Save Your Scrotum! I mean, Save Your Balls!

Save Your Scrotum! I mean, Save Your Balls!

Save Your Scrotum – You might have seen a dozen Hollywood box office movie which give you an extra scene when they have fought the gangster they will always show you the kick right into the balls. And it seems really painful (just looking at the picture above). For a man, its really painful when they get trauma there (in the testicles area). Some of you might think that the stunt men or the actor just made it so the scene will looks funny, but its actually really painful. Am I right sir ?

So actually the pain from your testicles not always comes from a trauma or accident (sports accident, fight,etc) but it can also causes by several factors including infection. You might be not really care with your balls before you understand it that your balls having a major roles for your fertility! So from now you must take care and save your scrotum! I mean, save your balls!

Also Read Vaginal Discharge Is it SEXUAL TRANSMITTED INFECTION ?

BALLS’s CYCLOPEDIA

Originally men has two balls and it located under the Mr.Banana. those two balls are protected by a skin layers in the external area that we usually called scrotum. The scrotum is a male reproductive structure located under the penis. This sac divided into two compartments by the scrotal septum. Each sac included external spermatic fascia, testes (your balls), epididymis, and spermatic cord. The average wall thickness of the scrotum is about 8 mm and it has two layers. First, the parietal layer has the function of covering the inner aspect of the scrotal wall and the second was the visceral layer which coats the testis and epididymis. The scrotum responsible for protecting the testes. It helps with the thermoregulation of the testicles. It keeps the temperature of the testis several degrees below the average body temperature, which is an essential factor for sperm production.

Figure 1. The Male Genital Organs, The scrotum. On the left side the cavity of the tunica vaginalis has been opened; on the right side only the layers superficial to the Cremaster have been removed. Contributed by Gray’s Anatomy Plates (Source: Anatomy, Abdomen and Pelvis, Scrotum. NCBI Bookshelf. 2021

The balls or testes are male reproductive gland that is responsible for producing sperm and making androgens.They are oval shaped reproductive structures that are bean-shaped and measures 3cm by 5cm in length and 2cm to 3cm in width.2 The double-layered tunica vaginalis envelop the testes except at the posterior and superior borders where the epididymis and spermatic cord are attached. The visceral or inner layer of the tunica vaginalis is close to the epididymis, testes and vas deferens. On the posterior lateral surface of the testes, there is a small space between the testes and body of the epididymis which is known as the sinus of the epididymis. Deep to the tunica vaginalis is located the tunica albuginea, which is a durable fibrous covering of the testes.

The epididymis is a small curved shaped elongated structure which is highly convoluted and tightly compressed. When open in a straight line, it is estimated that its length is about 20 feet. The epididymis is found on the posterior border of the testis and consists of three parts which include the head (caput), body (corpora), and tail (Cauda). The head of the epididymis lies at the upper pole of the testes and receive seminal fluid from the ducts of the testis. It then permits passage of sperm into the distal portion of the epididymis. Because of its length, the epididymal ducts have ample space for storage and maturation of sperm.2

Figure 2. Testicle, Vas (Ductus) Deferens, Head of Epididymis (shown lifted from testis), Body of Epididymis, Tail of Epididymis, Testicular Artery, Pampiniform Plexus, Efferent Ductules, Septa, Lobules, Tunica Albuginea. Contributed Illustration by Beckie Palmer. (source: Anatomy, Abdomen and Pelvis, Testicles. NCBI Bookshelf.

Vascularization of the testis has two main roles: transport and mobilizations of endocrine factors and metabolites, as well as regulation of testicular temperature. In men, testicular temperature is about 3°-4°C below core body temperature and about 1,5°-2,5° C above the temperature of scrotal skin.3

Story behind Testicular Pain

When your balls get kicked, you might get experiencing painful sensation not only in your balls area. You will experience pain in your tummy, your back, your thigh also you may experience vomit and headache! This kind of pain called referred pain. You must save your scrotum, i mean your balls okay ?

Sensory innervation of the testis and epididymis is conducted by autonomic(The part of the nervous system that controls muscles of internal organs (such as the heart, blood vessels, lungs, stomach, and intestines) and glands (such as salivary glands and sweat glands))4 and sensory (sensory nerve, also called an afferent nerve, is a nerve that carries sensory information toward the central nervous system (CNS) and all those nerves which can sense or recognize the stimuli (Internal or External) are known as sensory nerves. Fibers that travel through the spermatic cord. The somatic fibers of the cremaster muscle and the parietal and visceral layers of the pouch that surrounds testicles travel via the genital branches of the genitofemoral nerve (originating in L1-L2) and ilioinguinal nerve, arising from the first lumbar spinal nerve (L1). Testicular nociceptive fibers travel via the sympathetic plexus (T10 to T12), whereas the deferential and epididymal nociceptive fibers travel via the pelvic plexus (T10 to L1) throughout the vas deferens.5

Causes of testicular pain are various, such as trauma, testicular torsion, post-vasectomy pain, epididymitis, varicocele and chronic orchialgia.

  • Trauma

Trauma must be considered in all ages as the cause of acute pain. Severity varies from simple organ contusions to testicular rupture (a force of 50kg is required to tear or break the tunica albuginea)4The uncommon, but more severe dislocation of the testis is a result of trauma and produces damage or avulsion(an injury in which a body structure is torn off by either trauma or surgery) of the fascia  surrounding the testis and/or of the scrotal ligament

  • Testicular torsion

Testicular torsion is a medical emergency, requiring prompt treatment or risking the loss of the testicles. The incidence is 1 in 4.000 males under the age of 25 years. The classical presentation of testicular torsion is acute onset, intense, unilateral scrotal pain also may complain of nausea and vomiting. Testicular torsion requires immediate surgical intervention with scrotal exploration, detorsion and orchidopexy .6

  • Epididymitis

Epididymitis  is another common cause of acute scrotal pain that must be differentiated from the more severe testicular torsion.5 Sexually active men younger than 35 years are usually infected with Chlamydia trachomatis and Neisseria gonorrhea, whereas older patients, patients who have undergone recent genitourinary surgery, and patients with anatomical abnormalities often have infection with urinary tract infections. Fungal agents such as Candida species, very rarely, can also cause epididymitis.

  • Post-vasectomy pain

Vasectomy is a surgical procedure for male sterilization or permanent contraception. During the procedure, the male fibromuscular tube that has function to excretory sperm are cut and tied or sealed so as to prevent sperm from entering into the urethra and thereby prevent fertilization of a female through sexual intercourse.Most common adverse event affecting the patient’s quality of life after a vasectomy is pain. The presenting symptoms included testicular pain (9cases), pain during intercourse (8cases), pain with ejaculation (4cases) and epididymal pain (2cases).6

  • Varicocele

A varicocele is an abnormal dilation of the spermatic veins commonly due to an anatomical abnormality with an incidence of 10% to 20% in the general male population and 2% to 15% in adolescent males6 and more common in younger ages 15-25.7 Varicocele pain typically presents as a dull, aching, and throbbing sensation in the scrotum without sharp radiating components.6

  • Chronic Orchialgia

Orchialgia or testicular pain. It is defined as intermittent or constant testicular pain for a period of 3 or more months that interferes with daily activities.8 The etiology of chronic orchialgia remains largely unknown with up to 50% of patients presenting with an unknown cause, but has been found to be associated with nerve damage to the spermatic cord after vasectomy, trauma, inguinal herniorrhaphy () , and epididymitis.6

CRITICAL POINT TO UNDERSTAND!

Males has always to more concern about their testicles, because taking good care and save your scrotum or balls will save your future! The testicles pain etiology so many, but there are hundred cases that shows the cause of testicles pain are from trauma. Each treatment depends on the variation degree of the damage cell in your testicles, it could be only pain killer drugs, scrotal support, cold compress and the last thing is surgery.

Some tips here for you who loves sport (especially male in age of school and university) please try to wear athletic cup or jockstrap . While sports-related genital injuries are not very common, they still can give you testicular pain, but if you are not well treated it can become significant injuries.9

A Geisinger study showed that 18 percent of athletes experienced a testicular injury, and 36.4% observed injuries in team members, yet only 12.9% of athletes reported wearing athletic cups.
“A hard hit to the groin can cause severe pain and even nausea or vomiting for boys and men,” said Joel Sumfest, M.D., a Geisinger urologist who co-authored the study.

“And if the hit is hard enough, it can also lead to testicular fracture or testicular rupture.”10

REFFERENCES

  1. Rosa A.Garcia, Hussain Sajjad. Anatomy, Abdomen and Pelvis, Scrotum. 2021. StatPearls Publishing LLC. Bookshelf ID: NBK549893PMID: 31751083. Access: https://www.ncbi.nlm.nih.gov/books/NBK549893/ March 20 2021)
  2. Manpreet S. Tiwana, Stephen W. Leslie. Anatomy, Abdomen and Pelvis, Testicles. 2020. StatPearls Publishing. Bookshelf ID: NBK470201PMID: 29261881. Access: https://www.ncbi.nlm.nih.gov/books/NBK470201/ March 20 2021
  3. G.F. Weinbauer. E. Nieschlag et al. (eds.), Andrology, DOI: 10.1007/978-3-540-78355-8_2. Springer-Verlag Berlin Heidelberg. 2010. Page 37
  4. Autonomic nervous system. National cancer institute. Access: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/autonomic-nervous-system#:~:text=(AW%2Dtoh%2DNAH%2D,salivary%20glands%20and%20sweat%20glands).  March 20 21021
  5. Juan Fernando Uribe-Arcila, Andres Delgado-Montoya, Federico Gaviria-Gil. Etiology of testicular pain 2019: Classification into ten logical subgroups. Revista Mexicana de URología ISSN: 2007-4085, Vol. 80, núm. 4, julio-agosto 2020:pp. 1-19. Access: https://revistamexicanadeurologia.org.mx/index.php/rmu/article/download/498/922/ March 20 2021
  6. Chirag G Gordhan, Hossein Sedeghi-Nejad. Scrotal pain: Evaluation and management. The Korean Urological Association. 2015. Korean J Urol 2015;56:3-11. http://dx.doi.org/10.4111/kju.2015.56.1.3 pISSN 2005-6737  •  eISSN 2005-6745)
  7. Condition Treated. What is a Varicocele. UCLA Health. Access: https://www.uclahealth.org/urology/body.cfm?id=478&action=detail&ref=19 March 23 2021
  8. Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol 1990;143:936-9.
  9. Urology Associates. Protect Your Male Athletes from Genital Injuries&Testicular Pain. 2018. Access: https://denverurology.com/urology-blog/genital-injuries-testicular-pain/, March 23 2021
  10. Why your athletic son needs to wear a cup. Geisinger. 2016. Access: https://www.geisinger.org/health-and-wellness/wellness-articles/2017/02/21/19/38/why-your-athletic-son-needs-to-wear-a-cup, March 23 2021

Save Your Scrotum

Save Your Scrotum!

Save Your Scrotum!