NURS 5432Understanding Groin Pain in Adolescents: Diagnosis and Management Arlington, Texas

Elicit focused history of patients presenting with scrotal pain. Demonstrate the ability to perform proficient testicular examination and to elicit signs specific to identify or exclude testicular torsion. Develop a differential diagnosis for adolescent male presenting with scrotal pain. Identify appropriate laboratory and radiological studies as it relates to the differential diagnosis of scrotal pain. Outline the algorithmic approach to testicular pain. Discuss management of testicular torsion. Recognize sexually transmitted infections as a cause of testicular pain among adolescent males. Discuss the importance of counseling to prevent sexually transmitted infections. Discuss epidemiology and USPSTF recommendations for screening for common testicular cancers. Demonstrate caring and respect, including family in the treatment plan. Demonstrate how to get a focused history and physical examination to determine the most likely diagnosis of a patient with groin pain. Elicit a focused history that includes information about developmental stages, school, and home situations in an adolescent patient. Recognize "don't miss" conditions that may present with groin pain. Describe the initial management of common and dangerous diagnoses that present with groin pain. Describe principles of family medicine in the context of family and community, such as the patient centered medical home. Elicit focused history that includes sexual activity, including high-risk behavior. Develop a health promotion plan for adolescents that addresses general health. Develop a health promotion plan for patients of any age or gender that addresses sexually transmitted diseases. Describe an evidence-based plan for appropriate screening, assessment of risk and counseling on testicular tumor. Differentiate among common etiologies based on the presenting symptom. © 2025 Aquifer, Inc. - sunny bourne () - :51 EDT 2/11 © 2025 Aquifer, Inc. - sunny bourne () - :51 EDT 3/11 Scrotal Exam Findings Causes of Testicular Torsion Issues When Treating Adolescents 1. Confidentiality Concerns about privacy and confidentiality are important barriers in seeking medical care among adolescents with STIs. Inadvertent compromises of confidentiality are often made by pharmacists or other medical personnel. 2. Consent for diagnosis and treatment Self-consent for diagnosis and treatment of STIs in adolescent minors is recognized in all 50 states. 3. Fear of pregnancy Pregnancy or fear of pregnancy sometimes causes adolescents to seek care when they have a chief concern with genital symptoms. 4. Parent notification Most states do not require parental notification for HIV infection. 5. Mandatory reporting of sexual activity Syphilis, gonorrhea, and acquired immunodeficiency syndrome are reportable diseases in every state. 6. Notification of child protection authorities Most states have "age of consent" laws that require notification of child protection authorities if sexual activity between individuals with a large age discrepancy is identified. 7. Physical and sexual violence Physical and sexual violence from dating partners in the past 12 months is reported by one in 12 high school students. Females experience higher rates of physical and sexual dating violence than male students. Students who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) or those who were unsure of their gender identity experienced higher rates of physical and sexual dating violence compared to students who identified as heterosexual. 8. Self treatment Self-treatment with topical medications, antibiotics, or douching is reported by as many as 25 percent of adolescents with STIs. 9. Nonadherence with STI treatment Approximately 20 percent of adolescents fail to fill prescriptions for STI treatment. A single-dose, observed therapy may be preferable when available. Cremasteric reflex Cremasteric reflex can be assessed by lightly stroking or pinching the superior medial aspect of the thigh. An intact cremasteric reflex causes brisk ipsilateral testicular retraction. Absence of the cremasteric reflex is a sensitive but nonspecific finding for testicular torsion. It can be absent on physical exams in normal testes. It should be assessed after inspection and before palpation of the testicles. Blue dot sign Tenderness limited to the upper pole of the testis suggests torsion of a testicular appendage, especially when a hard, tender nodule is palpable in this region. A small bluish discoloration known as the "blue dot sign", may be visible through the skin in the upper pole. This sign is virtually pathognomonic for appendiceal torsion when tenderness is also present. Prehn sign A positive Prehn sign is pain that is relieved by lifting the testicle. If the sign is positive, it is more likely to be epididymitis than testicular torsion. Congenital anomaly A congenital anomaly that results in failure of normal posterior anchoring of the gubernaculum, epididymis, and testis is called a bell clapper deformity because it leaves the testis free to swing and rotate within the tunica vaginalis of the scrotum much like the gong (clapper) inside of a bell, causing an intravaginal torsion. A large mesentery between the epididymis and the testis can also predispose itself to torsion. Contraction of the muscles shortens the spermatic cord and may initiate testicular torsion. Undescended testes Although there is little solid evidence, the incidence of testicular torsion is thought to be higher in undescended testes than in normal scrotal testes. Torsion of an undescended testicle often occurs with the development of a testicular tumor, presumably caused by increased weight and distortion of the normal dimensions of the organ. Recent trauma or vigorous exercise The patient's history often indicates recent trauma to the genital area, hard physical work, or vigorous exercise. © 2025 Aquifer, Inc. - sunny bourne () - :51 EDT 4/11 Complications of Testicular Torsion: Testicular Loss HEEADSSS Adolescent Interview Treatment of Testicular Torsion Patient Centered Medical Home