Severe Pain in Left Testicle: Possible Causes and Next Steps - Urology

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Severe pain in the left testicle can be concerning and may have various underlying causes. Given your history of hernia surgery at a young age and the current symptoms you describe, it is essential to consider several potential diagnoses and the next steps for evaluation and management.


Possible Causes
1. Testicular Torsion: This is a medical emergency where the spermatic cord becomes twisted, cutting off blood supply to the testicle. Symptoms typically include sudden, severe pain, swelling, and sometimes nausea. However, your description of pain only upon light pressure and the absence of acute pain during normal activities makes this less likely.

2. Epididymitis: This is an inflammation of the epididymis, often caused by infection. Symptoms can include pain, swelling, and tenderness in the affected testicle. Since you mentioned that a urinalysis ruled out testicular inflammation, this may be less likely, but it could still be a consideration if symptoms persist.

3. Inguinal Hernia: Given your history of hernia surgery, it is possible that a recurrent hernia could be causing discomfort. Hernias can sometimes present with pain that radiates from the testicle to the groin area, especially when pressure is applied.

4. Nerve Entrapment or Neuropathy: Sometimes, nerve issues can cause referred pain to the testicle. This could explain the sensitivity and pain upon pressure without any visible abnormalities.

5. Varicocele: This condition involves enlarged veins within the scrotum and can cause discomfort or a dull ache, particularly when standing or after physical activity.

6. Referred Pain: Pain from other areas, such as the lower abdomen or back, can sometimes be felt in the testicle. This could be due to muscle strain or other non-genital issues.


Next Steps
1. Further Evaluation: Since your symptoms persist despite initial treatment, it would be prudent to seek further evaluation. A visit to a urologist is recommended, as they can perform a more thorough examination and may suggest imaging studies, such as an ultrasound, to assess blood flow and check for any abnormalities in the testicle or surrounding structures.

2. Detailed History and Physical Examination: When you visit a specialist, be prepared to provide a detailed history of your symptoms, including when they started, any associated symptoms (like nausea or sweating), and any activities that exacerbate the pain. A thorough physical examination will also help in diagnosing the issue.

3. Imaging Studies: An ultrasound of the scrotum can help identify conditions like testicular torsion, epididymitis, or varicocele. Doppler ultrasound can assess blood flow to the testicle, which is crucial in cases of torsion.

4. Pain Management: While waiting for further evaluation, managing your pain with over-the-counter pain relievers may help. However, avoid any activities that exacerbate the pain.

5. Monitoring Symptoms: Keep track of any changes in your symptoms, including the intensity of pain, any swelling, or changes in urinary habits. If you experience sudden severe pain, swelling, or fever, seek immediate medical attention.


Conclusion
Your symptoms warrant further investigation, especially given the severity of the pain upon pressure and the associated symptoms like sweating and nausea. While some causes may be benign, others could require urgent attention. Consulting with a urologist and possibly undergoing imaging studies will be essential in determining the underlying cause and appropriate treatment. Don't hesitate to seek care, as early intervention can often lead to better outcomes.