Pain in Testicles

Testicular pain can range from a dull ache to severe, sudden pain that requires emergency treatment. While some causes are minor and resolve on their own, others like testicular torsion are medical emergencies that can result in loss of the testicle if not treated within hours. Understanding the warning signs and knowing when to seek immediate care is crucial for preserving testicular function and fertility.

🚨 SEEK EMERGENCY CARE IMMEDIATELY For:

  • Sudden, severe testicular pain
  • Testicle positioned higher than normal
  • Nausea and vomiting with testicular pain
  • Abdominal pain with testicular pain
  • Testicle feels hard or enlarged
  • Pain after testicular trauma
  • Fever with testicular pain and swelling
  • Testicular pain in children or adolescents
  • Blue or dark discoloration of scrotum
  • Pain that wakes you from sleep

Testicular torsion is a surgical emergency - delaying treatment beyond 6 hours significantly increases risk of testicle loss.

Understanding Testicular Pain

The testicles are highly sensitive organs with an abundant nerve supply, making them susceptible to pain from various causes. Pain can originate from the testicle itself, the epididymis (coiled tube behind the testicle), or be referred from other areas like the abdomen or groin. The nature, onset, and associated symptoms of the pain provide important clues to the underlying cause.

Testicular pain requires careful evaluation because some causes, while initially presenting with similar symptoms, have vastly different outcomes. Quick differentiation between emergencies like torsion and less urgent conditions like epididymitis can mean the difference between preserving and losing testicular function.

Common Causes

Emergency Conditions

  • Testicular torsion
  • Trauma/injury
  • Incarcerated hernia
  • Fournier's gangrene
  • Testicular rupture
  • Torsion of appendix testis

Infections

  • Epididymitis
  • Orchitis
  • Sexually transmitted infections
  • Urinary tract infection
  • Mumps orchitis
  • Abscess

Structural Issues

  • Varicocele
  • Hydrocele
  • Spermatocele
  • Inguinal hernia
  • Kidney stones (referred pain)
  • Testicular cysts

Other Causes

  • Testicular cancer
  • Chronic pain syndrome
  • Vasectomy complications
  • Diabetic neuropathy
  • Post-surgical pain
  • Referred back pain

Key Conditions to Know

Testicular Torsion (EMERGENCY)

  • Sudden, severe pain
  • Most common ages: newborns and 12-18 years
  • Testicle may be higher and horizontal
  • Absent cremasteric reflex
  • Requires surgery within 6 hours

Epididymitis

  • Gradual onset pain
  • Swelling of epididymis
  • Often with urinary symptoms
  • May have discharge
  • Treated with antibiotics

Trauma

  • Clear history of injury
  • Swelling and bruising
  • May cause hematocele
  • Ultrasound to assess damage
  • Surgery if rupture suspected

Pain Characteristics

Onset and Duration

  • Sudden severe: Torsion, trauma
  • Gradual onset: Infection, varicocele
  • Intermittent: Intermittent torsion
  • Chronic dull ache: Varicocele, chronic epididymitis

Location and Radiation

  • Localized to testicle: Direct testicular pathology
  • Epididymal: Behind/beside testicle
  • Radiating to groin: Nerve involvement
  • Abdominal pain: Torsion, kidney stones

Associated Symptoms

Testicular pain may occur with:

  • Swelling: Scrotum or testicle enlargement
  • Redness: Skin changes
  • Fever: Suggests infection
  • Nausea/vomiting: Common with torsion
  • Urinary symptoms: Burning, frequency
  • Discharge: Urethral discharge
  • Lumps: Masses or nodules
  • Heaviness: Dragging sensation

Testicular Self-Examination

Monthly self-exams can help detect problems early:

  • Best done during/after warm shower
  • Examine each testicle separately
  • Roll gently between thumb and fingers
  • Feel for lumps, bumps, or changes
  • Note any size differences (slight variation normal)
  • Check epididymis (soft tube behind testicle)
  • Report any changes to doctor

Medical Evaluation

Physical Examination

  • Visual inspection
  • Palpation of testicles
  • Cremasteric reflex test
  • Transillumination
  • Abdominal examination

Diagnostic Tests

  • Ultrasound with Doppler: First-line imaging
  • Urinalysis: Check for infection
  • STI testing: If indicated
  • Blood tests: Inflammation markers
  • CT scan: For abdominal pathology
  • Nuclear scan: If ultrasound inconclusive

Treatment Options

Emergency Treatment

  • Surgical detorsion
  • Orchiopexy (fixation)
  • Repair of rupture
  • Drainage of abscess
  • Hernia repair
  • Pain management

Medical Treatment

  • Antibiotics for infections
  • Anti-inflammatory medications
  • Pain relievers
  • Scrotal support
  • Ice packs (first 24 hours)
  • Activity restriction

Self-Care Measures

  • Scrotal support: Athletic supporter or briefs
  • Ice application: 20 minutes at a time
  • Rest: Avoid strenuous activity
  • Elevation: Lie down with towel under scrotum
  • Pain relief: Over-the-counter as directed
  • Avoid heat: Initially can worsen swelling
  • Gentle hygiene: Keep area clean and dry
  • Follow-up: As directed by provider

Prevention Strategies

  • Protective gear: During sports
  • Safe sex practices: Prevent STIs
  • Proper hygiene: Reduce infection risk
  • Mumps vaccination: Prevents orchitis
  • Prompt treatment: Of urinary infections
  • Regular self-exams: Early detection
  • Avoid tight clothing: Adequate circulation
  • Manage chronic conditions: Diabetes, etc.

Related Symptoms

Groin Pain

Often occurs with testicular issues.

Scrotal Swelling

Common with testicular pain.

Urinary Symptoms

May indicate infection.

Abdominal Pain

Can occur with torsion.