Expert: Arthur Goldstein, M.D. - 2/3/2005

Question
I have a dull throbbing pain in my right testicle for a few days at a time. It happens whenever its touched or when I close my legs. The pain comes and goes. Should I be worried this is cancer or something else? Why would it hurt that bad for a few days at a time if I havent actually injured it. I appreciate your help.  

Answer
Keith, the most common cause for aching in the testicle(s) in the presence of anatomically normal testicles is an inflammation of the prostate gland, so called prostatitis.  Other symptoms that might occur with prostatitis include frequency of urination, slowing of the urinary stream, burning with voiding or ejaculation, burning in the penile tip unrelated to voiding, sexual dysfunction (such as difficulty with erection), aching in the penis, testicles, and discomfort in the lower abdomen, low back, groin, rectum or perineum (the area between the scrotum and rectum – betwixt the “wind and the rain”).  The prostate is the organ that produces the majority of the semen in response to sexual stimulation. At the time of orgasm, the prostate contracts and forces its fluid into the urethra (urinary canal). Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, aggressive bike or horse back riding, and excessive spicy foods, alcohol, and caffeine in the diet can predispose you to this.  One should avoid any of the above that apply and ejaculate in moderation (about once or twice a week).   Ejaculation beyond the tolerance of the prostate to fill and empty may also cause discomfort.  Likewise if one does so infrequently, fluid still builds up from thoughts, dreams, fantasies, etc. and has to be released periodically to decompress the gland and relieve the symptoms. A daily warm bath for 10-15 minutes also lessens the discomfort.  There are several types of prostatitis.  Sometimes prostatitis can be due to an infection of the gland with bacteria.  This usually requires a 4 week course of an appropriate antibiotic.  Typically, pus cells and bacteria are found in the prostatic fluid.  Abacterial prostatitis has several varieties.  In one, the prostatic fluid demonstrates pus cells but no bacteria.  In the other, called prostadynia, there are neither pus cells nor bacteria in the fluid, just the symptoms.  In all types of prostatitis, the urinalysis generally is normal unless the infection spreads into the bladder.   Abacterial prostatitis usually responds to the general measures mentioned above.  Medications that sometimes help include the over-the-counter natural supplement saw palmetto 320 mgm daily and alpha blockers (such as Flomax, Hytrin & Cardura).  The latter require a prescription from you physician if he thinks it is indicated.  Prostatitis may also be classified as acute (severe), subacute (mild), or asymptomatic.  It may also occur as a single episode,  recurrent or chronic.  Therefore, if symptoms persist or there is any question that you testicles per se are normal, consultation with a urologist should be scheduled.  A man should learn to listen to his body.   Incidently, a tumor of the testicle most often present with a mass that is more often painless than painful.  Good luck!