Cycling can lead to testicular pain for several reasons, such as nerve irritation or trauma. Safe-cycling strategies can help you avoid injury for a pain-free ride.
Your testicles are sensitive, and even minor pressure or injury can lead to discomfort. Plus, their location — hanging down inside your scrotum, on the outside of your body — puts them at risk of injury from an impact or too much pressure.
That’s why cycling may lead to pain in the testicles. Too much pressure from your bike seat or a very bumpy ride, for example, could lead to unwelcome aches.
“One way that you can injure your testicles is by cycling or bike riding,” says Ryan Berglund, MD, a urologic oncology specialist at the Cleveland Clinic, whose primary practice location is in Mayfield Heights, Ohio. “Long-distance cyclists and mountain bikers are at higher risk than recreational riders.”
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.
1. Nerve Irritation
“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.”
When cycling, your body weight can press your testicles against a hard bike seat and compress the pudendal nerve or blood vessels in the area, leading to tingling or numbness. It could also lead to severe, sharp pain or even longer-lasting issues.
Although more formally called pudendal neuropathy or pudendal neuralgia, this type of pain and numbness in the scrotum and groin area may also be known as cyclist’s syndrome.
Besides tingling or painful testicles, other symptoms of pudendal neuralgia may include:
Urinary urgency and frequency
Painful bowel movements
Pain during sex or erectile dysfunction
Numbness in your legs, feet, or butt
Using a bike seat that prevents testicular pain — like one with a wider saddle — and changing to a more upright riding position can help. Other tips include:
Wear padded bike shorts to help protect your scrotum.
Choose a soft bike seat that does not have a cut-out saddle.
Keep your handlebar height lower than your saddle.
Shift to a high gear periodically and stand on the pedals to give your testicles a break from the pressure of the bike seat.
Take frequent breaks off your bike during longer rides.
But keep in mind that if you already have pain or tingling in your testicles, you may have to decrease your riding time and rest until the discomfort subsides.
Some people may wonder whether tight biking clothing could also cause cyclist’s syndrome, but there’s no evidence to suggest that’s the case.
It is true, though, that tight underwear or cycling gear could make pudendal neuralgia symptoms worse, so try to avoid them if you’re experiencing any testicle pain or tingling.
2. Trauma
A very bumpy ride or an accident could lead to other issues.
“Mountain bikers can cause damage to their testicles from the shock absorbed during biking,” 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.
“The scrotum may be swollen and black-and-blue,” says Berglund. “If the covering of the testicle is badly torn, the testicle may rupture.”
This is an emergency, so the first step if you’ve experienced testicular trauma or have any testicular pain is to have a doctor or urologist evaluate your symptoms.
If the doctor doesn’t see any sign of injury, they might just recommend taking over-the-counter pain relievers and wearing a jockstrap for support.
If they can’t determine whether an injury is present or want more insight, they might recommend an ultrasound. If ultrasound imaging shows a severely damaged testicle, you might need surgery.
To lower your chances of experiencing testicular trauma, take safety seriously when cycling by avoiding rocky terrain, accidents, or anything else that could cause a hard impact to your genital area.
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. This could cut off blood flow to the testicle.
“Testicular torsion causes sudden and severe pain,” Berglund says. “It requires immediate medical attention to prevent loss of the testicle.”
So if you have sudden severe pain in one testicle or if a painful or numb testicle is accompanied by fever, chill, nausea, or blood in your urine, get medical care immediately.
Testicular torsion is rare. Research has noted its occurrence in cyclists, but studies are limited and no direct link has been proven.
Testicular torsion may happen after several hours of vigorous activity or after a trauma to the testicles. Sometimes the question of whether it’ll happen to you simply comes down to genetics, due to a trait that allows the testicle to rotate inside the scrotum.
So while you can’t do much in the way of specific prevention, you can still take the general steps provided in the sections above to protect your scrotum and avoid injury while cycling.
What About Cancer?
Most studies have found no link between testicular cancer and cycling. And injury or trauma to the testicle from other high-impact activities, like horseback riding, does not appear to increase the risk of testicular cancer.
Instead, risk factors of testicular cancer include having:
An undescended testicle, meaning a testicle that has not moved down into the scrotum
A family history of testicular cancer
HIV
Cancer in the other testicle
“Testicular cancer does not usually cause testicular pain,” Berglund says. In later stages, though, if the tumor becomes large, you could experience pain in the testes.
“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,” Berglund says.
Other Causes of Testicular Pain
“You may have testicular pain after riding a bike that has nothing to do with cycling,” Berglund says. “A common cause is infection called epididymo-orchitis, which is an infection of your epididymis and testicle.”
Infection of the epididymis — the coiled tube where sperm is stored — and the testicle can occur on one or both sides of your body. Infection of a testicle, called orchitis, can spread to your scrotum from the urethra, the tube that carries urine out of your body. You may also have other infection symptoms, such as fever, pain when urinating, blood in your urine, a frequent urge to urinate, or pain in other areas of your abdomen or anus.
In the case of an infection, a doctor may prescribe antibiotics. Treatment often resolves these infections, which is why it’s important to contact a doctor as soon as possible if you’re experiencing any testicular pain or other infection symptoms.
Takeaway
Cycling, especially for long distances or over bumpy terrain, can cause testicular pain due to nerve irritation, pressure, or trauma.
Choosing the right bike seat and taking other safety precautions can help minimize discomfort.
Testicular pain could also result from an infection, so it’s important to contact a doctor immediately if you experience any new or uncomfortable pain in your testicles.
