What is the reason for testicular pain after a long erection?

Testicular pain after a long erection may be related to prostate congestion, varicocele, epididymitis, testicular torsion or chronic pelvic pain syndrome.

1. Prostate congestion

Prolonged erection will cause continued congestion of the prostate, compressing peripheral nerves and causing referred pain. It manifests as testicular swelling and pain accompanied by a swollen feeling in the perineum, and the symptoms may be relieved after urination. It is recommended to avoid sitting for long periods of time or holding in urine. Sitz bathing with warm water can help relieve symptoms. If you need to seek medical treatment to rule out chronic prostatitis if the recurrence occurs, the doctor may prescribe drugs such as tamsulosin sustained-release capsules or celecoxib capsules.

2. Varicocele

When venous return is blocked, erection will aggravate scrotal venous congestion. Dull pain in the left testicle is common, aggravated by standing for a long time or after sexual excitement, and vermiform varicose veins can be seen on the surface of the scrotum. Mild cases can be improved by scrotal support, while severe cases require high spermatic vein ligation. After diagnosis, the doctor may recommend taking Maizhiling tablets or diosmin tablets to improve venous function.

3. Epididymitis

Bacterial retrograde infection can cause swelling and pain in the epididymis, and stretching during erection can aggravate the discomfort. It is often accompanied by frequent urination and urgency, and the skin of the scrotum becomes red and hot. In the acute stage, bed rest and ibuprofen sustained-release capsules are required for analgesia. Doctors usually choose antibiotics such as levofloxacin tablets or cefixime dispersible tablets based on drug sensitivity results.

4. Testicular torsion

Sudden severe testicular pain accompanied by nausea and vomiting requires alertness to this emergency. An erection may induce cremaster muscle spasm. The pain often radiates to the groin, and the testicles move upward into a transverse position. The golden period for surgical reduction is within 6 hours of the onset of symptoms. Delayed treatment may lead to testicular necrosis. Orchidopexy must be performed immediately after diagnosis.

5. Chronic pelvic pain

Long-term pelvic floor muscle tension can cause referred testicular pain, and muscle contraction during erection aggravates the symptoms. It may be combined with abnormal urination or sexual dysfunction, and pelvic floor electromyography can assist in diagnosis. Rehabilitation treatment includes biofeedback training and neuromodulation drugs such as gabapentin capsules. In severe cases, sacral neuromodulation may need to be considered.

It is recommended to wear loose cotton underwear to avoid local compression and wash the perineum with warm water every day. Avoid riding bicycles or sitting for long periods of time, and urinate promptly after sexual activity to flush the urethra. If the pain lasts for more than 2 hours or is accompanied by fever, hematuria and other symptoms, you should see a urology department immediately. Zinc and vitamin E can be appropriately supplemented daily, but relevant dietary supplements need to be used under the guidance of a doctor.