Every man knows what it feels like to get hit in the balls and how it can make you double over in pain. But just why does that pain have to be so intense?

You might want to find out whether a blow to your testicles can threaten your fertility, or simply learn why it hurts so much. Here's a breakdown of testicular pain.

Why does a blow to the balls hurt so much?

Your testicles are packed with an extremely high concentration of nerve endings. These nerve endings make you experience pleasure during sexual activity and intense pain following a blow to the balls. The difference in sensation depends on the amount of pressure being put on the testicles. A soft, delicate touch can cause extreme pleasure, while a hard, violent hit can have you seeing stars.

Additionally, your scrotum is a soft mass of tissues that lacks bones and muscle. This fact alone makes the balls vulnerable to pain after a whack or injury.

Many times, the pain you feel in your balls will extend up to your stomach and abdominal area as referred pain. Your scrotum and abdomen share many nerves and tissues, because your testicles developed near your kidneys during gestation in your mother's womb. These same nerves and tissues descended along with your scrotum as you grew older. This is why you may experience abdominal pain, nausea and vomiting after getting hit in the balls.

Can testicular injuries cause permanent damage?

It's possible for your fertility to be permanently affected following a testicular injury, given how your testicles produce sperm. A hard smack to the balls may also cause epididymitis or testicular torsion. It may also contribute to erectile dysfunction (ED), especially if the injury is untreated. 

Epididymitis is an inflammation of the epididymis, which is the tube located at the back of each testicle that stores sperm. Inflammation in this tube may cause you to experience persistent pain and pressure in the balls, as well as pain when urinating, having bowel movements and having sex. Reduced fertility is a rare but potential complication of epididymitis.

Testicular torsion is a medical emergency that should be addressed right away to avoid loss of the affected testicle. This injury occurs when one of your balls rotates around the spermatic cord to reduce or cut off blood supply to the testicle. Symptoms of testicular torsion include abdominal pain, nausea, vomiting and swelling and severe pain in the scrotum.

What to do after getting hit in the balls 

The pain you experience after getting hit in the balls usually resolves on its own within an hour. If you're having problems coping with the pain, try relaxing and lying down until the pain subsides, or apply a cold compress to your testicles. You may also try taking over-the-counter pain relievers or wearing compression shorts or tight underwear to prevent the balls from moving around and causing more pain.

When to see a doctor

Contact your doctor right away or seek emergency medical care if your testicles still hurt after one hour following the injury. A doctor can perform a physical examination of your genitals and confirm whether you have a more serious injury that requires immediate treatment.

You should also see a doctor if you experience ED or one or more the following symptoms after a hit to the testicles:

• Persistent nausea and vomiting
• Severe abdominal pain
• Difficulty urinating
• Blood in the urine
• Bruising on one or both testicles
• A cut or puncture wound on or near your genitals
• Fever

You may not be able to avoid getting knocked in the balls, as many of these instances occur purely by accident. However, if you play sports, you can reduce your risk of injury by wearing the appropriate protective gear. Ask your doctor for other tips and suggestions on what you can do to reduce pain following a blow to the balls.