Maybe it’s because of a stray football — a little Sunday romp in the park gone wrong, and now you’re laying in the fetal position, face in the grass. Or it could have been a bike seat. Maybe you just sat down wrong, anywhere, it doesn’t really matter. But most likely, it was a sack tap.
Men hurt their testicles because the testicles are very easy to hurt. Technically called testes, these oval-shaped male sex glands are housed in a fibrous outer covering and located in a sack of skin outside of the body called the scrotum. The right side is usually higher than the left and they produce testosterone and sperm, which is where the whole “family jewels” thing comes in.
But that’s Testicles 101. I don’t have testicles but I’ve heard that the pain is much worse than say a stubbed toe or childbirth, the latter which just isn’t true.
I spoke with a very nice and game urologist named Dr. Nathan Starke to figure out why it hurts to get hit in the testicles. He works at Houston Methodist Hospital and tells me “I talk about balls all day long” — so didn’t mind the questions.
Why It Hurts to Get Hit in the Testicles (Balls)
“At it’s most basic level, you feel pain because of receptors and nerves,” says Starke. “And the reason, from an evolutionary standpoint, why it hurts so much to get hit in the testicles is that they are the key to producing sperm.”
Pain comes from nerve signals and the nerves of the testicles aren’t protected by any large muscles, fat, or bone.
The sensitive structure of the testicle is much more likely to hurt upon impact than a flaccid penis because the penis doesn’t need to be as sensitive as the testicles. A flaccid penis, says Starke, “is just sort of like a slab of meat.” While “it’s evolutionarily favorable to have very sensitive testicles, so much so that you’re very invested in protecting them.”
Why Do You Have Unexplained Testicle Pain?
Sometimes Starke will see patients who have chronic, unexplained testicular pain — there’s no problem with the blood flow, there’s no tumor; they simply can’t find any explanation for the pain. And the theory is that this unexplained pain is related to unnecessary or incorrect nerve signals which say there’s a problem with the testicle when there really isn’t. When Starke performs surgery on patients who need that pain to stop, he preserves the important blood and sperm-carrying parts of the testicles and cuts the nerves. That may sound gnarly, but for 85 percent of people who receive the surgery, the pain stops.
But Why Is Testicle Pain Just So Much Worse?
Talking to my male coworkers, they brought up a “horrible moment of grace” that comes with a ball-hit.
Starke says that the pain of a ball-hit isn’t like the pain of a prick of a knife because there are different types of pain nerves. There’s one nerve fiber that carries a fast pain signal — that’s the pain you feel after a cut — and that alerts you that there’s something wrong. And then there are low pain signals: The pain signal is slowly transmitted across nerve fibers, creating a more excruciating sense of pain. That’s more of what happens when you break your finger, it doesn’t hurt immediately but soon there’s a crazy throb.
“Slow pain is designed to really hurt you so you remember it,” says Starke. “It engrains in you — this is what happens when you hit your balls.”
Why Does Getting Hit in the Balls Hurt Your Stomach?
A kick to the testicles typically means a cramping of the stomach. That’s because the two regions are connected: When a fetus is in utero, the testes lie close to the kidneys. And at about it’s seventh month of life, they begin to descend through the abdominal wall at the groin and enter the scrotum.
“They are almost like ovaries when they start out,” says Starke. “But then they move slowly out of the body, into the scrotum — but all of the blood vessels and nerve supply comes from higher up where they originated in the abdomen.”
That means that the pain signals felt in the testicles are transmitted up towards their embryological origin — and because the slow pain fibers take longer, the pain that shoots up towards the abdomen feels like an ache.
And contrary to rumors, unless the testicles didn’t develop and descend properly, they can’t go back up into the abdomen. The testicle is attached to the body via the spermatic cord and this so-called “ring” is closed. You can’t push it back in. Around the spermatic cord is a smooth and thin layer called the cremaster muscle, and it’s why it might feel like the balls will rise and never return
“As every guy knows, when you get into cold water your testicles will rise up and get closer to your body,” says Starke. “That’s because of the cremaster muscle — it moves closer to the body when it’s too cold. With an injury, you can potentially have a spasm of this muscle too and will make it rise up, but it can’t rise up back into the body.”
Why are Testicles Outside the Body?
It all comes back to sperm. According to a 2007 paper published in Reproductive Biology Endocrinology it’s believed that the testicular descent into a scrotum evolved in mammals more than 150 million years ago. The reason why, it’s believed, was to keep the sperm within the testicles cool: When it comes to humans, scrotal temperatures are about two to three degrees Celsius cooler than the overall body temperature.
Starke says that it’s pretty much agreed upon that the testicles are out there to keep your sperm at a specific temperature — heat, it’s established, can kill sperm count or just simply cause the sperm to become less fertile.
How Long Do Testicle Injuries Hurt and What Can You Do to Make it Better?
According to a different 2007 paper — a big year for ball study — called “Testicular Rupture: A Tough Nut to Crack,” giving one-size-fits-all advice to guys whose testicles hurt is tricky because of the varying circumstances of how the balls were hit. But Starke says the pain that the majority of men experience will “create the sting and sort of achy feeling in your abdomen” then go away. Meanwhile “a minor finger flick to the ball will hurt for a minute or two.”
The general piece of advice for treating more low-key testicular pain is taking a non-steroidal anti-inflammatory drug like aspirin or ibuprofen. These inhibit pain, but more importantly, decrease inflammation — which is more important for stopping long-term, chronic pain. He advises that you can also treat your balls like a rolled ankle because applying heat or cold can numb or mask the pain sensation.
If there’s a ton of swelling or a significant change in the testicle, then maybe it’s time to see a doctor. Really bad injuries can cause a testicular rupture — that’s more like if someone hunts you down and hits you with a baseball bat. That pain can persist, and typically you need surgery to fix it.
But hopefully that’s not what’s happened to you and why you googled “why do my balls hurt”! It’s more likely you’re suffering from your body caring too much about protecting your testicles.