Testicular pain in children

Overview

Testicular pain in children is pain felt in one or both testicles. It can happen suddenly and may be a sign of a serious problem that needs quick medical help, especially if it is caused by testicular torsion, where the testicle twists and cuts off its blood supply.

Testicular pain is fairly common in boys, especially during puberty, but is less common in younger children.

It affects boys from newborns to adolescents, with the highest risk in newborns and boys aged 10 to 14.

Symptoms

Common symptoms

• Sudden, severe pain in one testicle
• Swelling or redness of the scrotum
• Nausea or vomiting
• The testicle may be higher up than normal

Symptoms in children

• Children may cry, hold their stomach or groin, or refuse to walk
• They might not be able to describe the pain, so watch for fussiness, vomiting, or limping
• A baby may be unusually irritable or have a swollen scrotum

Causes

Main causes

• Testicular torsion – the testicle twists, cutting off blood flow
• Epididymitis – infection or swelling of the tube that carries sperm
• Trauma – a direct blow or injury to the testicles
• Inguinal hernia – part of the intestine pushes into the scrotum
• Torsion of the appendix testis – a small piece of tissue on the testicle twists

Risk factors

• Age: newborns and boys 10–14 are most at risk
• Family history of testicular torsion
• Previous testicular torsion (even if treated on one side)

When to see a doctor

See a doctor urgently if:

• Any sudden testicular pain in a child – call your doctor or go to the emergency room immediately

Book a routine appointment if:

• Mild pain that comes and goes and does not get worse
• Pain only during or after exercise that goes away with rest

Diagnosis

The doctor will ask about symptoms and examine the child's scrotum, testicles, and groin. They may also check for tenderness, swelling, and the position of the testicles.

Tests that may be done

• Doppler ultrasound – a painless scan that checks blood flow to the testicles
• Urine test – to look for infection
• Blood tests – if infection or other problems are suspected

What to expect at your appointment

The doctor will likely order an ultrasound first. If testicular torsion is suspected, the child will be taken to surgery quickly to untwist the testicle and fix it in place. The whole process may feel fast, but it is done to save the testicle.

Treatment

Treatment depends on the cause. For testicular torsion, emergency surgery is needed to untwist the testicle and secure it. For infections, antibiotics are used. Injuries may require rest and ice. Most children recover fully with prompt care.

Self-care at home

• Apply a cold pack wrapped in a cloth to the scrotum for 10–15 minutes at a time
• Have the child rest and avoid strenuous activity until pain improves
• Wear supportive underwear to reduce movement and discomfort

Medical treatments

If an infection is causing the pain, your doctor may prescribe antibiotics. Pain relief medications can help, but always ask your doctor or pharmacist before giving any medicine to a child. Never give aspirin to children.

When is surgery considered?

Surgery is almost always needed for testicular torsion, and sometimes for a hernia or torsion of the appendix testis if it does not get better on its own.

Living with this condition

After treatment, most children can return to normal activities within a few days to weeks. Follow your doctor's advice about rest and when to return to sports or gym class.

Lifestyle tips

• Encourage your child to wear supportive underwear during sports
• Teach your child to tell you about any groin pain right away
• After surgery, keep the area clean and watch for signs of infection like redness or fever

Diet and exercise

No special diet is needed. Children can usually go back to light activity after a few days, but avoid rough play or contact sports until the doctor says it is safe.

Mental health and emotional wellbeing

Testicular pain and surgery can be scary for a child. They may feel anxious or embarrassed. Talk to them calmly, answer their questions, and reassure them that the doctors are there to help. If you notice lasting sadness or worry, speak with your doctor.

Prevention

Testicular torsion cannot always be prevented. If a child has had torsion on one side, doctors sometimes recommend surgery to fix the other testicle in place as a preventive measure.

Complications

If left untreated

• Loss of the testicle (necrosis) if testicular torsion is not treated within 6 hours
• Chronic pain or discomfort
• Infection can spread to the blood (sepsis) if an infection is not treated

Long-term outlook

With prompt treatment, the vast majority of children recover fully and go on to lead normal lives. Even if a testicle is lost, the remaining testicle can usually produce enough hormones and sperm for normal development and fertility.

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