Your testicles are sensitive, and even minor pressure or injury can lead to discomfort. Enter bike seat-induced testicular pain. That's right — your rides could potentially be the source of those unwelcome aches.
Your testicles can be easily injured because of their location — they hang down outside your body, inside your scrotum, which makes them vulnerable to injury from a blow or crushing pressure, according to the American Urological Association (AUA).
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"One way that you can injure your testicles is by cycling or bike riding," says Ryan Berglund, MD, a urology specialist at the Cleveland Clinic. "Long-distance cyclists and mountain bikers are at higher risk than recreational riders."
Indeed, testicular pain after a workout can be one of the side effects of cycling for people assigned male at birth (AMAB). Here are some common reasons why the activity can lead to symptoms like pain, swelling or tingling in your testicles, plus what to do about it.
If you have sudden severe pain or if your painful or numb testicles are accompanied by fever, chill, nausea or blood in your urine, get medical care immediately. This could be a sign of a serious condition called testicular torsion (more on that later), according to the Mayo Clinic.
1. Nerve Irritation
Ever wonder why your balls feel squished or start throbbing while you're on your bicycle? Well, the pressure from your bike seat could be the reason why your balls are tingling or you experience sore testicles after a ride.
"The number one cause of pain felt in the testicles after cycling is nerve pain," says Dr. Berglund. "The pain comes from irritation of the pudendal nerve that goes to the scrotum, rather than injury to the testicle itself. This type of pain is more common in long-distance riders due to the riding position and the saddle."
Indeed, a tingling sensation in your testicles can be the result of over-compressing the area, which can contribute to increased irritation of and reduced blood flow to the pudendal nerve, according to Ochsner Health. The potential end result: You can't feel your balls.
This type of pain and numbness or tingling in the scrotum and groin area is called "cyclist's syndrome" and is pretty common in cyclists and triathletes, affecting about 60 percent of people AMAB who cycle.
Besides being the reason why your testicles tingle, other symptoms include:
- Pain with urination or bowel movements
- Urinary urgency and frequency
- Erectile dysfunction
Using a bike seat that prevents testicular pain — like one with a wider saddle — and changing to a more upright riding position can help, Ochsner says. But keep in mind that if you're having pain or tingling in your balls now, you may have to decrease your riding time until the discomfort subsides.
Testicular Pain and Tight Pants
While some people may experience testicular pain from wearing tight cycling gear, there's no evidence to suggest that that's always the case. In fact, some causes of testicular pain — like epididymitis, which causes inflammation in the testicle area — may actually benefit from more supportive or compressive undergarments, per Penn Medicine.
A very bumpy ride or accident could lead to other issues.
"Mountain bikers can cause damage to their testicles from the shock absorbed during biking," Dr. Berglund says. "They may be at higher risk for testicular trauma or testicular torsion."
Testicular trauma can occur if your testicle is crushed or bruised. That's right — you can bruise your testicles much like you bruise other parts of your body.
If that happens, the covering of the testicle can be torn and blood can leak into the scrotum, according to the AUA. "The scrotum may be swollen and black and blue," says Dr. Berglund. "If the covering of the testicle is badly torn, the testicle may rupture."
If ultrasound imaging shows a severely damaged testicle, surgery may be needed, according to the AUA. For a less serious injury, the treatment may be pain medication and supporting your scrotum with an athletic cup.
Does a Ruptured Testicle Heal on Its Own?
As Dr. Berglund says, you can bruise or injure a testicle, which can lead to a rupture. This is an emergency, so don't wait for it to heal on its own — you should seek medical care right away, per the Cleveland Clinic. You may require surgery to control the bleeding and repair the tissue.
3. Testicular Torsion
Testicular torsion occurs when the testicle twists and constricts the cord that attaches the testicle to its blood supply inside the scrotum, which can cut off blood flow to the testicle, according to the Cleveland Clinic.
"Testicular torsion causes sudden and severe pain," Dr. Berglund says. "It requires immediate medical attention to prevent loss of the testicle."
Why Does My Right Nut Hurt Really Bad?
Testicular torsion typically only occurs in one testicle, according to the Cleveland Clinic, so sudden severe pain and swelling in one ball could be a sign of the condition. However, the left testicle is more commonly affected than the right.
Regardless, seek medical care right away if you have symptoms of torsion.
What About Cancer?
According to the American Cancer Society (ACA), cycling is not included in the risk factors for testicular cancer. Similarly, injury or trauma to the testicle from other high-impact activities, like horseback riding, do not seem to increase the risk for testicular cancer.
Instead, major risk factors for testicular cancer include having an undescended testicle, meaning a testicle that has not moved down into the scrotum, and having a family history of testicular cancer, per the ACA.
"Testicular cancer does not usually cause testicular pain," Dr. Berglund says. "If you find a lump on your testicle, whether it is painful or not, you should let your doctor know. Testicular cancer is the most common cause of a cancerous tumor in men ages 15 to 45."
Other Causes of Testicular Pain
"You may have testicular pain after riding a bike that has nothing to do with cycling," Dr. Berglund says. "A common cause is infection called epididymo-orchitis, which is an infection of your epididymis and testicle."
According to the Urology Care Foundation, infection of the coiled tube where sperm is stored, called the epididymis, and the testicle can occur on one or both testicles. Infection of a testicle, called orchitis, can spread to your scrotum from the urethra, which is the tube that carries urine out of your body from your bladder.
You may also have other symptoms of infection, such as fever, pain when passing urine, a frequent urge to urinate, blood in your urine or pain in other areas of your belly or anus. In this case, antibiotics may be necessary.
Infection is a common cause of testicular pain, so let your doctor know if you have any of these signs of infection.
- American Urological Association: “What Is Testicular Trauma?”
- Ochsner Health: “Cyclist's Syndrome: You Can Prevent Tailbone Injury”
- Cleveland Clinic: “Testicular Pain”
- American Cancer Society: “Risk Factors for Testicular Cancer”
- Urology Care Foundation: “What Are Epididymitis and Orchitis?”
- Mayo Clinic: "Testicle pain"
- Cleveland Clinic: "Ruptured Testicle"
- Cleveland Clinic: "Testicular Torsion"
- Penn Medicine: "Epididymitis"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.