Testicular Pain: All You Need to Know

You have completed approximately half of your workday, or a football game, and the mild ache in your left testicle is now rapidly worsening.

Will you let it go until it goes away?

Testicular pain is an umbrella term for many types of pain, from a mild ache that disappears to a very serious condition requiring immediate medical attention.

This article, “Testicular Pain: Everything You Need to Know,” will help you determine what kind of pain you may be experiencing.

Pain that develops quickly (over hours or days) is referred to as acute pain. Pain that lasts longer than three months is referred to as chronic pain.

Severe, sudden pain could indicate a serious condition called testicular torsion, which occurs when a testicle twists around itself, cutting off the blood flow to the testicle.

If left untreated, testicular torsion can cause irreversible damage to the testicle. Emergency departments receive a minimum of 0.5%^[1] of their total patient volume due to scrotal complaints. There is therefore no reason to feel embarrassed about seeking medical attention for scrotal complaints.

The following paragraphs describe what causes testicular pain, what signs require emergency medical attention, how physicians arrive at a diagnosis, and what therapies are effective.

What Is Testicular Pain?

Testicular pain, also known as orchialgia, refers to discomfort in one or both testicles.

Pain can originate in the testicle itself, or it can develop in areas surrounding the testicle such as the epididymis, spermatic cord, groin, abdomen, and even kidneys.

Pain is a symptom; therefore, an underlying cause needs to be identified. Chronic pain is defined as three months of continuous or discontinuous pain^[2] that interferes with the patient’s daily activities. Chronic pain affects males of all ages.

Causes of Testicular Pain (Acute & Chronic)

There are many reasons for testicular pain.

Some examples include: 

Cause 1: Testicular Torsion – MEDICAL EMERGENCY

Torsion happens when the spermatic cord gets twisted and stops the blood supply to the testicle. Adolescents and young adults are the most likely group to get torsion, although people of all ages may experience it.

Torsion symptoms include sudden pain on one side of the scrotum, nausea, vomiting, and a swollen testicle that is positioned higher than usual. People experiencing torsion may also feel pain in their lower abdomen/groin area.

The longer you wait to get help for your condition, the lower the chance of saving the affected organ. Treatment within the first 4-6 hours provides the best chance of saving the affected testicle, although the outcome depends on the degree and duration of the torsion.

However, if you wait longer than 12-24 hours^[1] before seeking medical care, the likelihood of being able to save your organ drops significantly (to less than 50%^[1]).

Torsion is an emergency and must be treated surgically. There is no medication available to “untwist” the cord that supports the testicle.

Waiting too long to receive appropriate care has serious consequences: approximately 20-40% of all men ^[1] who experience torsion will lose one or both of their testicles. Additionally, complications may occur, such as infection or infertility.

Cause 2: Epididymitis – Infection of the Epididymis

Epididymitis is an infection in the coiled tube (the epididymis) that is located on the back of each testicle.

Bacteria, including Chlamydia trachomatis and Neisseria gonorrhoeae, can cause this condition. Enteric organisms such as Escherichia coli can also cause epididymitis.

Typically, pain and swelling will develop over time, along with possible other symptoms such as tenderness, Fever, urinary issues, or penile discharge.

Cause 3: Orchitis – Infection of the Testicle

Orchitis is an inflammatory condition that affects the testicles. It is commonly associated with epididymitis. Orchitis can be caused by either a virus (most notably mumps) or bacteria.

Approximately 14 per cent to 35 per cent^[1] of post-pubertal males who contract mumps will develop orchitis. Symptoms include pain, swelling, warmth, and Fever.

Cause 4: Varicocele – Enlarged Scrotal Veins

A varicocele is an aggregation of dilated scrotal veins; it occurs in 15-20 per cent of all males^[3], most frequently in the left testicle. Most varicoceles produce no symptoms.

However, if symptoms develop, the pain is a dull and heavy ache which worsens upon standing or as the day progresses, and typically improves with lying down. Varicoceles may affect male fertility.

Cause 5: Testicular Trauma / Injury

A direct strike to the genital area during sports or as a result of an accident results in immediate pain, swelling, bruising, and possibly nausea. A severe blow may tear the testicle and/or lead to bleeding inside the scrotum. 

While even a small strike to the genital area will result in discomfort due to the high density of nerve endings present in the testicles, any significant blow to the genital area resulting in swelling or bruising requires prompt medical attention and an ultrasound examination to determine whether the testicle has ruptured.

Cause 6: Testicular Cancer

An abnormal mass found in the testicle is commonly the first sign of testicular cancer, and sometimes men experience a heavy feeling in the scrotum with no mass present. 

The American Cancer Society estimates that 9,810 men will be diagnosed with this cancer in 2026^[4], and the average age of diagnosis is 33 years.

Since this cancer is often treatable, the risk of death from this cancer in a man’s lifetime is about 0.2% (1 in 500). 

If the cancer is diagnosed and treated early, the expected outcome is positive. 

Cause 7: Kidney Stones (Referred Pain)

Since nerve fibres from the testis and upper ureter have the same segmental innervation, a stone in the upper ureter may refer pain to the testicle.

Additional symptoms of a ureteral stone may include flank pain, blood in the urine, and waves of nausea. A ureteral stone may be present even if the testicle appears normal on physical examination.

Cause 8: Inguinal Hernia

If there is a defect in the abdominal wall in the inguinal region, intestinal tissue may push through and present as a hernia in the scrotum. A hernia may be reducible (can be pushed in) or irreducible (cannot be pushed in).

A hernia in the inguinal region is often painful, and the pain may increase with coughing, laughing, or physical activity.

Cause 9: Chronic Orchialgia – Unexplained Chronic Pain

Chronic testicular pain makes up 2.5-5% of all urology consultations^[2], and about 1-2% of men who undergo a vasectomy report chronic pain in the testicles. About 25-50% of cases of chronic testicular pain are idiopathic. 

Chronic testicular pain may be associated with psychological stress and anxiety. Treatment for chronic testicular pain is usually integrated and multidisciplinary.

EMERGENCY WARNING SIGNS – When to Go to ER Immediately

If testicular torsion is not ruled out, then very severe testicular pain is a medical emergency.

Go to the emergency room if you have:

Severe bruising and/or swelling of the testicle, especially with a previous traumatic event

Sudden, severe one-sided testicular pain requires immediate medical evaluation because testicular torsion must be ruled out.

In these cases, delayed treatment can result in permanent damage or loss of the testicle.

Teens are more susceptible to this condition, and because of the embarrassment factor, they will not tell their parents.

It is the duty of the parents to look for signs. Signs may include bending over or refusing to move. It is important to note that just because a person has a urinary tract infection does not mean there is not a case of testicular torsion.

Diagnosis – How Doctors Identify the Cause

Scrotal pain requires an evaluation of several factors. These may include your history, symptoms, Fever, discharge, trauma, and the position of the testes.

Doppler scrotal ultrasound is commonly used to assess blood flow and help evaluate suspected testicular torsion.

Other tests may include a urine test, NAAT testing, and blood tests. Blood tests may be done to evaluate for the presence of cancer and will be ordered based upon the clinical presentation.

Complete Treatment & Medicine Guide

This information provides a general idea about the causes and possible conventional treatments for males with testicular pain. It is not a prescription.

Self-medication is neither safe nor advised.

Delaying medical help with the use of pain medications to alleviate symptoms of an emergency condition like testicular torsion will not help. It is a surgical emergency. 

NSAIDs – Pain Relief for All Non-Emergency Causes

Use of NSAIDs^[5] is common for conditions like epididymitis. CDC advises the use of NSAIDs for symptomatic management until the epididymal inflammation subsides.

Antibiotics – For Epididymitis & Orchitis (2024 Updated Guidelines)

See your doctor within 3 days if the symptoms do not improve. In the meantime, avoid sexual intercourse.

Supportive Measures

Initially, patients should reduce their activity level and apply a supportive ice pack to the scrotum. Anti-inflammatory drugs and scrotal soaks may be beneficial as well.

Medicines for Chronic Orchialgia

After the inciting event has been resolved, treatment is directed at the nerve pain component with the following in a stepwise fashion. Medicines such as amitriptyline, Gabapentin 300 mg, or Pregabalin 75 mg may be considered in selected patients with chronic neuropathic testicular pain under specialist supervision.

Other measures include:

Surgical Treatments

Prevention & Self-Care

Routine mumps vaccination helps prevent mumps and its complications, including mumps-related orchitis; it is not a direct method of preventing testicular cancer.

Men should be aware of changes in their testicles, such as a new lump, swelling, or persistent change, and seek medical evaluation if they notice anything unusual.

In addition, it is important to seek treatment if you have a fever or have pain or swelling of the testes.

Use of protective gear is recommended in contact sports. Since testicular cancer may occur in both testes, it is recommended to perform a self-examination on both testes.

Use of a condom may reduce your risk of sexually transmitted infections, and you should be tested if you are at risk.

Conclusion

Sudden and severe testicular pain requires immediate medical evaluation because testicular torsion is a surgical emergency that must be ruled out.

Sudden, severe testicular pain requires immediate medical evaluation, while persistent or gradually developing pain should also be assessed by a healthcare professional to determine the underlying cause.

It is important to report any testicular pain to a doctor, since many conditions that affect the testicles can affect a man’s ability to have children.

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