Gonadal Pain in Males. Gonadal Pain in Females

Gonadal Pain in Males

In males with lower abdominal pain, the scrotum and its contents must be examined. Testicular torsion is a surgical emergency and must be treated within 6 hours of the onset of the pain to save the testicle.
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Testicular torsion may present as lower abdominal pain, which may be associated with recent trauma or cold The gonad is tender and elevated in the scrotum, with a transverse orientation. Although testicular torsion may occur at any age, it usually occurs in adolescent males at puberty or shortly afterwards. It may occur in neonates. If the scrotum is empty, then torsion of a testicle located in the groin or in the abdomen should be ruled out. Torsion of undescended testicles occurs more frequent than in normally descended ones.

Torsion of an appendix testis may cause testicular pain, which occasionally be visualized as a “blue dot” beneath the scrotal surface on the testicle, associated with point tenderness. This disorder requires only analgesics and bedrest.
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Laboratory Studies.

Ultrasound can sometimes help to localize an intraabdominal torsion. Doppler US may distinguish torsion (testes without blood flow) from epididymitis (where blood flow is normal or increased).

Gonadal Pain in Females

The leading causes of gonadal pain in females are ovarian cysts and torsion of uterine adnexal structures. Ovarian tumors are often associated with precocious puberty or virilization.

Ovarian cysts are responsible for 25% of childhood ovarian tumors. They are most common in adolescents. Bleeding into the cyst or cystic rupture causes pain, which usually subsides within 12-24 hours.

An ultrasound, performed after a cyst ruptures, may show pelvic fluid and the cyst.
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Surgery is required if bleeding is uncontrolled. Growing cysts >5 cm should be considered for surgical enucleation.

Torsion of Uterine Adnexal Structures

Torsion is associated with unilateral, sudden, severe pain with nausea and vomiting. However, the patient may have subacute or chronic symptoms, with intermittent pain for days. The pain is usually diffuse and periumbilical in younger patients, but in older children and adolescents, the pain may radiate initially to the anterior thigh or ipsilateral groin. Torsion is more commonly right-sided.

Fever and leucocytosis are usually present. Physical exam may reveal muscle rigidity and fixation of the mass on pelvic examination.
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Ultrasound will identify the mass accurately.

Surgical exploration may sometimes salvage the ovary. Malignant neoplasms may cause torsion in 35% of cases.

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