Clinical Focus
6 DECEMBER 2024 ausdoc . com . au
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Case Report
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Source : AusDoc website ; 25 Oct to 27 Nov .
An older patient complains of new discomfort during sex , which he attributes to a retractile testicle .
Dr Ryan Holmes ( top ) GP in Bondi Junction , Sydney .
Priyanka Pinto ( bottom ) Medical student at the University of Notre Dame , Sydney .
Eric , a 75-year-old male , presents with pain during intercourse . He has a lifelong history of a retractile right testicle , and is experiencing new discomfort due to blunt trauma to the testis during the thrusting of intercourse .
This discomfort is causing such disruption that he has resorted to tying a rubber band around the scrotum during intercourse to keep the testis located in the scrotal sac .
The retractile testis has been present for as long as Eric can remember . It doesn ’ t cause any pain at rest and can be easily reduced down into the scrotum from the groin .
He has no dysuria or lower urinary tract symptoms . He denies a history of significant erectile dysfunction or ejaculatory problems . There is no testicular discomfort apart from that associated with intercourse .
His medical history includes IBS , osteoporosis , lumbar back pain , facet joint arthritis , previous BCC and GORD . His regular medications are denosumab , esomeprazole , meloxicam PRN and sildenafil PRN .
He has no personal or family history of prostate disease .
On examination , he has normal external genitalia . The right testis is palpable in the groin but can be easily reduced into the scrotal sac without causing discomfort . There are normal secondary sexual characteristics .
Eric is referred for an ultrasound of the testis which shows a normal right-sided testis measuring 2.5 x 1.7 x 3.5cm with homogenous echotexture and no masses .
Both testes have small epididymal head cysts , with no other abnormal findings , including no hydrocoele or varicocele . There is normal blood flow to the testis on ultrasound .
Discussion
A retractile testis , whereby a heightened cremasteric muscle reflex causes the testicle to be located anywhere between the scrotum and the groin , is relatively common . This typically benign phenomenon is often identified during childhood and adolescence . The condition frequently resolves on its own , but can persist into adulthood . 1-3
Persistent retractile testis may remain asymptomatic . However , associated clinical
features may develop , including orchialgia , sexual discomfort , psychological distress and cosmetic concerns .
On examination , the testis may be found either in the scrotum or retracted into the groin , and can be manipulated manually
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