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COVID-19 Can Literally Be a Pain in the Balls

It’s uncommon and under-studied, but some men are reporting testicular pain as a COVID-19 symptom

At this point, it seems like just about any possible symptom could be linked to COVID-19. Brain fog? Check. Inability to taste? Check. Pain in your testicles? Yup, check. 

The latter is relatively uncommon, but the connection is there: In one study, nearly 11 percent of testicle-owning patients with COVID-19 reported testicular pain. 

Testicular pain has been reported as an “unusual presentation” of COVID since July, but there’s been little data to assess how often it occurs. In October, a study published in the International Journal of Clinical Practice observed 91 male patients with COVID-19 and found that 10.98 percent experienced testicular pain. Only one patient, however, displayed epididymo-orchitis, or inflammation of the testicles. Overall, testicular pain was most common among people who were hospitalized. But other than the presence of testicular pain in this group, the researchers found few correlated symptoms or similarities between the patients and their health history. 

As such, there’s still a lot we don’t understand about testicular pain and COVID. However, it’s not entirely unusual for viruses and infections to cause genital swelling or pain, particularly in childhood cases of mumps or rubella. 

More recently, researchers at the University of Miami published data in the World Journal of Men’s Health assessing whether COVID might infect testicles in the same way as mumps. To do so, the researchers performed autopsies on a small pool of patients who died from COVID, as well as biopsies on recovered patients, and tested their testicular tissue. Around half of the biopsies demonstrated impaired spermatogenesis, or the process through which sperm develop from germ cells. COVID-19 was also found in the tissue of one autopsy and one biopsy, the former of which also demonstrated other signs of cellular infection. 

Most interestingly, though, more than half of the patients displayed increased levels of ACE-2 receptors. This is something that was discussed early in the pandemic, with the idea being that coronavirus could be “stored” in the testicles. It’s thought, then, that COVID-19’s tendency to be expressed in these receptors in the testicles could be responsible for some of the testicle-related symptoms. 

Right now, the whole testicle-COVID correlation is still somewhat of a mystery. We don’t know who it will impact or why. In severe cases where inflammation is also present, it may even hinder one’s fertility. Still, the studies that have been conducted on the topic have utilized such small sample sizes that it’s difficult to know the true odds of it impacting the average person. In one case, though, testicular pain was the only symptom a patient had of COVID-19. 

If you do have testicular pain, regardless of cause, it’s probably a good idea to check with your doctor. 

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