Testicular Pain: Causes and When It Is an Emergency
The possible causes of testicular pain, the signs of testicular torsion and the situations in which you should go to A&E without delay.
In short
The most important cause of testicular pain is testicular torsion, in which the testicle twists and its blood supply is cut off; sudden, severe pain is an emergency and may need surgery within hours. With pain that develops more slowly, epididymitis or orchitis (inflammation) is common. Varicocele, injury, inguinal hernia and kidney stones can also cause pain in the testicular area.
Testicular pain can range from mild discomfort to unbearable pain. Although some causes are harmless, sudden, severe testicular pain is an emergency and every hour counts. In this article we explain the causes of testicular pain and the situations in which you should seek help without waiting.
What causes testicular pain?
It helps to group the causes of testicular pain according to how the pain started.
Pain that starts suddenly and severely:
- Testicular torsion (twisting of the testicle)
- Torsion of a small appendage of the testicle (appendix testis), particularly in children
- A blow to the testicle (injury)
Pain that increases over hours or days:
- Epididymitis and orchitis (inflammation of the testicle and the duct behind it)
- A trapped (incarcerated) inguinal hernia
Long-lasting dull ache or a feeling of heaviness:
- Varicocele (widening of the veins of the testicle)
- Hydrocele (a collection of fluid around the testicle); usually painless, but can cause a feeling of heaviness as it grows
- Chronic testicular pain, pain after vasectomy
- Pain spreading from a slipped disc or a kidney stone
What is testicular torsion, and how can you recognise it?
Testicular torsion means that the testicle rotates around its own axis, twisting the blood vessels that supply it and cutting off the blood flow. If the blood flow is not restored, the testicular tissue can be permanently damaged. The chance of saving the testicle is markedly higher with treatment in the first hours, particularly within the first 6 hours.
Signs that suggest torsion:
- Sudden, severe testicular pain, usually on one side
- Pain that sometimes wakes you up at night
- Nausea and vomiting
- The testicle becoming swollen and red and sitting higher than normal
- Pain spreading to the lower abdomen or groin
Torsion is most common in adolescence, but it can also occur in newborns and adults. Children and teenagers may describe the pain as tummy ache because they are embarrassed; for this reason, the testicles should always be checked in boys with sudden abdominal pain. For testicular problems in children, see also our paediatric urology page.
If torsion is strongly suspected, no time is lost on diagnosis; a colour Doppler ultrasound scan can help, but if clinical suspicion is high, the testicle is untwisted surgically without waiting and fixed in place so that it cannot twist again. The testicle on the other side is usually fixed in the same operation.
What are epididymitis and orchitis?
Epididymitis is inflammation of the duct behind the testicle where sperm mature (the epididymis); if the inflammation spreads to the testicle, it is called epididymo-orchitis. The pain usually increases more slowly than in torsion, over hours or days. There may be swelling, redness, fever and burning when passing urine.
- In young, sexually active men, the cause is mostly a sexually transmitted infection,
- In older men, urinary tract infections and prostate problems
are the main causes. Treatment involves a suitable antibiotic, rest, supporting the scrotum and painkillers. Where necessary, the partner also needs to be treated. Orchitis following mumps can also occur, particularly after puberty.
What kind of pain do a varicocele and other causes produce?
A varicocele is mostly on the left side; it causes a dull ache or feeling of heaviness that gets worse after standing for a long time or after exercise and eases when lying down. In some men it may be associated with infertility.
An inguinal hernia can extend down into the scrotum. If the hernia becomes trapped, the pain increases and the swelling can no longer be pushed back in; this is urgent.
Pain from a kidney or ureteral stone can spread to the testicle; in this case the testicle usually feels normal on examination, and the pain comes in waves from the side towards the groin. For details, see our article on kidney pain.
Does testicular cancer cause pain?
Testicular cancer is mostly noticed as a painless hard lump or an enlargement of the testicle. Sometimes there may be a feeling of heaviness or mild pain in the testicle. Because it is more common in young men aged 15–40, checking your testicles by hand once a month, after a warm shower, is recommended. For details, see the testicular cancer page.
How do you check your testicles at home?
A testicular self-examination takes a few minutes and is easiest after a warm shower, when the skin of the scrotum is relaxed:
- Examine each testicle separately, rolling it gently between the thumbs and fingers of both hands.
- Check whether the surface of the testicle is smooth and its consistency even. It is normal for the two testicles to be slightly different in size.
- The soft, coiled structure at the upper back of the testicle is the epididymis; it is a normal structure and should not be mistaken for a lump.
- Check for a hard nodule, enlargement or change in shape of the testicle, or a feeling of heaviness in the scrotum.
- Veins that feel like a “bag of worms” in the scrotum when standing may suggest a varicocele.
If you notice a new change, show it to a urologist rather than worrying about it. A large proportion of lumps that can be felt are benign conditions such as cysts or hydroceles; however, the distinction is made by examination and ultrasound.
When should you seek emergency care?
Go to the emergency department without waiting in the following situations:
- Sudden, severe testicular pain (particularly with nausea and vomiting)
- The testicle becoming swollen, hard or appearing pulled up
- Pain, swelling or bruising that does not go away after a blow to the testicle
- Testicular pain accompanied by a high fever and marked weakness
- A swelling in the groin that cannot be pushed back in and increasing pain
Pain easing on its own does not completely rule out torsion; the testicle can untwist by itself and then twist again. Episodes of sudden pain like this must always be assessed.
When should you see a urologist?
Testicular pain lasting more than a few days or keeping coming back, a hard lump or swelling in the testicle, a feeling of heaviness that increases on standing, and testicular symptoms together with difficulty having children all call for a urological examination.
Op. Dr. Mücahit Kabar sees patients in Bursa (Nilüfer), Turkey, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) and Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). Appointments are booked through the hospitals’ online booking pages or appointment lines. Consultations are held in English or Turkish and are confidential; the hospitals’ international patient departments can arrange interpreters for other languages. If you are travelling from abroad, you can send your questions and reports by WhatsApp to +90 541 622 54 82 before your visit. See the contact and appointment information for details.
Frequently asked questions
How can you tell if it is testicular torsion?
In torsion, the pain usually starts suddenly and severely, sometimes waking you from sleep. It often comes with nausea and vomiting; the testicle may swell and sit higher than normal. If you have these symptoms, go to the emergency department without waiting.
Does testicular torsion only happen in children?
No. It is most common in adolescence and in newborns, but it can occur at any age. In adults too, torsion must always be considered with sudden testicular pain.
Is a hard lump in the testicle important if it is painless?
Yes. Testicular cancer is mostly noticed as a painless hard lump or swelling. Any newly noticed hard lump in a testicle should be assessed by a urologist, even if it is not painful.
I get a heavy feeling in my testicle when I stand for a long time. Why?
This kind of dull, dragging ache can be a typical sign of a varicocele; it usually eases when you lie down. It is assessed with an examination and a colour Doppler ultrasound scan.
This page was prepared by Op. Dr. Mücahit Kabar for general information and does not replace a medical consultation. The right diagnosis and treatment for you are decided after examination and tests.