Testicular Torsion Concerns: Symptoms and Diagnosis

Concern about testicular torsion?

Hello Doctor, thank you for taking the time to read this letter amidst your busy schedule.
I am an anxious college student (I apologize for having many questions).
On Monday, I accidentally got my boxer shorts caught on my left testicle, which was quite painful at the time, and I wasn't sure if it had twisted.
Since then, I have been experiencing a dull ache, primarily above the testicle or in the spermatic cord.
Sometimes, the pain radiates to the groin and the side of the scrotum, as well as the lower back on the same side.
The pain is not severe, but it is uncomfortable.
The left testicle has not swollen, and it hangs lower than the right one (as usual).
I was very worried after researching online about testicular torsion, so I went to see a doctor at Renai Hospital in Taipei.
He performed a Doppler ultrasound and said that blood flow was normal, so it should not be torsion; it might be inflammation somewhere.
He prescribed a three-day course of antibiotics and told me to go home.
The doctor also mentioned that testicular torsion would be very painful, which my symptoms do not resemble, and that the testicle would become hard, while mine feels soft.
He did a slight physical examination but did not perform the cremasteric reflex test or support the scrotum because I felt some pain when I supported it myself.
I read that one of the symptoms of testicular torsion is similar, so I am very worried about being misdiagnosed.
I also read online that if it were epididymitis, lifting the testicle should relieve the pain, but when I lift it to a certain height, I still feel pain.

Could you please tell me what symptoms would indicate a testicular strain? How long does it typically take to heal? Is it possible that my condition is a strain or bruise? Additionally, if supporting the testicle causes some pain, could that indicate inflammation or torsion of an accessory structure? I have taken the three-day course of medication prescribed by the doctor, but there has been no improvement; the pain is still dull and feels somewhat like a strain.
The medications prescribed were: Dolcol 250mg, Famotidine 20mg, Zeropin 75mg, and Purfen 400mg.
The doctor did not explain the purpose and indications of these medications; could you please clarify that for me?
Furthermore, I have another question.
I may have accidentally strained a ligament while masturbating too vigorously.
Since I have phimosis, I cannot see where the injury is.
It was painful at the time but did not bleed.
Three days later, I still feel a dull ache.
I am unsure if it has torn; if it did, would it be very painful and bleed? How should I care for it? Thank you, Doctor, for your patience in reading this! Wishing you health and safety.

Jiao lü de xue sheng, 20~29 year old female. Ask Date: 2021/10/01

Dr. Li Xinyi reply Urology

It sounds like there are no issues, but after asking a lot of questions, the doctor still can't guarantee that everything is fine.
If the symptoms persist, you should return for a follow-up examination, because regardless of whether it's a physical examination or an ultrasound, ongoing symptoms should be monitored further.
The ligaments also need to be checked on-site for any injuries.

Reply Date: 2021/10/01

More Info

Testicular torsion is a serious medical condition that occurs when the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It is characterized by sudden, severe pain in the scrotum, often accompanied by nausea and vomiting. The affected testicle may also appear higher than the other one. Given your symptoms and the context of your injury, it is understandable to be concerned about the possibility of torsion.

From your description, it seems that you experienced a significant amount of pain after your underwear caught on your left testicle. The pain radiating to the groin and lower back can be concerning, but the fact that your doctor performed a Doppler ultrasound and found normal blood flow to the testicle is a reassuring sign. In cases of testicular torsion, the blood flow would typically be compromised, leading to a lack of blood supply and potential testicular necrosis if not treated promptly.

Your doctor’s assessment that your symptoms do not align with testicular torsion is important. The pain you are experiencing could be due to several other conditions, such as epididymitis (inflammation of the epididymis), which can cause discomfort and may be treated with antibiotics. The fact that your testicle is not swollen and that you have not experienced the classic severe pain associated with torsion further supports this diagnosis.

Regarding your concerns about potential injury or strain to the testicle, it is possible to experience discomfort from a minor injury or strain. Symptoms of a testicular strain or injury can include localized pain, tenderness, and sometimes swelling, but it typically does not present with the acute, severe pain associated with torsion. If you are experiencing persistent pain after three days of antibiotic treatment, it may be worth following up with your healthcare provider for further evaluation.

As for the medications prescribed, here’s a brief overview of their potential uses:
1. Dolcol (Diclofenac): This is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and reduce inflammation. It can help manage discomfort associated with inflammation or injury.

2. Famotidine: This medication is typically used to reduce stomach acid and treat conditions like GERD. It may have been prescribed to prevent any gastrointestinal side effects from the NSAID.

3. Zeropin (Zolpidem): This is a sedative used to treat insomnia. It may have been prescribed to help you sleep better if you are experiencing discomfort.

4. Purfen (Ibuprofen): Another NSAID, it is used to relieve pain, reduce inflammation, and lower fever.

If you are still experiencing pain after completing your course of antibiotics, or if the pain worsens, it is crucial to return to your healthcare provider for further evaluation. They may consider additional imaging studies or a referral to a specialist if necessary.

Regarding your concerns about potential injury from masturbation, it is possible to experience discomfort or minor injuries from vigorous activity, especially if there is a pre-existing condition like phimosis (tight foreskin). If you suspect a more serious injury, such as a tear or rupture, you should seek medical attention immediately. Signs of a more severe injury would include severe pain, swelling, bruising, or bleeding.

In summary, while your symptoms are concerning, the initial evaluation by your doctor suggests that you may not have testicular torsion. However, persistent pain should not be ignored, and follow-up care is essential to ensure proper healing and to rule out any complications. Always prioritize your health and seek medical advice when in doubt.

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