ER or Not: Kicked in the “Love Zone”Feb 13, 2014
It’s probably happened to every guy at least once - getting kicked or hit in the crotch. Sure it hurts when it happens, but does it really damage things? Is there ever a time where it merits a trip to the emergency room? You might be surprised at the answer. Find out from Dr. Troy Madsen on this episode of ER or Not.
Interviewer: Is it bad enough to go to the emergency room, or isn't it? Find out now. This is E.R. or Not on The Scope. If you're a man, it's one of the most painful things that can happen to you, but is it worth going to the E.R. for? It's time for another episode of E.R. or Not with Dr. Troy Madsen from University of Utah Hospital. What happens, Dr. Madsen, if as a man you end up getting kicked in the love zone, so to speak? Or you fall on your bike or something like that?
Dr. Madsen: Yeah.
Interviewer: Is that ever a reason to go to the E.R.?
Dr. Madsen: Absolutely.
Interviewer: Or will it pass?
Dr. Madsen: So, this is one of those things where probably E.R.
Dr. Madsen: Yeah. The big issue that we're talking about here is what's called testicular torsion.
Dr. Madsen: So, if you get kicked or hit, or sometimes just even move the wrong way, what happens is the testicle twists on the vessels that provide the blood supply to it, and once it does that it cuts off the blood supply, and that's the thing that causes that pain to just keep going on. And if that lasts more than four hours, that testicle could die.
Interviewer: I've heard about this.
Dr. Madsen: Yeah.
Interviewer: And some guys just . . .
Dr. Madsen: So, that's a serious thing.
Interviewer: Some guys just say, "Oh, it's no big deal."
Dr. Madsen: Yeah. "Walk it off."
Interviewer: Yeah. And the next thing you know . . .
Dr. Madsen: Yeah. And the next thing you know . . .
Interviewer: It's much more serious.
Dr. Madsen: Yeah. And the next thing you know it can be much more serious because if the testicle dies, then it's dead.
Dr. Madsen: You're not going to be having kids if the other testicle doesn't work as well.
Interviewer: So, is it sustained pain for a half hour? I mean, if the pain's starting to go away, I probably don't need to worry about it so much? Is that how I judge?
Dr. Madsen: Usually, yeah.
Interviewer: Because I don't want to send a whole wave of guys to the E.R. now . . .
Dr. Madsen: Exactly.
Interviewer: . . . when they don't have to.
Dr. Madsen: Yeah. But the problem I've seen oftentimes is a lot of guys wait too long.
Dr. Madsen: And most of the cases I've seen of this, the guys have waited too long and the testicle's already dead or there's no blood flow there at all. So, obviously you have to use your judgment, and if it were me, yeah I'd give it, say 30 minutes or so. See how things are going. But, if that pain just was not getting any better, if I was noticing more swelling there, I would err on the side of going to the E.R. And what we're going to do there is certainly examine the patient.
Typically, pretty much always we're going to get an ultra sound to look and just see are we seeing blood flow down to the testicle itself? And, if everything's okay, great. We say, "Yeah, it's bruised. It's going to hurt. Give it a few days. Try some ibuprofen." If not, then it's a sort of thing where we need to get that fixed, and usually that means getting our urologist in there, going to the operating room, getting that untwisted and making sure it's got blood flow there so everything's okay.
Interviewer: Have you seen cases of this?
Dr. Madsen: I have.
Interviewer: You have.
Dr. Madsen: I've seen several cases of it. Yeah. I mean, it's something that absolutely happens. Most of the cases I have seen have been after some sort of trauma. But, sometimes some guys just say, "Yeah, it just started hurting." You know, they say, "Maybe I moved the wrong way or something," which is a little scary. And I don't know, maybe if there was more to the story than what they were telling me. But, I've certainly seen several cases of it and it's something as a man that you have to be aware of.
Interviewer: So, other than that, are there other injuries that can occur from that happening?
Dr. Madsen: Yeah. You know, there are. And the other one we see is, let's say you're kicked or you're hit or something like that, the other one that's actually really serious also, is a urethral tear. Now, that's the tube that goes from the bladder and takes your urine out. If that gets torn, if that gets ripped as part of that trauma, that can be really serious too. The big thing you look for there is if you urinate and you see blood in it.
Dr. Madsen: Very serious.
Interviewer: All right.
Dr. Madsen: Also, another reason to come to the E.R. We'll get it scanned just to take a look. Make sure there's no sign of any tears there, anything like that. But, if there are tears, again, often time it's something that requires an operation.
Interviewer: Take away message?
Dr. Madsen: Take away message. Number one: try not to get kicked in the love zone.
Interviewer: Yeah, sure. That's a good call.
Dr. Madsen: Yeah. Number two: if you're in a sporting event, something like that, where you can wear some sort of protection like a cup or something, wear it, if it's recommended. And then, number three, if this sort of thing does happen to you, if you're having a lot of pain in the testicle, blood when you urinate, those are things to come to the E.R. for.
Interviewer: We're your daily dose of science, conversation and medicine. This is The Scope, University of Utah health sciences radio.