Acute genital pain

Genital areas, especially the male’s penis and testicles, can experience pain for many reasons. However, genital pain can sometimes be caused something serious that needs to be urgently checked by a doctor.

Testicular torsion

Testicular torsion is an emergency where there is twisting of the spermatic cord that attaches the testicles to the body. It can happen without warning and cuts off regular blood supply. Testicular torsion requires immediate attention.

Signs and symptoms

• Sudden severe pain and swelling of the scrotum, which may also only be felt in the abdomen, groin or thigh.
• Swelling or colour changes (red or blue) in the scrotum.
• Nausea and vomiting.

What causes testicular torsion

Testicular torsion commonly occurs in males during puberty, but it’s possible to occur at younger ages. In these children the testes lie more sideways and can twist after strenuous exercise, during sleep or after an injury to the scrotum.

Diagnosis

Testicular torsion is often diagnosed on examination if your child comes to the emergency with the relevant symptoms. In extreme situations, an ultrasound of the scrotum can be done at the request of the paediatric surgeon. However, this is rarely done as it can cause unnecessary delays.

A urine sample is usually collected in children with abdominal pain to rule out other causes.

Treatment

If torsion is present, your child must fast and have pain relief while awaiting urgent surgery (within 6 hours) to restore blood supply to the testes. The affected testicle may risk death if the surgery is not completed in this time frame.

Inguinal hernia

An inguinal hernia is a bulge in the groin region from issues in the abdominal wall. It can occur in both males and females, but they are 6 times more common in boys and mostly in very young boys. If the blood supply to the bowel within the lump gets cut off it can be very painful and quickly becomes a medical emergency and requires urgent medical attention.

Signs and symptoms

• Painless scrotal swelling in boys, which is more noticeable when your child is crying or straining.
• Soft and smooth swelling in the groin area.
• Swelling that disappears or reduces in size if your child is lying flat and is relaxed.

When an inguinal hernia becomes ‘strangulated’, which means it’s stuck and unable to be pushed back in, this is a medical emergency and can cause:

• severe pain
• nausea and vomiting
• bloating or full abdomen
• swelling that does not change in size when your child is crying.

What causes inguinal hernias

Inguinal hernias are due to a weakness in the muscles of the abdomen and so the bowel can poke through and cause a lump. Excessive straining can also increase the chance of an inguinal hernia (for example, straining on the toilet or frequent coughing).

Diagnosis

Inguinal hernias can be diagnosed on examination if your child comes to the hospital with the relevant symptoms. An ultrasound of the scrotum may be performed if the diagnosis is not clear during their examination. A urine sample is sometimes collected to rule out other causes.

Treatment

If the hernia isn’t strangled, your child will need a non-urgent surgery to repair the weakness in their abdominal wall. They will be referred to the surgical outpatient department to be booked in for a surgery.

If the hernia is strangulated, or if your child is an infant, they will need urgent surgery to repair the weakness in the abdominal wall and restore blood supply to their bowel.

Balanitis

Balanitis refers to pain, swelling and inflammation of the foreskin and head of the penis.

Signs and symptoms

• Pain at the tip of the penis while peeing.
• Red glans (the head or tip of the penis).
• White discharge around the glans.

What causes balanitis

Balanitis is typically due to the chemical irritation, trauma or overgrowth of bacteria. It’s common and can be due to irritation from:

• wet nappies
• soap or bubble bath
• retraction of a tight foreskin.

Treatment

Most of the time balanitis can be treated and prevented by at home by avoiding triggers and taking care of the genital area:

• Take warm water baths with a handful of salt in it (called sitz baths).
• Never forcibly retract the foreskin for cleaning.
• Take oral pain relief (paracetamol or ibuprofen).
• Sometimes applying 1% hydrocortisone cream.
• Apply antifungal cream if it looks like candida (fungal infection) is the cause.
• Oral antibiotics may be needed if redness spreads up the shaft of the penis.

Topical antibiotics are not recommended.

When to seek help

See your doctor if your child:

• has a penis/scrotum that appears red and swollen OR blue or black
• becomes distressed when passing urine
• has discharge or pus from the penis
• has severe pain in the genital area
• has scrotal swelling.

In an emergency, always call Triple Zero (000) immediately. Otherwise, visit the emergency department of your nearest hospital. For less urgent medical advice, call 13 HEALTH (13 43 25 84) 24/7 to talk to a registered nurse who can advise on the best course of action.