurts, with increasing pain that spreads to the entire scrotum;
• The pain is accompanied by elevated body temperature and vomiting;
• An injury to the scrotum that causes pain that does not subside within half an hour or an hour.

If the left testicle is bothering and hurting, this may indicate the following diseases or everyday, easily eliminated causes:

1. Left-sided varicose vein of the spermatic cord;
2. An inflammatory process of infectious etiology affecting the left side of the scrotum;
3. An inflammatory process of infectious etiology affecting the left appendage;
4. Left appendage cyst;
5. A testicular tumor is usually benign;
6. The habit of wearing uncomfortable, tight underwear that squeezes the left side of the scrotum.

Most often, the left testicle hurts when it is injured; even a slight blow poses a risk of rupture of the testicles, therefore, if the pain does not subside within an hour, you should seek medical help.

No less dangerous is testicular torsion, which can provoke compression of the vas deferens and death of the testicle. Torsion most often occurs in young men, possibly due to the developed muscles in the groin area; after 30-35 years, torsion is almost never seen, which is most likely due to the gradual loss of elasticity and firmness of the muscles.

Epididymitis is most often accompanied by very strong pain and a significant increase in the left testicle. Epididymitis, as a rule, develops against the background of a bacterial, microbial infection. The causative agents are gonococci, chlamydia, affecting the urethra. The inflammatory process is hidden at the first stages, not manifested, so it develops unhindered and affects nearby areas, including the organs of the scrotum. The appendages rarely become inflamed symmetrically, as a rule, one of them is affected. Pain manifests itself at the acute stage, which is also characterized by an increase in temperature to 39-40 degrees, a strong burning sensation when urinating.

The left testicle hurts due to orchitis extremely rarely, since mumps (parotitis) most often occurs in children before puberty, when the disease is relatively mild. Even in the case of mumps in an adult man, orchitis affects only one testicle, and the second remains healthy and produces sperm normally.

A much more alarming sign may be pain in the left testicle with varicocele, when the disease passes to the third stage and is accompanied by multiple lesions of the veins (clusters). As a rule, varicocele affects the left side of the scrotum due to the peculiarities of venous outflow. The danger of left-sided varicocele is that blood stops flowing to the left testicle, and it gradually begins to atrophy. Moreover, the development of varicocele contributes to an increase in temperature in the area of both testicles, sperm production is disrupted, since it requires a certain minimum - no higher than 34.5 degrees.

The left testicle hurts both with an inguinal hernia and with the formation of cysts or benign tumors. Such precancerous conditions require timely diagnosis and immediate treatment, since one of the main factors of recovery in oncology is the early detection of the oncological process.

The diseases are diagnosed using standard urological methods – examination, a set of laboratory tests (blood, urine, secretory fluid from the prostate), Doppler ultrasound of the vascular system (scrotum area), possibly ultrasound examination of the abdominal organs and X-ray.

To prevent testicular pain from leading to sexual dysfunction, infertility or impotence, at the first alarming symptoms you need to see a urologist to avoid more serious problems associated with a threat not only to health, but also to life.