16292 Testicular Pain

Overview

Testicular pain is any pain, aching or discomfort in one or both testicles (the two egg-shaped glands in the scrotum that make sperm and the male hormone testosterone). The pain can come from the testicle itself, or from nearby structures such as the tubes and cords that carry sperm, the scrotum (the pouch of skin holding the testicles), or the groin. Sometimes pain felt in the testicles actually starts somewhere else in the body, such as the kidney or the lower back. Most causes of testicular pain are not serious, but a few need urgent medical care — so it is always worth getting checked, especially if the pain starts suddenly.

Yes, testicular pain is a common reason for people to see a doctor or go to an emergency department. It can happen at any age but is seen most often in young men and boys, and in older men when infections or hernias are more likely.

Anyone with testicles can get testicular pain. It is most common in teenage boys and young men (where twisting of the testicle is a particular concern), and it becomes more common again in later life because of infections, hernias and urine flow problems. Babies and young children can also get pain or swelling in the scrotum, sometimes from a small build-up of fluid or a hernia.

Symptoms

Common symptoms

• Aching, sharp or throbbing pain in one or both testicles
• Tenderness when you touch the testicle or scrotum
• Swelling, redness or warmth of the scrotum
• Pain that spreads to the groin, lower belly or lower back
• A heavy or dragging feeling in the scrotum
• Pain that gets worse when you stand, strain, cough or move
• Feeling sick, or generally feeling unwell if there is an infection
• Pain when passing urine, or needing to pass urine more often
• A lump or swelling you can feel in the testicle or scrotum

Symptoms in children

• Crying that cannot be soothed, especially in babies, or pulling at the nappy area
• A swollen, hard or red scrotum, or one side looking bigger than the other
• Sudden pain in the groin or scrotum, sometimes with vomiting
• A bulge in the groin that appears when crying or straining and goes away when resting (a sign of a hernia)
• A painless fluid-filled swelling that looks like a small balloon (a sign of a hydrocele)
• Being reluctant to walk or sit, or holding the groin area

Symptoms in older adults

• A dull ache or heaviness in the scrotum that develops slowly
• A soft swelling in the scrotum that gets bigger over time
• A bulge in the groin that appears on standing or lifting
• Pain when passing urine, a weak urine stream, or needing to go often (often linked to a prostate or urine infection)
• Pain that radiates from the lower back or side, which can come from the kidney or urinary tract
• Any new lump in the testicle, even if it is not painful

Causes

Main causes

• Testicular torsion — the testicle twists on the cord that carries its blood supply. This is a true emergency and needs surgery within hours.
• Epididymitis — inflammation or infection of the epididymis, the small coiled tube behind the testicle where sperm mature. It often causes a dull ache that builds over a day or two.
• Orchitis — inflammation of the testicle itself, sometimes caused by a viral infection such as mumps, or by the same germs that cause epididymitis.
• Injury or trauma — a knock from sport, a fall, or a bicycle or motorcycle accident.
• Hernia — a loop of bowel or tissue pushes through the muscle wall in the groin and can cause a heavy ache or bulge.
• Varicocele — swollen veins in the scrotum, often described as feeling like a bag of worms. It usually causes a dull ache that is worse at the end of the day.
• Hydrocele — a build-up of fluid around the testicle that causes a painless or mildly achy swelling.
• Spermatocele or epididymal cyst — a small, harmless fluid-filled lump near the testicle.
• Referred pain — a kidney stone, urine infection or problem in the lower back or groin can be felt as testicular pain.
• Testicular cancer — usually felt as a firm lump or swelling. It is often painless, but some people notice a dull ache.
• Other causes — twisting of a small piece of tissue that hangs near the testicle (called an appendix testis), a harmless cyst, shingles, or nerve pain.
• Sometimes no clear cause is found, and the pain settles by itself.

Risk factors

• Being a teenage boy or young man, when testicular torsion is most common
• Being sexually active, which raises the chance of some types of infection that cause epididymitis
• A urine infection, or a prostate infection in older men
• Not being vaccinated against mumps (mumps can cause orchitis)
• Heavy lifting, coughing or straining, which can bring on a hernia
• Playing contact sport or riding a bicycle or motorbike without protection
• A previous hernia, torsion, or surgery in the groin or scrotum
• A family history of hernia or varicocele
• Being born early, which is linked to hernias and fluid swellings in baby boys

When to see a doctor

See a doctor urgently if:

• Sudden and severe testicular pain, or pain that comes on over a few hours and is getting worse — go to the emergency department or call your local emergency number
• The testicle looks or feels different in position, is high up, or is very swollen and hard
• You feel sick, vomit, or have a fever with the pain
• Pain after an injury that does not ease within an hour or two
• Pain when passing urine with discharge or fever
• A new lump or hardness in the testicle, found at any time — get it checked within days, not weeks

Book a routine appointment if:

• A dull ache or heaviness in the scrotum that has been there for more than a week or two
• A soft swelling or found lump that is not painful
• An ache that keeps coming back, especially after exercise or at the end of the day
• Pain that has settled but you want to understand what caused it
• Any worry about your testicles or scrotum — it is always reasonable to ask

Diagnosis

A doctor will start by asking about your symptoms — when the pain started, how bad it is, whether it came on suddenly, what makes it better or worse, and whether you have had fever, urine problems, or a recent injury. They will then examine your testicles, scrotum, groin and lower belly. The examination is quick and usually not painful; the doctor will be gentle and will explain what they are doing. In many cases the history and examination are enough to find the cause, but some tests may be needed.

Tests that may be done

• Urine test — a sample of urine is checked for infection
• Blood tests — to look for signs of infection or inflammation
• Swab from the penis — a soft cotton bud sample to check for sexually transmitted infections, if these are possible
• Ultrasound scan — a painless scan using sound waves that shows the testicles, blood flow and any swelling; it is safe and quick
• A hand-held Doppler probe — used in emergency settings to listen to blood flow to the testicle
• A pregnancy-style urine test in some cases, as part of general assessment
• An STI screen if you are sexually active
• In some cases, a referral to a specialist such as a urologist (a doctor who treats problems of the urinary system and male reproductive organs)

What to expect at your appointment

Most appointments take 10 to 20 minutes. You will be asked to undress from the waist down and will be given privacy and a chaperone if you would like one — you can always ask for one. The doctor will look at and gently feel the scrotum, testicles and groin, and may check your lower belly. If you need a scan, it usually happens the same day or within a few days. If the pain is sudden and severe, the assessment happens immediately, and you may be seen by a surgical team without waiting for tests. Testicular torsion is treated first and tested later — doctors do not delay treatment to do scans if they suspect it.

Treatment

Treatment depends completely on the cause. Some problems settle with rest and simple pain relief; some need antibiotics for infection; some need an operation. The key message is that a twisted testicle needs surgery straight away, while most other causes can be managed calmly over days or weeks. Your doctor will explain what they think is going on and what the next step is.

Self-care at home

• Rest and take it easy for a day or two while the pain settles
• Support the scrotum — close-fitting, supportive underwear or rolled-up towels under the scrotum can ease aching
• Apply a cold pack wrapped in a cloth for up to 15 minutes at a time, never directly on the skin
• Take simple over-the-counter pain relief if it is safe for you — ask your pharmacist for advice about which is suitable, and follow the packet instructions
• Avoid heavy lifting, straining and intense exercise until you feel better
• Drink plenty of fluids, especially if you have an infection
• Wear a protective cup or guard for contact sports once you are back to normal
• Do not have sex until you have been checked and, if you have an infection, until you have finished treatment and been told it is safe

Medical treatments

For infection or inflammation, doctors usually prescribe a course of antibiotic tablets, and sometimes a short course of anti-inflammatory pain relief. It is important to finish the whole course even if you feel better. For viral causes such as mumps, treatment is about rest, fluids and easing symptoms, as antibiotics do not work on viruses. For a varicocele or hydrocele that is not troublesome, no treatment may be needed at all. For repeated or persistent pain, your doctor may refer you to a specialist, who might suggest physiotherapy, nerve blocks, or other options. Doctors will also treat the underlying cause — for example, a kidney stone or a urine infection. If you are offered any medicine, ask your doctor or pharmacist to explain what it is for and how to take it.

When is surgery considered?

Surgery is needed for a twisted testicle — this is done as an emergency, usually by untwisting the testicle and fixing both testicles in place so it cannot happen again. Surgery may also be offered for a hernia that is painful or enlarging, for a hydrocele or varicocele that is causing real trouble, for an abscess, or for a lump that needs to be removed and checked. Many operations are day-case procedures, meaning you go home the same day.

Living with this condition

Most people recover fully within a week or two. While you are getting better, take things gently, wear supportive underwear, and give yourself permission to rest. If the pain has been going on for a while, keeping a simple diary of when it is worse can help your doctor work out the cause. If you are worried about fertility, sexual function or how your testicles look, say so — these are common concerns and doctors can talk them through with you.

Lifestyle tips

• Wear well-fitting, supportive underwear, especially for sport
• Warm up properly before exercise and use a protective guard for contact sports
• Avoid lifting heavy loads with a jerk — bend your knees and use your legs
• Stay active in general; regular gentle exercise helps recovery and overall health
• Avoid smoking, which slows healing and is linked to some groin problems
• Practise safer sex, including using condoms, to lower the risk of infections
• Keep up to date with vaccinations, including mumps
• Do not ignore ongoing pain — get it checked rather than putting up with it

Diet and exercise

There is no special diet for testicular pain, but eating well and drinking enough fluids helps your body heal and lowers the chance of urine infections and constipation (which can make straining and hernia pain worse). Aim for regular meals with plenty of vegetables, fruit, whole grains and lean protein, and drink water through the day. Gentle walking is fine while you recover. Wait until the pain has gone and your doctor is happy before returning to running, cycling, heavy weights or contact sport — usually a week or two for simple causes, longer after surgery.

Mental health and emotional wellbeing

Pain in the testicles can be worrying. Many people feel anxious about fertility, masculinity, sexual function or cancer, and it can be hard to talk about. These feelings are completely normal and worth mentioning to your doctor. If worry is affecting your sleep, mood or daily life, or you feel low or hopeless, please reach out for support — talking to a GP, a counsellor or a trusted person helps, and mental health support is available. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away.

Prevention

Not all testicular pain can be prevented — a twisted testicle, for example, often happens without warning. But you can lower your risk of some causes: use protection during sport, lift safely, treat urine infections promptly, practise safer sex, keep up with vaccinations, and get any lump or lasting ache checked early. Getting to know what your testicles normally feel like — for example in the shower — means you will notice changes sooner. If you have had a twisted testicle, surgery to fix both testicles in place greatly reduces the chance of it happening again.

Vaccines

The mumps vaccine (usually given as part of the MMR vaccine in childhood) protects against mumps, which is one cause of painful testicle inflammation. Check with your GP or pharmacist that you and your children are up to date.

Screening programmes

There is no national screening programme for testicular problems in most countries. Instead, be aware of what is normal for you and see a doctor about any new lump, swelling or lasting ache. If you have a strong family history of testicular cancer or a previous history, ask your doctor whether extra follow-up is right for you.

Complications

If left untreated

• A twisted testicle that is not treated quickly can lose its blood supply and may need to be removed
• An untreated infection can spread and form a collection of pus (an abscess), or cause ongoing pain
• A strangulated hernia — where the bowel becomes trapped — is a surgical emergency
• Long-standing, untreated pain can affect sleep, work, mood and relationships
• Some infections can be passed to partners if not treated
• Rarely, reduced fertility can follow serious infection, injury or torsion

Long-term outlook

The outlook is good for most people. Simple infections, swellings and minor injuries usually settle within days to a few weeks with treatment. The one situation where speed really matters is a twisted testicle — when treated within a few hours, most testicles are saved. Whatever the cause, getting checked early means you get the right treatment and peace of mind. Most people recover fully and can get back to normal life, sport and relationships.

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