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*Urgent* Dull uncomfortable ache/pain in Right Testicle (slightly higher than left and feels somewhat strained)

Pain is worse when exercise is induced, simultaneous pain in right testicle and right oblique/ab with exercise/twisting/lifting.

HELP! Long read, apologise in advance for spelling, grammatical errors.

Hi, my name is Aaron, I am a 19 year old male with a slightly higher/strained/retracted right testicle which is very very uncomfortable. It has affected my life physically, emotionally mentally and tested relationships with people in my life, it is a very frustrating injury which has gone on too long for a 19 year old. I got this injury in 2010 when i was just 15 years old. I have been playing competitive sports since i was around 8-9, soccer bust mostly basketball. I played for state teams in basketball at a high level for about 4 years and was very fit and active. I could run freely with no pain at all. In highschool in the first half of 2010 I started playing AFL which is footy but involves a lot of kicking (i wasnt used to all the kicking and overloading the right side of my body's muscles) i only played a for a few months while playing state basketball. This injury came out of n where after a basketball game when i got home. I took off my ankle guards and pants ready to have a shower but as i twisted my body slightly to take of the ankle guards i immediately experienced sharp pains simultaneously in my right oblique-abs and right testicle. At that time i felt the testicle rise up slightly giving me a very unpleasant feeling and sensation (numb/dull/dead) i experience to this day. I got it checked out thinking i had cancer being the young lad i was at the time. Dr said i had epiditymitis on the right testicle and was given anti-inflammatory tablets for about 1-2 weeks. i had hot and cold bathes whilst taking the tablets thinking it was some sort of strain, thinking it would go away in a few days, boy was i wrong. its been over 4 years and i have seen over 10 specialists and doctors and it has definitely taken its toll on me, earlier this year 2014, i also saw another urologist who said everything seemed fine, there was no testicular torsion or kindey stone or hydrocele or anything wrong with the testicle anatomically and functionally. everything seemed okay, but it didnt make sense with the pain i am experiencing, it still felt numb, weird, and just uncomfortable as if its strained or soemthing (hard to explain) i felt like a dickhead when he said i was fine, as if i was some liar.. it was bascally another just another kick to the balls... over the 4 years i have had countless apointments with physios which only seemed to make the pain worse when i did their exercises. (this pain can be greater when exericise is induced) i physically can not run at all without the pain in my testicle and gut/oblique. but yea i have had many MRI's, xrays, ultrasounds and they didnt pick up much until this year when i went down to Sydney - Australia ( i live in townsville norht queensland AUS) to see DR john Garvey who is a general diagnostic surgeon of the groin, best in his field.i saw him and got more scans down there and they picked up on alot of musculoskeletal problems. i had a large tear in the conjoint tendon, 6 stiches were needed usually they put in 4, but the tear was that big, also i had deterioration in one of the tendons in my hip or soemthing which was pain i started experiencing early this year. also somehting with the adductor and he took out the ilioiguinal nerve i believe. unfortunately my memory is foggy as i havent got a copy of the report. but yea i was issued to get a quadruple groin reconstruction. so i got that and its been a few weeks now, maybe 4-5 weeks now, and im still experiencing the same testicle pain i have had all these years which is very depressing. so i dont really know what to do at all... im only 19 and im studying sprt exercise science, trying to get into physiotherapy to learn about my injury but my knowledge is just too novice to treat soemthing not even the best doctors int he world cant figure out.. the only time i experience any relief is massage on my back, glute, oblique abs, right adductor, hammys and hip flexor stretches, i have very tight muscles from all the sport and kicking for AFL. however this relief is close to nothing, the only time i experienced full relief where my testicle literally drooped back down to its original position and relaxed was around 2011 where i had accupuncture on the right side of my body, oblique psoas trigger point areas, it was like a breath of fresh air and i felt a million bucks, for soem reason the accupuncture helped my uncomfortabe pain but only lasted till the car ride home. where it then shot up again and went back to the uncomfrtable position and since then i havent experienced that relief. i still see that accupuncturist from time to time but i havent had the same relief, i see him again this wednesday and hope to get ome needles in the oblique area which is tight. but yes these are all just theories, i think i have a tight deep muscle affecting a nerve (possibly one that innervates the scrotum /cremasteric muscle) thats why the needles worked cos they got deeper, i assume... but yes when i rub the inside of my right leg down to my knee my testicle retracts/jumps up and is just very sensitive as well. so yea thats about it, i cant do anything, its very frustrating and debilitating, was 85kgs at the time now i weigh 110kgs due to inactivity. but yea thankyou for taking hte time out to read this, i sound like a bit of a whinger/complainer but really im just a frustrated 19 year old who wants to play competitive sport again and fix this injury so i can focus on that and my career, but until then im going around in circles and its been very tough.. look forward to hearing from you guys, thanks so much :)​

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Aaron,

I have a similar injury to the right testicle as yours, except I have not gone as far as you have in your search for a solution - and also I had this injury approximately 7 months ago on January 30th (I was 33 at the time and I'm now 34). I got this injury in a seemingly simple way: I was laughing while my scrotum was tensed up and the more I laughed the more the testicle felt as if it rose up until it was "stuck" in the external inguinal ring. The testicle was then stuck in that position for almost 8 hours. The pain was unbelievable - it felt as if I had received a swift kick to the yarbles. I thought I was undergoing torsion of the right testicle because the pain shot up to the inguinal canal, the right lower abdomen, and all the way to the centre of the back where the right kidney is located.

During this 7-month period, I've seen three GPs, four urosurgeons, four emergency room visits, one pain clinic, countless urinalyses, five or six testicular ultrasounds, a CT scan, a MRI scan, and have gone through a bit of hell. I've already come to some conclusions about this condition:

1. Urosurgeons and general surgeons will hesitate to touch this area, and will discourage you from seeking a surgical approach for fear you will come out worse than when you came in. There is a chance, however small, you will regret ever going for surgery and you might think you were better off not touching it at all. Here in the USA, surgeons are even more afraid due to medical liability and lawsuits.

2. The vast majority of GPs, urosurgeons, and other specialists have no clue what went/is wrong. If you're not in their textbook, then you're an anomaly they've never studied, much less seen.

3. The initial approach is to treat this as an infection of the epididymis (i.e., epididymitis), so you'll be given toxic amounts of antibiotics. This is just their initial guess. It's not epididymitis, prostitis, orchitis, urethritis... it's not an infection of anything.

4. Once the specialists have gone through a battery of urine, blood, and imaging tests, and they cannot come up with a correct diagnosis, they will either drop you or send you on a fool's errand looking for more imaging tests to check for hernias and other lumps and intrascrotal growths.

I think you have it nailed  - it's probably the cremaster muscle and the lumbar nerves associated with it. This is something I've read and have discussed with the pain clinic specialist and part of the reason why I was referred to them by a UC Irvine urologist. If a nerve block works in relaxing the right testicle, if at least a little bit, then the next step would probably be denervation with possibly the removal of the cremaster muscle. The urosurgeon warned me that while this may work in finally relaxing the testicle back in place that the numb sensation along the pelvis and near the base of the penis could also drive a guy crazy. Short of removing the testicle, this looks to be the only other permanent solution to this medical problem.

What you've written is so familiar to me, it's almost as if I was reading something I've written before. Ever since this injury, I've not been able to sleep on my sides, sleep on my stomach, walk long distances, bend, crouch, jump, run, ride a bicycle, have sex, and a number of other things. I went from 141 lbs. (64 kg.) to 170 lbs. (77 kg.) in the span of 7 months. I can barely move and any movement of my right leg causes the testicle to rise and twist.

This problem is further compounded by an unrelated injury to my left testicle hahah. I wish I was joking... 

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Wow man, thanks for replying, that sounds pretty hectic and I can certainly feel your pain! its not fun at all having this type of issue, especially in such a sensitive area. I feel as if I am slowly cornering in on the answer but at the same time, far from it. However, i noticed something interesting when I had acupuncture the other day. I had needles in my right adductor (inner thigh) and along the right side of my psoas muscle (trigger points on the belly anteriorly) and also along my abdominal muscles (part of obliques) i noticed that it was all super tight and with the insertion and twisting of the needles i could feel the right testicle jolt and lift up, which I believe is the cremaster msucle spasming, causing this ascension or retraction.
As you probably already know the cremaster muscle contracts and relaxes to alter the temperature for the sperm inside, so when you go for a cold swim, obviously your nuts retract to receive body heat from the body, but when the temperature inside the testicle is too great then the cremaster muscle relaxes allowing the testicle to droop to a lower position away from the body's heat in a comfortable relaxed position catching the cool breeze i oh so long for! The cremaster muscle also contracts when you are alarmed to protect them from damage. So yes, the cremaster muscle exists covering each testicle on their own, so there are two of them, they are connected to and form from your abdominal muscles, I believe it is the internal oblique. Once strained and inflamed, the cremaster will tend to stay that way. (Which is happening to us!) You must get the muscles to relax and get the inflammation down to let them heal (as I am told, from researching) A guy on another forum suggested doing this:

1. Warm baths, twice a day. This will relax the muscles. (good for cremaster and other muscles)

2. Do not ice, as this will cause the muscles to contract. Take an anti-inflammatory (aspirin or ibuprofen) instead.

3. Do not do anything that will put pressure on your testicles:

- Ridding a bike, rowing, etc.
- Sitting straight up: slouch for a while, with your butt on the end of the seat. Do as much standing as you can.
- Resist the urge to check on how the recovery is going. Any touching of sore spots will start a new cycle of pain.
- Wash very gently, and avoid sore spots.

4. Important: sleep on you back, with your legs slightly spread. I've found that sleeping on my side causes pressure on the testicles in their current state, and the next day is painful. If you normally can't fall asleep on your back, use a sleeping aid such as Melatonin (make sure you get a full 8 hours sleep, or you will be groggy the next day).

5. Don't suck in your gut for a few days. Sucking in your gut activates your abdominals, and the Cremaster muscles involuntarily contract.

6. Keep up the regimen, if it works, for a few days after the pain is gone, to ensure that the muscles are healed.

I need to start taking warm baths to test this out. But yes, When I had acupuncture the other day my obliques were very tight and tender and the needles caused more spasming, although not the whole oblique had needles in it, the lateral side did not have any needles. I wish to trial more needles in the lateral portion of the obliques next Wednesday. The needles were inserted more medially to the body, but in 2011 as I mentioned in the first comment, i had a few on the lateral side of my right oblique and it literally relaxed the cremaster muscle which felt AMAZING! couldn't believe the relief, but I have been unable to replicate the same feeling since then, hopefully will next Wednesday. I do a lot of stretching of other muscles such as back and glutes and massaging with a tennis ball and use my weight on it against the ground (cheap massages) this sometimes gives me jolting reactions and relieves the pressure in the testicle but hasn't fixed it or come close. But yes I will have to talk to my sports doctor next Monday to determine the next plan of attack. By the way, When you mentioned you got this injury from laughing, that made me think of the obliques, both external and internal, as they are associated with movement of the body/trunk such as twisting and laughing. Do you have tight or sore abdominal muscles at all? if so maybe get that checked out, I will let you know how I go, but yea maybe its tight muscles putting pressure on nerves im not entirely sure. but perhaps stretch and massage and apply heat. that's all I can offer at this point in time. Look forward to hearing how your pain management is going,
Cheers, Aaron.

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Aaron,

There are differences to my injury, though. The main one is the injury to my left testicle, which is now hanging lower (and is also painful). I have to wear scrotal support 24 hours a day because of this. It looks as if I have the opposite thing going on with the left testicle - hardly any muscle movement and when it is at its most relaxed state, there is an ache above it, which the doctors have not been able to determine either. It's a separate injury unrelated to the right testicle that occurred around the same time. This further compounds my medical problems, as doctors try to treat both as the same thing. Hell, it makes it hard to briefly explain this to any medical staff.

The other difference is that I have what looks and feels like an accumulation of fluid behind and above the right testicle. I don't know if this is the hydrocele the ultrasound imaging picks up or if it's something else altogether. This accumulation of fluid appears to push the testicle forward and up. When the testicle is in that position, it begins to twist sideways and turn horizontally. I took a photo of it to show the doctors at the pain clinic and they were freaked the hell out. The doctor's assistant there keeps referring to it as "torsed." To him, there is no other explanation.

In a couple of weeks, I'm scheduled to possibly go for a nerve block to see if there are any results. After that, I will schedule another consultation with the UC Irvine urologist. Much like yourself, I try to look for specialists or groups that are ranked the best in the nation (UCI's urology group is in the top 50). If nothing pans out from discussing this matter with him, then I'll go to UCLA's Clark Urology group (top 5 in the nation). If nothing comes from that, then I'll pay more for medical insurance and go to Sedars-Sinai or even Johns Hopkins (ranked #1).

I shouldn't get caught up in their ranking too much. I mean, I've already seen specialists at UCI and UCLA - and they both did not say much on the initial visits. The UCLA specialist seemed a bit dismissive. He said the right testicle was "normal" and ignored it while placing emphasis on the left testicle. The UCI specialist said there may be nothing they can do for me, which was disheartening. This is why I'm not too insistant on pursuing a surgical approach (yet); they just didn't seem interested in helping me out.

I don't know if you've read this medical journal article before, but you might glean something from it. The article is called Cremasteric Cramp with Testicular Retraction, written by John A. Baty for the British Medical Journal in... 1956! It's a really old article, nearly 60 years, but it may still be useful for the description and surgical treatment of the symptoms. Again, it beats having the testicle removed altogether, I'd think.

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Its messed up that you can go through tons of forums and see people complain and no Dr. ever seems like they can help us out. It's frustrating. I have a similar problem and have seen Dr's with no solution. There is a tight sensation in the right testi and behind the testi it feels like its retracted. Also, my inguinal area seems like there's a tare or something. I can't even exercise or bend over without feeling it. I'm an athletic person and this is annoying the hell out of me.

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You need to be very specific about your symptoms, esp. if you're describing them to a doctor. "There is a tight sensation in the right testes and behind the testes it feels like it's retracted" means what, exactly? You feel a "tear" on or in the inguinal area? How did it the onset of symptoms come about? When you exercise, what does the right testes do? What sorts of analysis has the GP ordered and what do they say?

I don't mean be descriptive with me, but what you say may lead to more questions. A lot of this, unfortunately, is about watchful waiting. If you insist on a quick solution, the doctors will run you through all sorts of unnecessary tests or even delicate procedures, which may end up doing more harm than good. I've read of guys going through painful cystoscopies, embolisations, denervations, muscle removal, epididymectomies, orchioectomies, etc., only to come out worse.

You need to find an attentive GP who will listen to you and keep track of these symptoms. While you may not get back to 100%, things might improve over time on their own, which is the best case.

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I have a remarkably similar thing going on. Not sure when it started but a few years ago I realized I could not lift my right testicle by squeezing. I actually regained control of it briefly after a 3 hour restorative yoga workshop among other temporary increases in the same area. The day after I went to a kickboxing class and strained an oblique when throwing a kick I have on and off pain from it. Things that have helped me are myofascial release,qi gong, and of course the restorative yoga; however i haven't been able to take a class with that teacher sense. Pretty sure it's an imbalance in the fascia due to a bad habit of making my right psoas hip leg much more responsible than the right throughout my life. ( I'm 26)
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Any updates from your guys problems. I have similar things going on and every doctor and test says normal. If someone can email me so we can discuss what helped. Thanks 

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Hi Aaron

I read ur case and it seems like i have problem. I injured my cremaster or maybe lower oblique muscle in the gym while doing leg raises with weights and my life had been miserable ever since. This happened 5 yrs ago and i have gone to doctors ever since and all they do is prescribe drugs. Also my left testicle is raised up and causing me a lot trouble when i sit or stand. I have done therapy hot bath heating gel acupuncture hot swamp therapy u name it... now soon i am going to see another urologist surgen who seem to be promising... any news on ur case? I will post updates again. I swear if i find a cure to this problem i will write a book on it
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