This article reviews the anatomy and physiology of the scrotum and its contents as it pertains to chronic scrotal pain. Physiology of chronic pain is reviewed, as well as the pathophysiology involved in the development of chronic pain. The scrotum is a pigmented external sac of skin and muscle that physically protects and facilitates temperature regulation of the testes to ensure optimal spermatogenesis. It is formed from fusion of the left and right labioscrotal folds, and has a septum that separates the two halves Figure 1. The layers of the scrotum are continuation of the abdominal wall layers Table 1.
The spermatic cord contains a bundle of nerves, blood vessels, lymphatic vessels, Sensitive part of the scrotum the vas deferens. Superficial left and deep right venous drainage of scrotal contents. Labioscrotal folds. The growth and function of the prostate gland depends on the male sex hormone testosterone, which is produced in the scrrotum. Pathophysiology of chronic scrotal pain The pathophysiology of chronic scrotal pain is complicated, multifactorial, and not well understood. Be careful though, your man might also be against crossing that lineso proceed slowly and read his reactions. Namespaces Pary Talk.
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National Institutes of Health. The anus is made up of a cone of muscle that has two draw-string Sensitivee circular muscles. Electronic Code of Federal Regulations. This Escort services in bejing does not have an Arabic version. It should be required reading for all men, young and old. Genital branch Sensitive part of the scrotum genitofemoral nerve. Perineum The perineum is the pleasantly sensitive skin between the base of the scrotum and the anus. Accessed Feb. The coronal ridge is the Sensitive part of the scrotum of flesh that circles the penis and connects the head of the penis to the shaft. Women, do not be afraid of an uncut guys penis. Human sexuality portal Biology portal.
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- One testis is typically lower than the other to avoid compression in the event of impact.
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- Testicle pain has a number of possible causes.
This article reviews the anatomy and physiology of the scrotum and its contents as it pertains to chronic scrotal pain. Physiology of chronic pain is reviewed, as well as the pathophysiology involved in the development of chronic pain.
The scrotum is a pigmented external sac of skin and muscle that physically protects and facilitates temperature regulation of the testes to ensure optimal spermatogenesis. It is formed from fusion of the left and right labioscrotal folds, and has a septum that separates the two halves Figure 1. The layers of the scrotum are continuation of the abdominal wall layers Table 1.
The testis, epididymis, and spermatic cord are housed within the scrotum. Other than being attached to the base of the scrotum by the gubernaculum to prevent torsion, the testes are free to move around. The epididymis has three parts—head, body and tail. Only the epididymal head is fixed to the upper part of the testis; relationship of the body and tail to the testis is often variable Figure 2. Blood and nerve supply for the epididymis and testis are generally found on the posterior side 1.
The spermatic cord is a connective tissue matrix that contains the vas deferens, three arteries, three veins, lymphatics, and two nerves. A third nerve, the ilioinguinal, lies just lateral to the cord Table 2.
Relationship of the testis to the epididymis. The scrotum is well supplied with blood from both the internal and external iliac arteries and has rich interconnected anastomoses. Anterior scrotum is supplied by the anterior scrotal artery, a branch of the deep external pudendal artery from external iliac. Posterior scrotum is supplied by the posterior scrotal artery, a branch of the internal pudendal artery from internal iliac.
Main source of blood to the testis is via the testicular artery also known as the internal spermatic artery , which arises from the aorta. Artery of the vas deferens deferential artery branches from the internal iliac artery. Cremasteric artery comes from the external iliac artery via inferior epigastric artery. Due to the rich inter-connected anastomoses amongst the arteries that supply blood to the scrotum and its contents Figure 3 , even the division of the spermatic cord will likely only cause testicular atrophy, and not gangrene 2.
Rich interconnected blood supply to the scrotal contents: I posterior scrotal artery; II testicular artery; III deferential artery; IV cremasteric artery; V anterior scrotal artery. Athens: P. The scrotum has both a superficial and deep venous network Figure 4. Superficial left and deep right venous drainage of scrotal contents. Left gonadal vein drains into the renal artery and right gonadal vein drains into IVC at a different angle , the distinction being significant for higher prevalence of left-sided varicoceles.
The deep network consists of an aggregate of 10—12 small veins that drain the testis and epididymis, called the pampiniform plexus, which coalesce to become the gonadal vein, emptying into the renal vein on the left or the inferior vena cava IVC on the right.
Deferential vein empties into the pelvic plexus, and cremasteric vein drains into the inferior epigastric vein 3. These pathways are not absolute; there is a significant amount of inter-individual variation with venous drainage. Lymph from the skin, scrotal layers, and tunica vaginalis drains into the superficial then deep inguinal lymph nodes. Lymph from testes and epididymis drains into the retroperitoneum along a defined path, due to the migration route of the testes during development.
The somatic supply to the testes and scrotum originates from the L1—L2 and S2—4 nerve roots through the iliohypogastric, ilioinguinal, genitofemoral, and pudendal nerves Figure 5 4. The iliohypogastric nerve provides sensory innervation to skin above the pubis. The ilioinguinal nerve innervates skin of the inner thigh, penile base, and upper scrotum.
The genitofemoral nerve divides into genital and femoral branch after passing through the psoas muscle. The femoral branch provides sensory innervation to a small area of skin on the inside of the thigh and the genital branch travels with the spermatic cord to provide innervation to the cremaster muscle, as well as the tunica vaginalis 5.
Somatic and autonomic nerves supplying the scrotal contents. Not shown is pudendal nerve, which arises from S2—4, whose branches provide somatic supply to posterior scrotum. In: Waldman SD. Pain Management, Philadelphia: Elsevier, Somatic innervation to the scrotum varies based on the specific scrotal region.
The anterolateral surface is supplied by genital branch of the genitofemoral nerve. Anterior surface is supplied by the anterior scrotal nerves branching from ilioinguinal nerve. Posterior surface is supplied by posterior scrotal nerves from perineal nerve, branch of pudendal nerve , and the inferior surface is supplied by the long scrotal branches of posterior femoral cutaneous nerve 1. The testes are embryologically derived from the same level as the kidneys.
Three groups of autonomic nerves travel with the gonadal vessels and vas deferens to the epididymis and testis—superior spermatic nerves, middle spermatic nerves, and inferior spermatic nerves Figure 5. Superior spermatic nerves, composed of fibers from the renal and intermesenteric plexuses follow the testicular artery to the testis.
Middle spermatic nerves arise from the superior hypogastric plexus, pass to the mid-ureter and travel alongside the vas deferens to the internal ring, where they join the spermatic cord. The ureteral proximity may explain pain radiation to the scrotum of an obstructing ureteral stone. Inferior spermatic nerves originate from the pelvic plexus inferior hypogastric plexus , and join the middle spermatic nerves at the prostate-vesical junction.
Some afferent and efferent fibers decussate to the contralateral pelvic plexus, which may explain how lesions in one testis affect the function of the other testis 6. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
There are three types of pain: I nociceptive—refers to direct stimulation of the nociceptors in response to noxious insult or tissue injury examples include musculoskeletal pain, skin pain, or pain from distension of hollow organs such as a full bladder. It can be perceived as tingling, burning and hypersensitivity to pain; III inflammatory—caused by release of mediators released at the site of tissue inflammation such as rheumatoid arthritis.
Any pain persisting after three months is typically classified as chronic 7. How a stimulus turns into pain is shown in Figure 6. The stimulus first activates nociceptors, which are free nerve endings found in both somatic and visceral tissues. The signal then ascends via the spinal cord to the thalamus. From here, the signals are relayed to multiple areas of the brain including the somatosensory cortex, the insula, frontal lobes and limbic system 7.
Neural pathway for pain. Some of the brainstem nuclei send descending impulses to the dorsal horn that causes inhibition of nociception. Prior to ascending to the thalamus, some signals branch to various brainstem nuclei. Certain antidepressants such as the tricyclics and selective norepinephrine reuptake inhibitors SNRIs enhance descending inhibition, providing a mechanism for their role in alleviating neuropathic pain.
Multiple areas of the brain are involved; there is no one location where awareness of pain occurs. The pathophysiology of chronic scrotal pain is complicated, multifactorial, and not well understood. Many patients recall their chronic pain starting after an injury to the scrotum or testes. Altered or hyperactivated nerve sensation in and around the spermatic cord is considered a major factor in promoting chronic orchalgia.
A potential mechanism for this hypersensitivity is Wallerian degeneration, characterized by auto destructive change in the axon after injury that normally promotes regrowth and healing. A heightened immune cell response initiated by neutrophils and macrophages causes inflammation surrounding the nerves which may then lead to neural hypersensitivity. Parekattil and colleagues found a high density of nerves in the spermatic cord with Wallerian degeneration in patients with chronic orchalgia, supporting this hypothesis 8.
This hypersensitivity manifests itself as allodynia perception of pain from a normally non-painful stimulus or hyperalgesia exaggerated response than what would be typically expected.
Hyperalgesia and allodynia occur from sensitization in either the peripheral or central nervous systems.
These changes are termed neural plasticity and can result in perception of pain even months after the injury has healed 9. Back pain may radiate to the testicle due to sensory nerve root irritation T10—L1. Inguinal hernias may stretch the genitofemoral and ilioinguinal nerves causing discomfort in the scrotum and testes. Pain arising in the ureter, hip, the presence of aortic aneurysm, intervertebral disc prolapse, or pudendal neuropathies can also cause chronic testicular pain.
Pain which is generated by some change within the scrotum itself usually stimulates somatic as well as autonomic fibers and is therefore accurately localized to the scrotum Some authors have also suggested that chronic orchalgia might be part of a larger behavioral syndrome that begins with a painful episode that is then reinforced either internally or externally and provides secondary gain to the patient.
Some of these reinforcements include emotional relief, attention from family and friends, time off work, obtaining pain medications, and socialization with the physician. Once the behavior is reinforced, it occurs in the absence of a noxious stimulus The scrotum, testes, epididymis and vas deferens have a rich inter-connected vascular supply.
The iliohypogastric, ilioinguinal, genitofemoral, and pudendal nerves provide innervation and are involved in chronic scrotal pain. The pain pathway starts with nociceptor triggering, transduction via the peripheral nervous system, transmission to the central nervous system via the dorsal root ganglion through the thalamus and to various regions of the brain. Descending modulation through the brainstem serves to inhibit some of the nociceptive pain signals. Neural plasticity after injury may result in abnormal sensitization of nociceptors and ultimately chronic pain.
Conflicts of Interest: The author has no conflicts of interest to declare. National Center for Biotechnology Information , U. Journal List Transl Androl Urol v. Transl Androl Urol. Abhishek P. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Correspondence to: Abhishek P. Patel, MD. Email: moc. Received May 19; Accepted May Copyright Translational Andrology and Urology. All rights reserved. This article has been cited by other articles in PMC.
Abstract This article reviews the anatomy and physiology of the scrotum and its contents as it pertains to chronic scrotal pain.
Hugh Tyndale-Biscoe Human Reproductive Biology. Seminal vesicles excretory duct Prostate Urethral crest Seminal colliculus Prostatic utricle Ejaculatory duct Prostatic sinus Prostatic ducts Bulbourethral glands. A single copy of these materials may be reprinted for noncommercial personal use only. New Scientist. The foreskin protects the glans! The analogous organ in a woman is her clitoris.
Sensitive part of the scrotum. Appointments at Mayo Clinic
Everything You Need to Know About Playing with Testicles
Typically, males have two testes. The testes are contained within the scrotal sac , located beneath the penis and in front of the anus. They are round in shape and tend to be about the same size as golf balls. Testicles are attached to the body via the spermatic cords, which are cord-like tissue structures formed by the vas deferens that run to each testicle. The spermatic cords carry the sperm from the testicle, to the vas deferens, and towards the prostate where they exit via the urethra.
Testes, also called testicles, are the male reproductive organs responsible for producing sperm. Sperm are the cells that hold the male genetic makeup necessary for reproduction. Testosterone is important for creating and maintaining male physical traits during and after puberty and for spermatogenesis.
The testes grow drastically during puberty , which occurs from the ages of 11 to Both testes are usually of similar size, but it is normal for one to be slightly larger than the other. However, if one testicle is much bigger than the other and is painful, that might be a sign of testicular torsion.
Testes have the ability to regulate their temperature. This is crucial because the temperature within the testicles has to be within a specific range in order for them to produce viable sperm at an optimal level. In order to effectively regulate its temperature, the testes control how close or far away they are to the body. For example, the testes tend to drop lower in hotter temperatures in an attempt to cool down, and vice versa in colder weather.
Testicles also lower during intense exercise as the internal body temperature rises, and they need to keep cool. Seminiferous tubules are thin, tightly coiled tubes that are found in great numbers within the testicles. They are the site of germination , maturation , and transportation of sperm within the testicles. The epididymis is a thin, extremely convoluted tubular structure that is attached to the top and back surface of each testicle to produce and store sperm.
The spermatic cord contains a bundle of nerves, blood vessels, lymphatic vessels, and the vas deferens. Each testis has one spermatic cord that connects it to the rest of the body. The spermatic cord also contains the cremaster muscle, which contracts to pull the testicles closer to the body in cold temperatures and during sexual arousal.
The muscle also facilitates the passage of semen, which travels from the vas deferens , through the testicles, to the urethra. Issues with the function of the spermatic cord may result in an inability to develop and maintain an erection. The two vasa deferentia are long, slender tubes that carry sperm up from the epididymis and into the ejaculatory ducts.
The tubes loop around the side of the bladder and terminate near the seminal vesicle. Each vas deferens transports mature sperm from the epididymis to the ejaculatory ducts, like the urethra, for ejaculation.
During a vasectomy , the two vasa deferentia are severed as a form of male sterilization. The testes have a high concentration of nerves on the scrotal skin surrounding them, causing them to be very sensitive. The scrotum, otherwise known as the scrotal sac, contains and protects the testicles.
The scrotum is divided into two sections by a fold in the skin that separates the two testes. The scrotum controls the movement of the testes in order to regulate their temperature to ensure optimal sperm production.
Testicles are very sensitive to injury. Since the testicles are located in the scrotum , a sack of skin that is located outside of the body and hangs down under the penis, their location allows for testicular accidents to occur relatively often.
Because the testes play such a crucial role in sperm production and male reproductive abilities, they have many nerve endings responsible for alerting the nervous system of possible danger or impact to the testes. Blunt trauma does not generally cause any permanent damage to the scrotum or testes, but may cause temporary back and abdominal pain. On the other hand, injuries that cut or pierce the scrotum or testicles can have long-lasting effects that can result in sterilization.
Rupture, fracture, development of a contusion, torsion , hematoceles, or dislocation are some testicular injuries that can lead to castration or sterility. Several health issues may occur with your testicles. Some are genetic or medical issues that you cannot control; however, others can be prevented, such as injuries. Although testicular cancer is relatively rare and highly treatable, it is important that males know how to give themselves a self-examination to check for lumps that may indicate the development of a tumor.
Any sign of lumps, redness, pain, or other changes or discomfort should be immediately presented to a doctor for further consultation. In the case that one has testicular cancer, treatments such as surgery, radiation, and chemotherapy may result in infertility. Testicular torsion occurs when the spermatic cord that provides blood flow to the testicle rotates and becomes twisted. This is usually caused by an injury or medical condition.
The lack of blood flow causes severe pain and swelling. The treatment for testicular torsion is immediate surgery, as waiting too long could lead to permanent damage to the affected testis. Epididymitis is the inflammation of the epididymis as a result of a viral or bacterial infection, such as gonorrhea or chlamydia.
It is marked by severe scrotum pain and swelling that may be warm to the touch. The safest way to prevent against epididymitis is to practice safe sex that prevents the spread of sexually transmitted infections STIs.
If you think you may have epididymitis, it is best to consult a doctor and get a urine test to check for an STI. These infections are easily treated with antibiotics. In addition, painkillers may help ease the pain and inflammation. Once treated, there are usually no permanent effects.
Hydrocele is another noncancerous testicle health issue that is a result of injury to the testicle. It is noted by a swelling of the scrotum as fluid builds up around the testicles. It usually goes untreated unless the swelling becomes uncomfortable or unbearable to manage. Treatment usually consists of draining the fluid with a syringe.
Lastly, one can develop a varicocele , which is a varicose vein within the testicle. A variocele is recognized by swelling and fertility problems. Varicocele is not preventable and can be caused by a damaged valve in the vein that drains blood from the testicles. Varicoceles usually go untreated with only the aid of supportive underwear; however, if one has fertility issues , the doctor may recommend surgical options to try to restore fertility.
The scrotum and testes can be a highly erogenous zone for men. The testicles are very sensitive, but when touched in the right way, the experience can be very pleasurable for males. One technique to stimulate the scrotum is to cup the scrotum with a hand and gently move the fingers. Doing so can also be very enjoyable when combined with oral sex so the penis and the testes are stimulated simultaneously.
The testicles can be a great erogenous zone for many males, so remember to start off slow, communicate , and enjoy! Since testicles are so sensitive, it is extremely important to take proper precautions when it comes to protecting them. The testes are unique organs, that play a apart in both procreation and pleasure. Skip to main content. The Testes. References Taylor, Tim. Utiger, M. Robert D. Encyclopedia Britannica. Healthline Medical Team.
Spermatic Cord. LeVay, Simon, Janice I. Baldwin, and John D. Discovering Human Sexuality. Sunderland, MA: Sinauer Associates, Heathline Medical Team.
Last Updated: 10 November Male Reproductive System. Vas Deferens. Prostate Gland. Testicular Cancer. Was this article helpful to you? All Rights Reserved.