Testicular Pain: Causes and Concerns After Risky Behavior

Testicular pain sensation

Hello doctor, around the beginning of September, I engaged in risky behavior (oral sex without a condom).
By the end of September, I noticed a slight burning sensation when urinating, which made me very worried.
I underwent an RT-PCR test at the end of September, which came back negative, and I also had a urine screening.
After taking medication, the burning sensation disappeared.
A few days later, I felt a round lump near the spermatic cord that was slightly painful, but it disappeared after a few days.
Two to three days later, I experienced a dull ache in both testicles.
By mid-October, I had another urine screening, and the bacterial culture showed no significant issues.
In early November, I had an ultrasound examination, which indicated mild varicocele on both sides.
I was relieved to hear that it was just a varicocele, and the aching sensation gradually diminished.
As of now, I no longer feel the previous discomfort.
In mid-November, the doctor mentioned that my varicocele was very mild and prescribed some antibiotics, stating that I do not need to return for follow-up.
What could be the cause of these symptoms?

Xiao Xiao Zhu, 20~29 year old female. Ask Date: 2006/11/18

Dr. Xu Weikai reply Urology

Hello, regarding your varicocele, many cases are asymptomatic.
In your situation, if this incident had not occurred, you might never have noticed that you had varicocele.
Most varicoceles do not present symptoms, and unless there are specific concerns, surgery is not necessary.
Indications for surgery include: 1.
Pain that cannot be alleviated with medication, and 2.
Impact on fertility (abnormal semen analysis).
Therefore, in your case, I believe that follow-up for the varicocele is not required.
If you are still concerned, you can check your semen analysis; if it is normal, then there is no need for further action, and you can wait until symptoms arise to seek medical attention.
I recommend that after mid-December, you undergo serological testing for HIV and syphilis.
If the results are still negative at that time, there should be no issues.
Note: The tests you conducted at the end of September only indicate that you were not infected at that time (if, unfortunately, you were infected in early September, it would not be detectable by the end of September's serological tests).
A blood test after 8-12 weeks (after mid-December) will confirm whether there was an infection in early September.
These are my suggestions and points of caution; I hope they are helpful.
If you have any questions, feel free to ask for further discussion.

Director of Urology, Taitung Hospital, Department of Health, Executive Yuan, Hsu Wei-Kai.

Reply Date: 2006/11/18

More Info

Testicular pain can be a concerning symptom, especially following risky sexual behavior. It is good to hear that you have sought medical attention and undergone various tests, including RT-PCR and urine cultures, which have returned negative results. This is a positive sign, as it suggests that there is no active infection present.

From your description, it seems that you experienced a few different symptoms: initial pain during urination, a lump in the area of the spermatic cord, and subsequent testicular discomfort. These symptoms can be attributed to several potential causes, and understanding them can help alleviate your concerns.

1. Urinary Tract Infection (UTI): The initial burning sensation during urination could indicate a UTI or urethritis, which is inflammation of the urethra. Your negative urine culture suggests that this is less likely, especially since the pain resolved after treatment.

2. Epididymitis: This is an inflammation of the epididymis, the tube that carries sperm from the testicle. It can cause pain and swelling in the testicular area and is often associated with infections, including sexually transmitted infections (STIs). However, since your tests have come back negative, this may not be the case for you.

3. Varicocele: The ultrasound findings of "venous dilation" in the spermatic cord area suggest a condition known as varicocele. This is a common condition where the veins within the scrotum become enlarged, similar to varicose veins in the legs. Varicoceles can cause a dull ache or discomfort in the testicles and are often more noticeable after prolonged standing or physical activity. The fact that your doctor described it as "mild" is reassuring, as many men with varicoceles experience no significant symptoms and do not require treatment.

4. Testicular torsion: This is a medical emergency where the spermatic cord twists, cutting off blood supply to the testicle. It typically presents with sudden, severe pain and swelling. Your symptoms do not align with this condition, especially since the pain has subsided and you have not experienced acute symptoms.

5. Psychogenic Factors: Anxiety and stress can also manifest as physical symptoms, including testicular discomfort. Given the context of your recent risky behavior and subsequent health concerns, it is possible that anxiety may have contributed to your symptoms.

In conclusion, it appears that your symptoms were likely related to mild varicocele and possibly some transient irritation from your earlier activities. The resolution of your pain and the reassurance from your doctor are positive indicators. However, if you experience any recurrence of pain, swelling, or other concerning symptoms, it is essential to follow up with your healthcare provider for further evaluation.

Maintaining open communication with your doctor about any ongoing concerns is crucial. Additionally, practicing safe sex in the future can help prevent potential complications and infections. If you have any further questions or if symptoms return, do not hesitate to seek medical advice.

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