Perineal pain, genital pain, lower abdominal pain
Groin pain is tenderness/irritation in the area where the abdomen is ending and the legs start. Groin pain is more common in men than women.
1. Inflammation of the epididymis (epididymitis)
It usually begins as inflammation in the vas deferens which spreads to the lower pole of the testis. The testicle may become swollen or inflamed. The most common cause for this condition for men under the age of 35 is gonorrhea. Other causes are non-sexually transmitted diseases, for example. E coli or tuberculosis. The pain is of gradual onset and the epididymis (testis) may swell to three times its normal size in three to four hours. Patients may also present with a fever and the contents of the scrotum may become warm and very tender.
If you experience the above symptoms, you should consult your doctor immediately, to start the correct treatment and to have the necessary blood tests done, as well as an ultrasound of the testis itself.
2. Superficial skin infection
This may present as swelling and redness of a part of the skin in the groin area. It will be tender and warm to the touch and may look like a pimple. You can treat this at home with topical antibiotic cream, as well as non-steroidal anti-inflammatories. You should consult your doctor if the condition persists after five days or worsens.
3. Testicular torsion
Testicular torsion is the sudden onset of pain in the scrotum. The pain may alternately be located in the lower part of the abdomen or groin area. Onset of pain may occur after exertion or during deep sleep. The patient may be vomiting and experience nausea in association of the scrotum pain. It usually presents with a swollen, firm and very tender testis. The testis can also be high-riding.
It is very important that you consult your doctor immediately. This condition will be treated with an operation, stabilising the testis inside the scrotum, in order to save the testis.
4. Inflammation of the testicle (orchitis)
The most common cause of orchitis is a viral infection, such as mumps, and resolves spontaneously within one to four weeks. A less common cause is a bacterial infection. In bacterial infections, the patient may become very ill and feverish. Pain can travel into the groin area. Associated nausea and vomiting can occur. Scrotal skin becomes warm, red and swollen and very painful.
In the case of mumps, it is not necessary to treat the orchitis. Symptoms can be alleviated by using anti-inflammatory medication. Severe orchitis (due to bacterial infection) needs to be treated by a doctor with the necessary antibiotics.
5. Muscle pull
6. Testicular tumour (Leydig cell tumour)
7. Kidney stone
Kidney stones are mineralised stones present in the renal system. When the stone passes into ureter, it is called ureterolithiasis. The majority of stones are calcium oxalate or calcium phosphate. Other stones can be magnesium ammonium, uric acid or cysteine stones.
Kidney stones present with the acute onset of colicky abdominal pain that starts at the flank and radiates to the groin, scrotum or labia. It is often associated with nausea and vomiting.
It cannot be treated at home and you should immediately consult your doctor, in order for him/her to do an abdominal CT scan, to assess if the stone can be passed through the urinary tract or if it will have to be removed surgically.
Hernia is a soft, spongy swelling in the groin area that can protrude through to the scrotum. This condition is usually painless but torsion of the hernia can lead to severe pain that needs to be attended to by your doctor immediately. A hernia is treated with surgery to remove the hernia itself.
9. Enlarged lymph glands (lymphadenitis)
Pre-disposing factors of lymphadenitis are trauma to the groin area, obstruction of normal drainage, chemical irritation, haematoma (formation of a blood clot) and foreign bodies. The process usually begins as a cellulitis (infection of the skin), which leads to necrosis (dead skin formation) and loculation of pus and the forming of an abscess, as well as lymphatic spread, i.e. lymphadenitis.
Upon inspection, the groin area will appear red, tender, warm and swollen. The patient can also be systemically ill and can present with symptoms of mild fever and malaise.
You have to consult your doctor immediately to have the correct diagnosis made and to commence with the correct treatment.
Written by Dr Anrich Burger, MB ChB (Stell)