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Whenever men get testicular pain, it's not unusual to worry that it might be testicular cancer. Let's get that worry out of the way, or send you on to see your doctor right away, as the case may be.

The symptoms of testicular cancer are:

  • A dull ache or pain in the lower abdomen. At least at first, the pain from testicular cancer is dull, not sharp or excruciating, and it's up from the testicles, not down.
  • Pain and enlargement of just one testicle. Only about 2 percent of cases of testicular cancer involve both testicles.
  • Gynecomastia, enlargement of the breasts. This doesn't always occur in testicular cancer.
  • Symptoms of metastasis including fatigue, loss of appetite and loss of weight, muscle wasting, and difficulties breathing.

Testicular cancer is something that hits men most often between the ages of 20 and 34, although it also is relatively frequent in men who about age 60. This cancer is much more frequent in men of northern European descent than it is in men of Mediterranean, Middle Eastern, Asian, African, or Hispanic descent.

If it isn't testicular cancer, what could pain in one testicle going down one leg be?

In some cases, pain in just one testicle that goes down one leg is a complication of a "close-ended," surgical vasectomy. Open-ended vasectomy is less likely to cause this complication. Reversing the vasectomy reverses the pain in about 70 percent of cases, but not in all cases. If a testicle has to be removed because of surgical complications, then it is usually impossible to reverse the vasectomy.

In other cases, pain in just one testicle that goes down one leg may be due to a condition called epididymitis. This hard-to-spell health problem occurs after urine flows backwards from the prostate into the testicles. The underlying problem can be a stricture, or narrowing, in the urethra, which flows urine away from the prostate into the penis, or an injury (most commonly due to picking up a heavy weight), or the Vasalva maneuver, trying (too) hard to breathe through a closed airway. Urine flowing backwards can carry bacteria from the tip of the penis back into the testicles and cause infection. This problem can also result when a catheter is inserted improperly.

In epididymitis, pain builds up over several days. It's not immediate. When the problem happens in boys, there are usually fever and swelling, but when the problem happens in men, there usually aren't. The scrotum usually isn't enlarged, and symptoms may be mild enough that they are ignored for weeks while the problem worsens. Sometimes the treatment is a procedure called an epididymectomy, which involves removing part of the scrotum to relieve chronic pain.

Testicular torsion is a medical emergency that causes severe pain as the spermatic cord is twisted and blood circulation is lost in the testicle on the same side as the twist. The onset of pain is almost always immediate and severe. The scrotum swells quickly. In 96 percent of cases, there are nausea and vomiting. If the underlying problem is not treated within 12 hours, it is usually necessary to remove one or both testicles. If you have these symptoms, you should not look for information on the Internet. You should get to an emergency room immediately. Surgery is not always necessary, but manual detorsion has to be verified by ultrasound before you are discharged from the hospital.

It's also possible to have these symptoms with a condition called hydrocele, in which the scrotum fills with fluid that makes it translucent in strong light. Oddly enough, this condition is also caused by the Vasalva maneuver. If you snore, your scrotum usually will be larger in the morning and shrink during the day. Hydrocele may cause a condition most common in men and sometimes called "hanging balls," but it is only rarely painful. Treatment may be as simple as antibiotics.

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