Testicular Issues: Symptoms and Concerns for Young Men

Testicular issues

Hello doctor, I am 21 years old.
About a month ago, after holding my urine, I experienced inflammation of the left epididymis.
After taking medication from a small clinic, the symptoms disappeared.
However, I have started to experience bilateral testicular torsion more easily (it occurs when squatting, during physiological changes, or when the weather is cold and the testicles retract).
The torsion resolves on its own.
During retraction, the left testicle feels tighter and is positioned more straight, causing discomfort.
When not retracted, there is still slight discomfort.
The right testicle feels softer and does not cause any discomfort during retraction.
Both testicles can experience torsion; previously, I did not have this issue even with vigorous exercise or side sleeping, but now it occurs easily with little provocation.
I am currently worried every night about falling asleep and not being able to resolve the torsion in time, which could lead to testicular necrosis and necessitate surgical removal.

Mr. Hsu, 20~29 year old female. Ask Date: 2019/01/19

Dr. Lin Wenxu reply Urology

It is normal for the testicles to experience upward and downward contractions, and they typically return to their original position on their own without any issues.
However, if they cannot return to their normal position and are accompanied by acute testicular pain, medical attention is necessary for evaluation and treatment by a physician.

Reply Date: 2019/01/19

More Info

Hello! Thank you for reaching out with your concerns regarding testicular issues. It's important to address these symptoms, especially at your age, as they can have significant implications for your health and well-being.

From what you've described, it sounds like you experienced an episode of epididymitis, which is inflammation of the epididymis, often caused by infection. The fact that your symptoms resolved after treatment is a positive sign. However, the subsequent development of testicular torsion symptoms is concerning. Testicular torsion is a medical emergency where the spermatic cord becomes twisted, cutting off blood supply to the testicle. This condition requires immediate medical attention to prevent permanent damage or loss of the testicle.

The symptoms you are experiencing, such as the sensation of twisting or discomfort in the testicles, especially when squatting or in response to cold temperatures, could indicate an underlying issue. It's not uncommon for individuals who have had a previous episode of epididymitis or other testicular issues to experience heightened sensitivity or changes in the way their testicles respond to physical stimuli. The fact that you are experiencing these sensations bilaterally (on both sides) is noteworthy.

Here are some important points to consider regarding your symptoms:
1. Testicular Torsion Risk: If you are experiencing recurrent sensations of twisting or discomfort, it is crucial to consult a urologist. They can perform a physical examination and possibly imaging studies (like an ultrasound) to assess blood flow to the testicles and determine if there is any risk of torsion.

2. Anatomical Variations: Some individuals may have anatomical variations that predispose them to torsion or other issues. This could include a condition known as "bell clapper deformity," where the testicle is not anchored properly and can rotate freely, increasing the risk of torsion.

3. Psychological Impact: It’s understandable to feel anxious about the possibility of torsion, especially after experiencing symptoms. This anxiety can sometimes exacerbate the perception of discomfort. It may be beneficial to discuss these feelings with a healthcare provider who can help you manage both the physical and emotional aspects of your health.

4. Follow-Up Care: Given your symptoms, it is advisable to have a follow-up appointment with a urologist. They may recommend further evaluation to rule out any underlying conditions that could be contributing to your symptoms. This could include hormonal evaluations or imaging studies to assess the anatomy of your testicles and surrounding structures.

5. Self-Care and Monitoring: In the meantime, monitor your symptoms closely. If you experience severe pain, swelling, or any other alarming symptoms, seek immediate medical attention. Avoid activities that exacerbate your discomfort, and consider wearing supportive underwear to minimize movement and potential discomfort.

In summary, while your initial episode of epididymitis seems to have resolved, the subsequent symptoms you are experiencing warrant further evaluation. Testicular torsion is a serious condition, and it's essential to ensure that you are not at risk. Please reach out to a urologist as soon as possible to discuss your symptoms in detail and receive appropriate care. Your health is paramount, and addressing these concerns early can help prevent complications in the future. Thank you for sharing your concerns, and I wish you the best in your journey toward better health!

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