The Testicles and the Scrotum
The testicles are two male sex organs that produce sperm and the male sex hor- mone testosterone. The testicles are suspended in a pouch of skin called the scro- tum. Each testicle hangs from a structure called the spermatic cord, which is made up of the vas deferens, nerves, and blood vessels. The vas deferens trans- ports newly formed sperm to the urethra from a tube behind each testicle called the epididymis.
Having the scrotum hanging from the lower torso has its disadvantages. The legs help protect it from blows from the side, and the buttocks shield it from the back. But every man, at some time in his life, has gotten or will get a frontal blow to the groin and scrotum that causes excruciating pain. Despite the natural ten- dency to coil up in a fetal position, the blow usually is not as bad as it feels. The testicles are capable of moving about inside the scrotum in response to a blow. They usually bounce back with no lasting effects because the tissues within the scrotum are spongy and ﬂexible and can absorb a great deal of shock without sustaining permanent damage.
Pain associated with testicular injury is very different from other types of pain. Testicles are organs that are located outside the body. Pain for them is similar to pain sensed by any other internal organ. It tends to be deeper, more intense, and more widespread than pain to the outside of the body. This is why a blow to the testicles can cause pain that is accompanied by sweating, nausea, and dizziness. It is the brain’s way of acknowledging that a crucial organ has been hit and that the whole body must respond to this potential emergency.
The initial pain felt after an injury is caused by the swelling of the testicle within its protective pouch. The pressure caused by the swelling affects the surrounding nerves, causing pain to spread to the lower abdomen. An ice pack applied to the scrotum and anti-inﬂammatory drugs (such as aspirin or ibupro- fen) can be used to reduce the swelling and the pain.
If pain and swelling persist after an hour, see a doctor immediately. The blow may have caused the testicle to rupture, or it may have twisted the spermatic cord that supports the testicle. Also, too much pressure from swelling within the scro- tum can cause tissue damage that can lead to infertility, blood clots, or the loss of a testicle.
The testicles are located inside the abdomen before birth. They normally descend into the scrotum about a month before birth. In 1 percent of males, for unknown reasons, one or both testicles may remain in the abdomen at birth. Usu- ally this condition corrects itself within the next 3 months. If the testicles have
not descended by 1 year of age, the infant should be examined by a physician to determine whether surgery is needed to bring them into position.
A male whose testicles remain undescended until puberty will be incapable of producing viable sperm. He is also at a signiﬁcantly higher risk of developing testicular cancer. Surgery is usually performed while the child is a toddler, because critical emotional problems may arise when genital surgery is performed on an older child.
Each testicle is suspended in the scrotum by a spermatic cord made up of blood vessels, nerves, and the vas deferens. On rare occasions, and for reasons not well understood, the cord becomes twisted and cuts off blood ﬂow to and from the testicle. It is a very painful condition. Torsion usually occurs in children and teenagers, but it can occur in adults. Most cases have no identiﬁable cause. Tor- sion also can occur during sleep.
Signs and symptoms of testicular torsion may include sudden, severe pain in the groin; one testicle resting higher in the scrotum; one testicle lying horizon- tally in the scrotum; nausea and vomiting; swelling of the scrotum; and fever. Prompt treatment, usually surgery, is required to untwist the cord, ﬁx both testi- cles in position, and prevent testicular strangulation. Permanent damage can result if the condition is not treated within 4 to 8 hours. If left twisted, the testi- cle will swell and then atrophy.