By Dr Pius Musau
Pain evolved to enhance our survival in the world. If we went about hitting our bodies against anything on site without pain, there would be less of us in the world.
In the scrotum lies the factory that makes the human species. Hence, pain in the scrotum turns out not only as the most dreadful discomfort a man can experience, but also triggers anxiety on your reproductive prospects.
Some of the pain may be no more than what a headache is to the rest of us, but the emergency with scrotal or testicular pain could determine your reproductive career.
Causes of scrotal pain
The common causes are classified according to the underlying problems either due to infections or those that are non-infective.
• Infective causes: These may be sexually transmitted or free of sexual contacts. The sexually transmitted include gonorrhea and Chlamydia. They will affect the pouch in which sperms are transiently stored, the testis or both. Those not sexually transmitted include tuberculosis and mumps.
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• Non-infective causes: Include hernias that have descended into the scrotum, physical trauma, and residual effects of past surgeries, testicular twisting (torsion), twisting of the epididymal or testicular appendices and engorged testicular veins.
Testicular twisting is a urological emergency that requires surgical intervention within six hours of onset. In this condition, the vessels that supply blood to the testis get twisted and deprive the organ of oxygen and nutrients. The extent of the twist determines how long it would take before the testis is completely dead.
Identifying a testicular twisting
Testicular twisting is common in the younger age groups but rare beyond 35 years. It has no accompanying urethral discharge or fever. While it may be triggered by trauma, it mostly is spontaneous and often wakes one from sleep.
There may be preceding episodes of similar, but less intense pain that resolved in the past. There is a familial risk and even though it commonly affects one testis at a time, both stand the risk of undergoing twisting.
Resolving the problem
A young male not sexually active with an acute onset of scrotal or testicular pain has testicular twisting unless proved otherwise.
Cases abound in which the diagnosis was not reached in time to salvage the affected testis. We all need to think of testicular twisting instead of treating every testicular pain with antibiotics.
—The writer is a lecturer in the department of surgery at Moi University, Eldoret.