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Q: Cold Testicles ( Answered,   5 Comments )
Subject: Cold Testicles
Category: Health > Conditions and Diseases
Asked by: duiker-ga
List Price: $50.00
Posted: 02 Jan 2006 15:53 PST
Expires: 01 Feb 2006 15:53 PST
Question ID: 428186
I am a 31 year old male. When I was 19 I had a right hydrocele
operation. Cause unknown. Over the past 12 years or so I have always
had occasional discomfort in the right testicle. Recently I've been
experiencing extreme cold in my testicles and penis, and pain in my
right testicle and also a pinching feeling in my scrotum. They are so
cold I have to put a heating pad on my groin to alleviate the pain.
Underwear is very uncomfotable as is sitting. My doctor has no idea
what to make of it. I've had an ultrasound which came back normal and
a urine test, also normal. I'm going in for a sperm analysis but have
little hope of finding anything. I've also noticed some minor burning
when I pee and occasional shooting pain in my penis. It almost feels
like there is fluid moving in the scrotum but there is no sign of
swellling. I've been all over the internet and have found nothing on

Request for Question Clarification by umiat-ga on 02 Jan 2006 23:15 PST
This is all I have found so far - have you seen this forum thread? It
doesn't offer an answer, but at least you are not alone in this!
Subject: Re: Cold Testicles
Answered By: crabcakes-ga on 04 Jan 2006 01:26 PST
Hello Duiker,

    I have listed numerous possible causes of your coldness,pain, and
pinching feelings. While none actually directly list coldness as a
symptom, different people experience different symptoms. A feeling of
cold, anywhere in the body, can suggest poor circulation, and/or nerve
damage. Are you a smoker? Smoking can aggravate and cause poor
circulation. Have you been tested for diabetes? Did your doctor order
a PSA test (screening test for prostate cancer)?

?The annual examination includes a digital rectal examination and PSA
blood test. Both are accomplished quickly with little or not
discomfort. While most problems can successfully be treated, cancer of
the prostate can only be cured it if is detected very early, at a time
before any symptoms have developed.?

From umiat-ga?s posted site, notice the man took Viagra to stop his
cold problem. Viagra allows more blood to reach and stay in the
genital area,  meaning you could be suffering from circulatory
problems. (I do not recommend taking Viagra, until the cause of your
problem is diagnosed however!)

?An erection is a complex process that involves many steps from the
brain to the penis and its blood supply via the spinal cord and nerves
- all of which can be affected in diabetes.?

?Sometimes I have shooting pains in my penis and anus. Is something
wrong or is this normal?

We can?t give you a specific answer without a lot more information
about the location, duration and nature of the pains you experience.
Possible causes range from constipation to kidney or bladder problems
to sexually transmitted infections, if you are sexually active."

Have you been tested for STDs?

?Fifty per cent of patients notice prodromal symptoms (early warning
signs of an impending attack) before recurrent lesions occur. These
include itching, tingling, pins and needles, numbness, burning and
shooting pains in the buttocks, thighs, penis, scrotum or even the
feet. These prodromal symptoms are due to irritation as the Herpes
simplex virus travels up or down the sensory nerve axons.?

?Primary pathologic processes within the penis that can result in pain
include urethritis, urethral foreign bodies, priapism, Peyronie's
disease, trauma, paraphimosis, and external dermatologic conditions
and/or insect bites (for example ant and spider bites). Primary
processes involving areas adjacent to the organ that result in penile
pain include prostatitis and scrotal disorders (such as testicular
torsion, epididymitis, and orchitis). Pain experienced in a flaccid
penis typically is the result of inflammation caused by sexually
transmitted diseases or balanoposthitis, whereas pain in an erect
penis is usually due to priapism or Peyronie's disease. Paraphimosis
and balanitis should be considered in the differential diagnosis of
penile pain in men who are uncircumcised.?

?Penile pain is associated with testicular torsion, blunt/straddle
injury (penile trauma or penile fracture), penetrating injury, and the
relatively under-diagnosed conditions of male genital pain syndrome,5
reflex sympathetic dystrophy,6 and painful male urethral syndrome.7
Patients with direct inguinal hernia,8 pudendal neuralgia,9,10 and
pain disorder associated with psychological factors11,12 may also
experience penile pain.?

   One possibility is another hydrocele! Also possible is scar tissue
from your previous surgery pressing on a nerve or blood vessel.

?A hydrocele is a fluid collection that surrounds the testicle.?

?A hydrocele is an accumulation of fluid in any sac-like cavity or
duct - specifically in the tunica vaginalis testis or along the
spermatic cord. The condition is caused by inflammation of the
epididymis or testis or by lymphatic or venous obstruction of the
cord. The term hydrocele literally means a sac of water.?

?What complications can occur from the surgery?
Because the patent processus is close to the spermatic cord these structures
can be damaged but this is rare (well less than 1 in 100). If this were to occur
the testicle may not grow properly (if the blood supply was damaged) or be
infertile (if the vas deferens which carries the sperm from the testicle was
damaged, sometimes the testicle can get caught in scar tissue and pulled
back into the groin (less than 1 in 100). Recurrence of the hydrocele is rare.?

?Hydrocele, a common intrinsic scrotal mass, results from excessive
accumulation of sterile fluid within the tunica vaginalis due to
overproduction (inflammation of the testis and its appendages) or
diminished resorption (lymphatic or venous obstruction in the cord or
retroperitoneal space). Usually, it appears as a painless scrotal
swelling that can be transilluminated. Some men have pain or
discomfort from its mass effect. There are no signs of inflammation in
most cases; however, inflammatory hydrocele with epididymitis may be
painful. Hydrocele may be congenital. Treatment of persistent,
symptomatic hydrocele is surgical (hydrocelectomy). Aspiration is a
temporary measure, but aspiration with injection of sclerotic drugs
may produce resolution. Aspiration poses the risk of secondary


   Another  possibility is a varicocele. (Not all patients feel the
same symptoms, and some patients are more sensitive than others.)
?A varicocele occurs when the valves within the veins along the
spermatic cord don't work properly. The abnormal valves prevent normal
blood flow and cause blood to backup, which dilates and enlarges the
veins. (This is essentially the same process as varicose veins, which
are common in the legs.)
Varicoceles usually develop slowly and may not have any symptoms. They
are more common in men between 15 and 25 years old. Varicoceles are
more common on the left side. Varicoceles are often the cause of
infertility in men.
The sudden appearance of a varicocele in an older man may be caused by
a kidney tumor that has affected the renal vein and altered the blood
flow through the spermatic vein.?

?A groin strain is always a possibility. Another consideration would
be a groin hernia. To test this, a hernia test would have to be done
by your physician.

Imaging tests to consider would be a pelvic CT scan or groin ultrasound.?

?To further test the innervation of the penis, I would also consider a
neurology referral. Electrodiagnostic testing can determine the
patency of the nerve structure and may be an explaination for your

Followup with your personal physician is essential.?

?The veins of the spermatic cord are known as the pampiniform plexus.
These veins drain blood from the testes, epididymis, and vas deferens,
eventually becoming the spermatic veins that drain into the main
circulation at the level of the kidneys. The pampiniform plexus of
veins may at some time become tortuous and dilated, much like a
varicose vein of the leg. In fact, a scrotal varicocele is simply a
varicose enlargement of the pampiniform plexus around the above
testicle. There are two other vein "the cremasteric and deferential"
that also drain the testicles. These veins are rarely involved in the
varicocele process.
The varicocele is a well-recognized cause of decreased testicular
function and is present in about 40% of infertile males. In order to
understand the significance of this abnormality in the infertile
patient, a brief review of the historical background, current concepts
of its anatomy and function, and methods and results of surgical
repair must be considered.?\

?A varicocele is an irregularly swollen or varicose vein on the
testicle. There are valves that keep the blood going in the right
direction in the veins. Sometimes those valves weaken or don't work
correctly and the blood backs up. When that happens the blood can
collect and become congested and clogged. This enlarged vein produces
a higher temperature than is normal for testicles, and - over a period
of years - can lower the number of normal sperm as a result.?

?This is a swelling of the epididymis. The epidiymis is located on the
backside of each testicle that serves as a storage point for sperm.
Swelling can be caused by infection or by harmless cysts. The National
Institute of Child Health and Human Development (NICHD) says that
cysts in the epidiymis are the most common abnormality in sons of
women who took DES, a drug used to prevent miscarriages during the
middle of the 20th century. They can come and go for no reason at all.
NICHD says they do not need to be treated unless they are painful.
Swelling caused by bacteria can be the result of a sexually
transmitted disease (Read about "STD's") or from other infections.
This needs to be treated, often with antibiotics. (Read about

?Chlamydia is the most common STD causing epididymitis in young men.
You should wait for your doctor to tell you your culture is clear
before resuming intercourse.?

?A spermatocele is a benign cystic accumulation of sperm often found
in the head of the epididymis that usually presents as a smooth, firm,
well-circumscribed mass of the scrotum. Spermatoceles are considered
in the differential diagnosis of any scrotal mass and must be
differentiated from hydroceles, varicoceles, epididymal cysts, and
other scrotal masses.
Spermatoceles are typically found in the region of the epididymis,
which lies on the posterior lateral border of the testis. Location can
be helpful when differentiating spermatoceles from other scrotal
masses, including hydroceles and varicoceles. Hydroceles refer to
fluid collections that surround the entire testicle, rather than
collections localized to a specific intrascrotal structure.
Varicoceles are a dilated system of veins along the spermatic cord and
are typically described as feeling like a ?bag of worms? on physical
examination. Varicoceles, unlike spermatoceles, can enlarge during
times of increased abdominal pressure (eg, Valsalva maneuver). In
contrast, spermatoceles do not fluctuate in size upon provocative
maneuvers. Epididymal cysts are often very difficult to differentiate
from spermatoceles, and definitive differentiation depends on
aspiration of the cystic fluid. If sperm is present, the cystic mass
is a spermatocele. If no sperm is present, the mass is probably an
epididymal cyst.?

?Many men are entirely asymptomatic and notice the spermatocele
incidentally on self-examination, or a physician discovers it on a
routine physical examination. Spermatoceles are typically located
superior and posterior to the testis in the area of the epididymis.
They are frequently painless and usually less than 1 cm in diameter.
Spermatoceles are round, firm, and cystic with distinct borders. They
also transilluminate well, which allows this cystic fluid-filled
lesion to be differentiated from more ominous solid lesions. Most
spermatoceles are associated with no other anatomic or medical
abnormalities. Occasionally, they may cause discomfort or become large
enough to warrant intervention, which is primarily surgical. Needle
aspiration of a spermatocele should not be performed because it leads
to infection, spillage of very irritating sperm within the scrotum,
and reaccumulation of the spermatocele.?


?	Scrotal swelling 
?	Tender, swollen, heavy feeling in the testicle 
?	Tender, swollen groin area on affected side 
?	Fever 
?	Discharge from penis 
?	Pain with urination (dysuria) 
?	Pain with intercourse or ejaculation 
?	Groin pain 
?	Testicle pain aggravated by bowel movement or straining 
?	Blood in the semen

Inguinal hernia
?Inguinal hernia may extend into the scrotal compartment. It must be
differentiated from hydrocele and hematocele. With an inguinal hernia,
the cord is not palpable above the mass, whereas with a hydrocele or
hematocele, normal cord structures usually are palpable above the
mass. The mass can often be reduced when the patient lies down. By
definition, a congenital inguinal hernia includes a hydrocele
(persistent processus vaginalis). Surgery is recommended because of
the probability of progression and possibilities of incarceration and

Testicular Cancer

?Signs and Symptoms
In the early stages, testicular cancer may have no symptoms. When
there are symptoms, they include:
?	Small, painless lump in a testicle. 
?	Enlarged testicle. 
?	Feeling of heaviness in the testicle or groin. 
?	Pain in the testicle. 
?	A change in the way the testicle feels. 
?	Enlarged male breasts and nipples. 
?	Blood or fluid that accumulates suddenly in the scrotum. 
Testicular cancer is curable 90 to 95 percent of the time if found and
treated early.?

?	?Enlargement of a testicle or a change in the way it feels 
?	Lump or swelling in either testicle 
?	Dull ache in the back or lower abdomen 
?	Gynecomastia (excessive development of male breast tissue), this can
also occur normally in adolescent males, in whom it is not a symptom
of testicular cancer
?	Testicular discomfort/pain or a feeling of heaviness in the scrotum 
?	Occasionally, the initial symptoms are related to the spread of the
cancer to other parts of the body, such as the lungs, abdomen, pelvis,
or brain


?Prostatitis is the most common genitourinary ailment in men younger
than age 50, but the bacterial form occurs most often in men age 70
and older. If left untreated, infection can spread to the testicles
and epididymis (tubules in back of the testis) and, in severe cases,
destroy the prostate gland.?

Various and unlikely causes:
Testicular Torsion

?Torsion is a twisting of the spermatic cord upon itself that results
in obstruction of the blood vessels supplying the testis and
epididymis. It is usually the result of anomalous suspension of the
testes within the scrotum. Torsion is more common in children, but
accounts for 20% of acute scrotal pathology in post-pubertal males.
Testicular torsion and acute epididymitis or epididymo-orchitis are
the most common causes of an acute scrotal pain. Differentiating
between these entities is often difficult on physical examination and
testicular sonography with pulsed and color Doppler examination is
helpful in this regard. On sonography, the torsed testicle is usually
enlarged and hypoechoic compared with the contralateral normal
testicle, and may contain echogenic areas representing hemorrhage.
Common extra-testicular findings include an enlarged epididymis, skin
thickening and reactive hydrocele formation. The gray-scale findings
are not specific and may also be seen in epididymo-orchitis. However,
decreased or absent blood flow within the testicle on Doppler
examination indicates acute torsion.?

?In early epididymitis, the epididymis exhibits tenderness and
induration, but the testis itself is not tender. Swelling to the
degree that the epididymis is no longer palpable can indicate torsion
if the symptoms have been present for only a few hours. With both
appendiceal torsion and epididymitis, loss of testicular landmarks
occurs later in the clinical course.?

?Poor circulation, specifically poor blood flow to the penile arteries
due to hardening and narrowing of the arteries (arteriosclerosis), or
thickening of the blood, can cause impotence.?

?How do I carry out a self-examination?
We recommend this is done after a warm shower or bath when the scrotal
skin relaxes. Support the scrotum in the palm of your hand and become
familiar with the size and weight of each testicle. Examine each
testicle by rolling it between your fingers and thumb. Gently feel for
lumps, swellings, or changes in firmness. Remember each testicle has
an epididymis at the top which carries sperm to the penis. Don?t panic
if you feel this ? it?s normal.?

You may find these answers interesting:

    Groin strain, pinched nerves, bicycle riding, medications you are
taking (particularly anti-depressants), drinking, smoking,
psychological problems, scar tissue from previous surgeries, or injury
are other possible sources of your problem. A good urologist should be
able to determine the cause of your chilly genitalia.

Please see a good urologist, and if unhappy with your current
physician, look for one who will work with you.  Please remember, the
above is for informational purposes  only and is  not to serve as a

If any part of my answer is unclear, please request an Answer
Clarification. I will be happy to assist you further, before you rate
this answer.

Sincerely, Crabcakes

Search Terms

penis + testicles + poor circulation
circulatory problems + testicles
shooting pain + penis
feeling of cold + testicles
feeling of cold + penis
numbness + testicles + penis
chilly testicles
testicular +  penile disorders
Subject: Re: Cold Testicles
From: cynthia-ga on 03 Jan 2006 00:01 PST
At this point, you need a specialist, not a regular MD. 

We can't diagnosis you online... But you can go here:

The Urology Channel - Ask a Question (free)

...and ask a Board Certified Urologist your question. They will give
you advice  and recommend a course of action.
Subject: Re: Cold Testicles
From: cynthia-ga on 03 Jan 2006 00:02 PST
I just noticed it's now $25.00 !!  It used to be free --Sorry!
Subject: Re: Cold Testicles
From: duiker-ga on 03 Jan 2006 13:39 PST
Thanks umiat, I had already seen that thread. It is my firm belief
that this is somehow related to my hydrocele operation as most of the
discomfort is focused on the right side where I had the operation.
Subject: Re: Cold Testicles
From: hardtofindbooks-ga on 14 Jan 2006 00:54 PST

Given that the symptoms possibly include episodic neuralgia and with
the pain distribution and the history of previous inguinal surgery, a
very good possibility not mentioned is ilioinguinal neuralgia.


"The ilioinguinal nerve originates from the L1-2 nerve roots and is
similar in course and function to the intercostal nerves (figure 4).
It innervates the lowest portions of the transversus abdominis and
internal oblique muscles, as well as the skin overlying the inguinal

It transmits sensation from the base of the penis and scrotum (or
labium major) along with part of the medial thigh. Direct trauma,
intense abdominal muscle training, or inflammatory conditions can lead
to entrapment of this nerve as it passes through or close to the
abdominal muscle layers. Ilioinguinal nerve entrapment is a
well-established cause of chronic inguinal pain in patients who have
had lower abdominal surgery (eg, appendectomy or inguinal
herniorrhaphy) (5).

Patients will describe a burning or shooting pain in the distribution
of the nerve. Light-touch sensation in the inguinal area may be
altered, and pain may be exacerbated by hyperextension of the hip.
Tenderness may be localized near the anterior superior iliac spine
where the ilioinguinal nerve pierces the fascia. The diagnosis can be
confirmed by a blockade of the nerve with local anesthetics.

Treatment consists of repeated infiltrations at the confirmed site
with anesthetics and/or corticosteroids. Nerve ablation may be
indicated in severe cases.

Subject: Re: Cold Testicles
From: claudiompas-ga on 04 May 2006 02:06 PDT
Acquired or Adult Hydroceles
Acquired or adult hydroceles are usually idiopathic but may be
secondary to tumor, infection, or systemic disease. An imbalance
in fluid secretion and absorption by the tunica vaginalis has been
suggested as a possible cause. Treatment is generally indicated to
allow easy palpation of the testis or because of symptomatic dis-
comfort or disfigurement. Simple needle aspiration is an effec-
tive temporal-)' treatment; however, the hydrocele will often
recur. Injection of a sclerosing solution after aspiration can be
successful in coapting the visceral and parietal layers of the tuni-
ca vaginalis and preventing reaccumulation of fluid. A mixture of
250 mg tetracycline diluted in 5 ml 0.5% bupivacaine (Marcaine)
is often effective and minimizes the pain that accompanies injec-
tion. Sclerosing therapy is contraindicated with a patent proces-
sus vaginalis or an associated hernia. Definitive therapy is surgi-
cal drainage and excision of tunica vaginalis.  After surgery, less
than 1 percent of cases have a hydrocele return.

Do you have a history of Diabetes?  Can a recurrent hydrocele reoccupy
a region with nerve involvement secondary to a concominant infection? 

Ref: Urology: Dr Macfarlane- p 45

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