I Did 500 Sit-Ups and Now Have Testicular Pain!

Abdominal Tension, a common cause of testicular pain

Disclaimer: The title of this blog does not represent an actual comment made by a patient (that I know of), but how else was I supposed to get your attention!!

Truth: Tension within the abdominal muscles and the associated fascial tissues CAN indeed be a contributing factor to testicular pain.

Read on to find out how!

During fetal development, the testes descend from the back wall of the abdomen, near the location of the kidneys.  They drop through the abdomen and eventually settle within the scrotum. Below is a visual depicting the abdominal layers surrounding the testes in their final resting location (highlighted regions).

Testicular PainTension within these layers, at any level, can lead to tension, pulling, and ultimately pain surrounding the testes as well. Think of a knot or “pull” in a shirt, as shown in the second image.

As you can see, tension isn’t only located at the swirl created. It spreads away from the swirl into each shoulder and lower corner of the shirt, even pulling the edge of the shirt closer to the midline. In order to relieve all areas of pull and tension, the “swirl” needs to be released. The same is true with the fascial and connective tissues of the body. Hence, tension within the abdominal region can contribute to testicular tension and pain symptoms.

Look at the swirl pattern

Other Causes of Testicular Pain:

  • Nerve irritation following a vasectomy or other surgical procedure: Scar tissue or a granuloma could place pressure on the nerves supplying the testes and contribute to pain.
  • Testicular Retraction: Activation of the cremaster reflex causes the testicles to retract up into the groin region. The cremaster reflex can be stimulated by rubbing a nerve on the inner thigh and by emotion, such as fear and laughter. The cremaster is also activated by a cold environment. (https://www.mayoclinic.org/diseases-conditions/retractile-testicle/symptoms-causes/syc-20377197)
  • Stress: The pudendal nerve, responsible for innervation of the skin and skeletal muscles of the perineal region (including the penis, scrotum and external sphincters) has an autonomic function that allows for control of continence, perspiration, and sexual function. The autonomic system is also responsive to stress. Therefore, increased stress can lead to pain flare-ups.
  • Surrounding muscles/tissues: Along with the abdominals, tension in iliacus, psoas, and obturator internus (deep hip muscles) can lead to irritation of the pudendal nerve and associated pain symptoms. Tension within the adductors (inner thigh muscles) can lead to irritation of the ilioinguinal and genitofemoral nerves (two other nerves supplying the testes).

As you can see, testicular pain can stem from many different regions. Not all causes are discussed above, though many that I’ve mentioned can actually be treated by a pelvic health physical therapist with specific training in the anatomy and physiology of the above-mentioned structures.

If you have been medically screened for your testicular pain and have been unable to determine a cause, consider seeing a physical therapist for further assessment and treatment.

The answer may be easier than you think!

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