Men are always just one misstep away from groin pain. Even if they manage to avoid serious injury, some aches and pains just come with the territory. It's important for a man to know which types of pain can be shrugged off and which require medical attention.
Pulled groin muscle (adductor strain)
Groin injuries are common among athletes, especially soccer players. One common type of injury is a "pulled groin muscle," which doctors would call an adductor strain. Soccer players may be at higher risk for adductor strains because of their constant stop-and-go movements and the long strides they take. The pain may grow gradually, and you may not be able to point to the moment when the trouble started. Eventually, the muscle becomes very painful when it moves or is pressed against.
When your groin muscle starts limiting your game, you should see a doctor. X-rays or ultrasounds may be needed to make sure you don't have a fracture, tear, or more serious condition. You'll need to take at least several weeks off from sports to give your groin a chance to heal. Your doctor or physical therapist can suggest stretches and exercises to help strengthen the muscle and speed your recovery. In the meantime, rest and ice may help ease the pain.
If you notice a small bulge in your groin area, there's a good chance you're looking at an inguinal hernia, a common condition that occurs when part of an internal organ -- usually the intestine -- breaks through the abdominal wall and starts intruding into the space that holds the spermatic cord. The bulge can also move into your scrotum (the skin pouch containing the testicles, below the penis). This is what doctors look for when they ask you to turn your head and cough during a checkup.
Inguinal hernias can occur when there is a weakness in the abdominal wall or groin muscles. Some men are born with this weakness. In others it can develop over time due to excessive weight loss or gain, persistent coughing or sneezing, or straining while using the bathroom.
This type of hernia usually doesn't hurt much, although you might feel some pain when sneezing, coughing, or lifting. For some people, this pain is the only sign of trouble. If the pain becomes severe -- and if the bulge doesn't disappear when you lie down -- a section of the intestine may be pinched. If so, you'll probably suffer nausea and vomiting, and you won't be able to have a bowel movement. This is an emergency situation: Without prompt surgery, your life could be at risk.
Most inguinal hernias aren't dangerous. While they can often be managed by wearing a supportive belt (also called a truss) and avoiding heavy lifting, men generally opt to have corrective surgery to keep the intestines where they belong.
Trauma to the testicles
Every man has a story about a game of catch or a wrestling match that went seriously wrong. It goes without saying that any blow to the testicles will be very painful. If the pain goes away within an hour and there are no other symptoms, it's safe to chalk it up to a lesson learned. But if you're still in serious pain one hour or more after the trauma, you need to see a doctor immediately. There's a chance that the testicle has become twisted, choking off the flow of blood. This is called testicular torsion, and it's an emergency. If you don't get help within six hours, there's a good chance you'll lose your testicle.
In some cases, you'll know right away that you need medical help. Any trauma that breaks through the scrotal sac is an obvious emergency. According to the American Urological Association, you should also get prompt treatment if you develop swelling, bruising, or fever after a trauma to the testicles. A doctor will perform a physical examination -- possibly including an ultrasound -- to check for injuries. If nothing has been damaged, you can get by with painkillers and, for extra protection and support during recovery, a jockstrap. More serious cases may require surgery.
Epididymitis: A common cause of pain and swelling
Sometimes testicular pain seems to come out of nowhere. Even if you haven't had an injury, one of your testicles may start gradually aching and swelling. This is often the first sign of epididymitis, a bacterial infection in the tubes that store sperm. The pain may spread to your lower back or side, and it may hurt when you urinate. Some men may also have fever or a milky discharge.
Several different kinds of bacteria can cause epididymitis. You might have caught the germs during sex, or they may be bacteria that have spread from the urinary tract. No mater how it starts, epididymitis is easily treated with oral antibiotics. So don't put up with that achy feeling. Make an urgent appointment with your family doctor or urologist. With the right medication, you'll feel much better within a few days. If the symptoms don't get better or if they return, see your doctor promptly.
Other causes of scrotal pain and swelling
There are a few other, less common causes of pain or swelling in a testicle. The testicle itself can become inflamed, a complication of an infection from a bacteria or a virus. This condition, called orchitis, may follow a viral illness such as the mumps. In fact, about one in three males who get the mumps after puberty will develop orchitis in one or both testicles. Treatment for bacterial orchitis is similar to the treatment for epididymitis. A short course of antibiotics should clear up the problem. If a viral infection is to blame, the only treatment is time. The pain will fade and the swelling will recede. In some cases, the testicle may end up smaller than it was to begin with.
If fluid builds up around a testicle, it can start swelling. It is usually painless, even when it grows rather large. This fluid accumulation is called a hydrocele (HI-dro-seel), and it is generally harmless. Hydroceles usually occur in men over age 40 who have experienced injury or infection in the scrotum or who have had radiation therapy. If the scrotum grows large enough to cause discomfort, the hydrocele may have to be surgically removed.
In cases where surgery is especially risky, a needle may be used to remove the fluid instead.
A kidney stone can also cause pain in the groin if it moves into the urinary tract. In addition to pain in the groin, you may feel nausea or the need to vomit. Men are twice as likely as women to form kidney stones. Call your doctor immediately if you have any of these symptoms.
Should I be worried about testicular cancer?
Whenever you notice any changes in your testicles, it's only natural to wonder about cancer. While cancer is much less common than epididymitis and other testicular problems, it's always wise to know the symptoms. The most common sign of testicular cancer is a painless lump. Less often, the testicle may swell. There may be a heavy or achy feeling in the scrotum or the lower abdomen, but severe pain is rare. If you're concerned about testicular cancer, see your doctor.
American Urological Association. Testicular trauma. 2008. http://www.urologyhealth.org/
American Cancer Society. Do I have testicular cancer? 2008. http://www.cancer.org/
Morelli, V. and V. Smith. Groin injuries in athletes. American Family Physician. October 15, 2001. 64: 1405-1414. http://www.aafp.org/
Ringdahl, E. and L. Teague. Testicular torsion. American Family Physician. November 15, 2006. 74: 1739-1743.
Cleveland Clinic. Inguinal hernia. 2005. http://www.clevelandclinic.org/health/health-info/docs/1800/1809.asp?index=8099
Inguinal Hernia. Penn State Milton S. Hershey Medical Center College of Medicine. http://www.hmc.psu.edu/healthinfo/i/inguinalhernia.htm
Epididymitis. Sexually Transmitted Diseases Treatment Guidelines 2006. Centers for Disease Control and Prevention. http://www.cdc.gov/std/Treatment/2006/epididymitis.htm
Top Five Soccer Injuries. University of Pittsburgh School of Medicine. http://sportsmedicine.upmc.com/MySportSoccerTop5.htm
Parmar, M.S. Kidney Stones. BMJ 2004;328:1420-1424 (12 June), doi:10.1136/bmj.328.7453.1420 http://bmj.bmjjournals.com/cgi/content/full/328/7453/1420