Scrotal and Lower Abdominal Pain: Causes and Concerns

Scrotal and lower abdominal pain?

Hello doctor, I experienced an erection that lasted for about half an hour without ejaculation, and after some time, I felt intense pain in my scrotum and lower abdomen that made it difficult to walk.
It took about four to five hours for the pain to subside.
This happened twice last weekend and once yesterday.
What could be the cause? Is it testicular torsion? Could this lead to fertility issues?

Jie, 10~19 year old female. Ask Date: 2015/12/12

Dr. Xu Weikai reply Urology

Hello, testicular torsion is very painful.
Usually, patients come to the emergency department because they can't tolerate the pain.
Testicular torsion requires emergency surgery for correction; otherwise, it can lead to testicular necrosis.
If testicular torsion cannot be ruled out, it is advised to seek emergency medical attention.
If it is not testicular torsion, it may just be muscle or nerve tension or other types of pain.
If you have any further questions, feel free to ask, and we can discuss and research together.
Information obtained online should only be used as a reference; if necessary, it is still important to seek care at a medical facility.
This message is from Dr.
Hsu Wei-Kai, Chief of Urology, Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2015/12/12

More Info

Understanding scrotal and lower abdominal pain can be quite complex, as there are several potential causes for the symptoms you are experiencing. Based on your description, it seems that you are experiencing significant discomfort in the scrotal area and lower abdomen, particularly after prolonged erections without ejaculation. This can indeed be concerning, and it’s important to consider various possibilities.

One of the most serious conditions that could be causing your symptoms is testicular torsion. This occurs when the spermatic cord becomes twisted, cutting off the blood supply to the testicle. Testicular torsion is a medical emergency that typically presents with sudden, severe pain in the scrotum, which may also be accompanied by nausea and vomiting. If not treated promptly, it can lead to loss of the testicle. The pain you describe, especially if it is severe and associated with an inability to walk, could suggest this condition. However, testicular torsion usually presents acutely rather than after prolonged erections.

Another potential cause of your symptoms could be epididymitis, which is inflammation of the epididymis, often due to infection. This condition can cause pain and swelling in the scrotum and may be associated with urinary symptoms or discharge. Epididymitis can also occur after sexual activity or prolonged erections, particularly if there is an underlying infection.

Varicocele, which is an enlargement of the veins within the scrotum, can also lead to discomfort and pain, particularly after prolonged periods of sexual arousal. While varicoceles are often asymptomatic, they can sometimes cause a dull ache or a feeling of heaviness in the scrotum, which may worsen with prolonged standing or sexual activity.

In addition to these conditions, inguinal hernias could also be a consideration. An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. This can lead to discomfort in the lower abdomen and groin, especially during physical activity or straining.

Regarding your concern about fertility, conditions like testicular torsion and varicocele can potentially impact fertility if they lead to testicular damage or impaired sperm production. Testicular torsion, if not treated quickly, can result in loss of the affected testicle, which can affect fertility. Varicocele has also been associated with decreased sperm quality and fertility issues.

Given the severity and recurrence of your symptoms, it is crucial to seek medical attention promptly. A healthcare provider will likely perform a physical examination and may order imaging studies, such as an ultrasound, to assess blood flow to the testicles and to rule out conditions like torsion or epididymitis. They may also consider other diagnostic tests based on your medical history and symptoms.

In summary, while there are several potential causes for your scrotal and lower abdominal pain, conditions such as testicular torsion, epididymitis, varicocele, and inguinal hernia should be considered. It is essential to consult a healthcare professional for a thorough evaluation and appropriate management to address your symptoms and any potential impact on fertility.

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