Groin Pain in Men: Could It Be Testicular Torsion?

Grain pain in men is a common symptom that causes discomfort from mild annoyance to debilitating pain. The groin is the sensitive area, and any pain down there can be bothersome. Groin pain in men can be caused by various factors, ranging from minor injuries to serious medical conditions. One significant cause of groin pain is testicular torsion, a medical emergency that requires immediate attention. Understanding this condition can help recognise symptoms early and seek prompt treatment. 

Common causes of grain pain  

The groin is the region that connects the lower abdomen, pelvic region and testicles. Pain in the groin area is caused by many medical reasons. Some of them include:  

• Muscle strains and pulls: Sudden movements or overexertion during exercise can strain the muscles in the groin area, leading to pain and discomfort. 
• Inguinal hernia: This occurs when tissue protrudes and pushes the abdominal wall, causing a bulge and pain in the groin. 
• Kidney stones: These hard deposits can cause sharp, radiating pain that may be felt in the groin area. 
• Epididymitis: Inflammation of the epididymis (the tube that stores sperm), often caused by infection, leads to testicular pain and swelling. 
• Orchitis: Inflammation of the testicle itself, often associated with epididymitis or viral infections like mumps, causes groin pain. 
• Prostatitis: Inflammation of the prostate gland, which can cause pain in the groin, lower back and perineum, leads to groin pain. 
• Nerve entrapment: Nerves in the groin area can become compressed or irritated, leading to pain and numbness. 

Of these possible reasons, testicular torsion stands out as a medical emergency.   

What is testicular torsion pain? 

Testicular torsion pain is a sudden onset of pain caused when the spermatic cord, which is critical to supply blood flow to the testicle, twists and cuts off the blood supply. This can lead to severe pain and potential loss of the testicle if not operated promptly. 

Groin pain due to testicular torsion can occur in one in 4000 men, which is a spontaneous condition that occurs without any obvious cause. Left testicular torsion is more commonly reported than right testicle.  

Testicular torsion symptoms 

• Sudden, severe pain in the testicle: This is a hallmark symptom. 
• Swelling of the scrotum: The affected testicle, either left or right side, will often become swollen and tender. 
• Nausea and vomiting: These symptoms often accompany the intense pain. 
• Abdominal pain: Pain can radiate to the lower abdomen. 
• A testicle that is positioned higher than normal or at an unusual angle: The twisted cord can cause the testicle to shift position. 
• Frequent urination 

Testicular torsion requires urgent treatment, ideally within six hours of symptom onset, to maximise the chances of saving the testicle. 

What to do: 

• Don’t wait: Don’t try to self-diagnose or wait for the pain to subside. 
• Go to the emergency room: This is a medical emergency. 
• Be prepared to provide a detailed medical history: This will help the doctor make a diagnosis. 

Testicular torsion causes 

The causes of testicular torsion can be attributed to various factors, which include trauma and strenuous activity. Some of these important causes include: 

• Congenital abnormality: In some individuals, the tunica vaginalis is attached to a high, allowing the spermatic chord to twist freely inside, leading to intravaginal torsion. This is often bilateral in about 40% of cases and is more common in younger individuals under 25 years old. 
• Neonatal extravaginal torsion: In newborns, the tunica vaginalis has not yet adhered to the gubernaculum, making both the spermatic cord and tunica vaginalis prone to twisting. This can occur even before birth. 
• Spontaneous, exertional or trauma-induced onset: The twisting may happen spontaneously due to physical exertion or, less commonly, following an injury. 
• Association with testicular malignancy: In adults, testicular torsion has also been reported in cases where testicular cancer is present. 

These factors contribute to the development of testicular torsion, which is a significant cause of groin pain requiring emergency medical attention. 

Diagnosis 

Diagnosis of groin pain triggered by testicular torsion involves: 

• Detailed patient history and physical examination, which involves examination of key parameters such as swollen, tender testicles and scrotal erythema  
• Ultrasound is the preferred imaging study due to its high specificity and sensitivity in detecting torsion. 
• Colour Doppler flow imaging is crucial to assess blood flow to the testis. The lack of blood flow strongly suggests torsion. 
• If torsion is suspected, immediate involvement of a urologist is critical. 

Testicular torsion treatment 

• The primary treatment for testicular torsion is surgery. The procedure, called orchiopexy, untwists the spermatic cord and safeguards the testicle to prevent future torsion. 
• Recovery after surgery: The first few days post-surgery are usually the most painful, with possible swelling or bruising in the scrotum or groin for about a week. Pain typically decreases after a week, allowing a return to normal activities, including work or school. 
• Activity restrictions: Patients should avoid heavy lifting and strenuous activities, including sports, for at least three to four weeks. It’s important to follow healthcare provider instructions for managing pain and ensuring a smooth recovery. 
• Individual recovery times can vary, so it’s crucial to adhere to personalised medical advice for the best outcomes. 
• Importance of timely intervention to prevent complications: Timely intervention is vital to prevent complications such as testicular atrophy or loss. Surgery within six hours of symptom onset offers the best chance of saving the testicle. The condition is managed by a team of healthcare professionals such as emergency physicians, urologists and radiologists to ensure prompt and effective treatment. 

How to prevent testicular torsion? 

While some risk factors cannot be controlled, wearing protective gear during sports and avoiding trauma to the groin can help reduce the risk. 

Surgery is the only way to prevent testicular torsion. Most individuals are unaware of their susceptibility to testicular torsion until it occurs. Surgical intervention can prevent it from happening to the other side of the testicles.  

When to see a doctor? 

Suppose you experience sudden, severe groin pain, swelling or any other symptoms of testicular torsion. Early medical treatment is key to preventing complications such as infertility. 

Prioritising your health and well-being by seeking timely medical advice can make a significant difference in outcomes.  

Complications 

Delay in treatment may cause complications. Some of them include: 

• Loss of testis 
• Infection 
• Infertility 
• Physical deformity 
• Inhibition of exocrine and endocrine function in men 

Early and accurate diagnosis, followed by emergency surgical intervention, is essential to prevent complications and preserve testicles.  

Conclusion 

Groin pain in men can have various causes, with testicular torsion being a critical one. Recognising the symptoms and seeking prompt treatment is essential. Surgery is the main treatment intervention for testicular torsion. Always consult your doctor if you notice testicular torsion or any other groin pain.