SEXUAL HEALTH: What causes pain in the testes?

Doris was seriously annoyed with her husband. For close to two weeks they had been arguing. The bone of contention was a nagging pain in her husband’s testis.

“He is accusing me of infecting him with a sexually transmitted disease!” Doris exclaimed. “He thinks I have been sleeping out with other men!”

John, her husband, stared into space, paying little attention to what she was saying. He was breathing heavily and moving his fingers aimlessly, his rage badly disguised. I feared that he would soon blow up. I interrupted Doris and led the discussion by taking medical history in the conventional way.

Doris was 40 years old. She was a secretary in a government office. John was a procurement officer at an NGO. He was 43 years old. The couple had been married for 12 years and had two children.

Problems started when John developed a nagging pain in his testis. The pain was dull and made worse by movement. There was no accompanying pain on urination. Further, there was no discharge from the urethra.

You see, pain in the testis accompanied by urethral discharge and pain on urination can signify acute infection and I was keen to rule this out, not forgetting that chronic infection can be present as pain in the testis without any of these other symptoms.

I asked if there had been trauma to the testis. Sometimes pain in the testis can follow acute trauma such as being hit by an object or falling and injuring the testis. Chronic pain can result from trivial causes such as loose underwear or riding a bicycle in uncomfortable positions. John did not have any of these causes.

Occasionally, pain can result if a couple handles each other roughly during sex. There are many cases where, in the heat of the moment, the lady squeezes the man’s genitals too hard. John and Doris denied having such an experience.

Seemingly getting nowhere with my medical interview, I decided to examine John. There were no abnormalities. I then went ahead to examine his testis. There was no obvious swelling. There was, however, pain on palpation of the right testis.

I ordered a urine culture to rule out infection. I also ordered an ultrasound of the testis. The urine test was normal but the ultrasound was quite revealing. John had an enlargement of one of the veins. An enlarged vein, e.g. in the legs, is called a varicose vein.

When it happens in the testis however, it is called a varicocele. A varicocele can cause pressure in the testis and result in pain. John’s varicocele was quite severe as shown in the ultrasound.

“So now tell me, why did you accuse me of infecting you with disease?” Doris blurted out, obviously still annoyed.

“But who tells you the varicocele is not sexually transmitted?” John shouted back.

I intervened and explained the cause of varicocele: A natural weakness in the veins causes them to balloon. “Let’s get treatment to alleviate this pain,” I said.

If not treated in good time, a varicocele can interfere with sperm production since it alters the temperature in the testis, making it warmer than normal. Further, testicular pain interferes with sexual function.

“Oh, you better give him medicine,” Doris suddenly mellowed. “There are things I still value and I would hate it if I missed them. Sex is one of them!”

Unfortunately, a severe varicocele does not respond to medicine. Treatment calls for surgery to deflate and remove the enlarged vein. Both Doris and John listened keenly as I explained the theatre procedure.

The surgery went well and the healing process after was uneventful. The couple attended two intimacy building sessions to repair the damage resulting from the bitter exchanges that occurred before the diagnosis of varicocele was made. Soon after, they were back on their feet and enjoying their conjugal rights.