What is the spermatic cord and why does it become inflamed?
The spermatic cord is a kind of tourniquet that suspends the testicle. It contains the vas deferens, artery and veins of the testicle, lymphatic vessels and nerves, all surrounded by membranes and the muscle that lifts the testicle. The infection usually enters upward from the urethra or prostate and spreads along the duct, so funiculitis is rarely isolated: the appendage and membranes become inflamed nearby. Less commonly, the cause is injury, interventions on the scrotum, or the spread of infection from adjacent tissues.
- Ascending infection from the urethra and prostate
- Associated epididymitis or orchitis
- Sexually transmitted infections
- Complication after vasectomy or groin surgery
- Trauma and hypothermia
- Rarely - tuberculous and parasitic lesions
Symptoms
In the acute form, the pain appears within several hours or days, intensifies with walking and physical activity, and radiates to the groin, lower back and lower abdomen. A thickened, sharply painful cord is felt above the testicle. The skin of the scrotum may become red and swollen, and the body temperature rises. With chronic funiculitis, the pain is dull, aching, intensifies in the evening and after exercise, and the cord remains dense and moderately sensitive. Often there are complaints of a burning sensation when urinating and discharge from the urethra.
- Painful lump above the testicle
- Pain radiating to the groin and lower abdomen
- Swelling and redness of the scrotum
- Temperature rise
- Discomfort when urinating
- Increased pain when walking
Be sure to exclude testicular torsion
The main danger with pain in the scrotum is torsion of the spermatic cord, when the testicle rotates around its axis and blood flow stops. Without surgery, the testicle dies in the first hours. With torsion, pain usually occurs suddenly and very sharply, often at night or after exercise, accompanied by nausea, the testicle is pulled up. With inflammation, the pain increases gradually, often there is fever and signs of a urinary tract infection. Ultrasound with Doppler ultrasound helps to reliably distinguish them, so the examination cannot be postponed “until tomorrow.”
- Torsion is a sudden sharp pain, often in teenagers
- Funiculitis and epididymitis - gradual increase in pain
- When torsion occurs, blood flow on ultrasound is absent or sharply reduced
- Delay in torsion leads to testicular loss
- If there is any acute pain in the scrotum, consult a doctor immediately
Diagnostics
The doctor examines and palpates the scrotum and groin areas, assesses the condition of the prostate. The key study is an ultrasound of the scrotum with Doppler ultrasound: it shows thickening of the cord, the condition of the appendage, the presence of fluid in the membranes and, most importantly, the preservation of blood flow in the testicle. Laboratory tests include a general urinalysis, urine culture, urethral smear for sexually transmitted infections, and a blood test. If an inguinal hernia or hydrocele is suspected, the examination is supplemented.
- Examination by a urologist or andrologist
- Ultrasound of the scrotum with Doppler sonography
- General urine test
- Urine culture
- Urethral swab for STIs
- General blood test
- Ultrasound of the prostate with concomitant prostatitis
Treatment and prevention
The basis of treatment for acute funiculitis is antibacterial therapy, selected taking into account the likely pathogen and the patient’s age, as well as non-steroidal anti-inflammatory drugs. The regime is important: rest, elevated position of the scrotum with the help of supportive underwear, limiting physical activity, avoiding alcohol and avoiding warming up. If the pain is severe, the urologist may perform a spermatic cord block. If funiculitis is associated with a sexually transmitted infection, both partners are treated. The course cannot be interrupted at the first improvement - this is a common reason for the transition to a chronic form.
- Full course of antibiotics as prescribed by a doctor
- Anti-inflammatory and painkillers
- Rest and support garments
- Blockage of the spermatic cord with severe pain
- Treating your partner for STIs
- Treatment of chronic prostatitis
- Avoid hypothermia and groin injuries
