What is testicular pain?

Testicular pain is a condition that can affect males at any age. The testicles (testes) are small egg-shaped reproductive (sex) organs inside a thin pouch of skin called the scrotum.

If you have testicular pain, you may feel it in one or both testicles. However, the pain may not actually be coming from your testicles themselves. The pain may be coming from another part of your body such as the stomach or groin. This type of pain is called referred pain.

Testicular pain can be either acute (sudden and short) or chronic (gradual and long-lasting). Aside from the sharp pain of sudden injury, your first symptom might be a dull ache that increases with time or with activity. Testicular pain can be severe because the testicles have many sensitive nerves.

You should get medical care if your pain lasts longer than an hour or if it’s unusually intense, as this could be a sign of an emergency condition called testicular torsion.

Who’s most at risk?

Boys and men of any age can get testicular pain. You may be at a higher risk for testicular pain if you do heavy physical work or if you play full-contact sports.

Is testicular pain a warning sign of testicular cancer?

Testicular pain can be a possible sign of testicular cancer, so if you don’t know why you have testicular pain be sure to seek medical attention.

Can testicular pain be caused by a sexually transmitted infection?

Sexually transmitted infections (like gonorrhea, syphilis and chlamydia) can affect multiple body parts, including the testicles. This can cause the testicles to become swollen or inflamed (a painful, burning feeling).

What causes testicular pain?

The source of the testicular pain may be obvious if you have had a recent injury or an accident, but in other cases it may not be clear why you have pain.

Causes of testicular pain might include:

• Injury or trauma: An injury to your testicles may happen during sports, exercise or an accident.
• Orchitis: Inflammation (swelling and a burning sensation) in one or both testicles may be caused by a bacterial or a viral infection. In children, the mumps virus is also a possible cause of orchitis. In the case of mumps the swelling usually starts four to six days after the start of the mumps.
• Inguinal (groin) hernia: An inguinal hernia occurs when part of your intestine pushes through a weak part of your abdominal muscles near the groin. It’s usually not dangerous but it can be painful. If it is painful, you should seek immediate medical attention as you may require urgent surgery.
• Epididymitis: This condition is due to inflammation of the epididymis. The epididymis is a tightly coiled group of thin tubes carrying sperm from the testicles to the sperm duct and out of the body. Epididymitis symptoms include pain and inflammation. The scrotum may be swollen and hot to the touch. This can last for days to weeks. Chronic epididymitis lasts longer than six weeks.
• Spermatocele: A spermatocele is a space filled with fluid that can form inside the epididymis near the testicle. These cysts aren’t cancerous and are usually not painful, but at times they can grow to a large size and become uncomfortable.
• Hydrocele: A hydrocele forms when fluid builds up around the testicles. Hydroceles are common, and sometimes they can cause pain or become infected.
• Hematocele: A hematocele occurs when blood surrounds the testicle. This is usually the result of an injury.
• Varicocele: A varicocele is a group of abnormally large veins near the testicles. These large veins may cause a dull discomfort in the affected testicle during daily activities. The testicle pain usually improves when lying down. Varicoceles may sometimes affect the ability to have children, and are sometimes surgically treated.
• Testicular torsion: Torsion is the twisting of the blood supply to the testicle. This cuts off the blood supply to the testicle and results in a severe, sharp pain. Torsion can occur at any time. This condition needs immediate surgery to save the testicle.
• Kidney stones: Kidney stones happen more commonly when you are dehydrated. Stones can get stuck in the ureters (tubes draining urine from the kidney into the bladder), causing pain in the back, groin or scrotum. Small stones may pass if fluids are increased. Larger stones may need surgery.
• Post-vasectomy pain syndrome: Men who have had a vasectomy sometimes get testicular pain afterwards. This pain can be caused by higher pressure in the vas deferens (tubes carrying sperm) or epididymis and can result in a post-vasectomy pain syndrome.
• Testicular cancer: Testicular cancer is the most common cancer in men aged 15-35. It can sometimes present with a dull ache or pain in the groin or testicles, testicular swelling or heaviness and aching in the lower abdomen or scrotum. Imaging methods can be used to examine the testicles for signs of testicular cancer.

What are some other symptoms that may occur?

Symptoms may include:

• Pain: Testicular pain can feel different depending on the cause. A sudden injury results in sharp, sudden pain, followed by a dull ache. The pain of epididymitis can worsen with time. Kidney stones can cause sharp pains in the back that spread to the testicles and to the tip of the penis.
• Bruising: There may be bruising on the scrotum if the testicles were injured.
• Nausea and vomiting: Feeling sick to your stomach and vomiting can be a symptom of many conditions. These include testicular injury, orchitis or kidney stones.
• Swelling: There may be a lump in the scrotum. The scrotum may appear red or shiny. These can signs of injury, orchitis, epididymitis or a testicular tumor.
• Fever: Fever together with testicular pain is a sign of orchitis or epididymitis.
• Urination problems: Some kidney stones can cause frequent urination. There may also be a burning sensation on urination, or blood may be seen in the urine.

Who treats testicular pain?

If you have testicular pain or if you have recently had high-risk sexual activity, you should seek medical help. High-risk sexual activity includes having more than one partner or having a partner who has had more than one partner. You can get diagnosed by specialists including:

• Urologist: If you have signs of testicular cancer or kidney stones, you may be referred to an urologist (a surgical specialist who treats urinary problems).
• Nephrologist: If you have kidney infections or poorly functioning kidneys, you may be referred to a nephrologist (a medical specialist who treats urinary problems).

How is testicular pain diagnosed?

Your doctor will exam you standing up and lying down. You’ll be asked questions about when the pain started, how long you have had it, how much it hurts and exactly where you hurt. You’ll also be asked about your sexual, medical and surgical history. Tell your doctor if any activities make your pain better or worse, like going to the bathroom, exercise, sex or sitting.

Blood or urine tests can help to rule out infections as a possible cause. If there’s a lump in your testicle, an ultrasound will be ordered to check for testicular cancer. If the ultrasound scan shows signs of cancer, you’ll be referred to an urologist to have the cancer removed.

If you get diagnosed and treated early, testicular cancer has a very high cure rate.

How is testicular pain treated?

You may be able to ease your testicular pain at home. Some remedies to try:

• Apply ice to the area.
• Place a rolled up towel under your scrotum if you’re lying down.
• Wear a cup or athletic supporter.
• Take warm baths.
• Try non-prescription pain relievers.

If home remedies don’t work, testicular pain can be treated medically. Pain can usually be reduced with medications. These may include:

• Pain relievers: Acetaminophen (Tylenol®) or non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen and naproxen, can help relieve pain. They’re often prescribed in cases of injury, trauma or orchitis.
• Antibiotics or anti-infective medications: Orchitis or epididymitis caused by a bacterial infection should be treated with a course of antibiotics.
• Tricyclic antidepressants: Medications such as amitriptyline can be used to treat nerve pain.

Is surgery needed for testicular pain?

Surgery isn’t usually needed for testicular pain, but if you have an emergency condition like testicular torsion or testicular cancer you may need surgery.

Types of surgery for testicular pain depending on the cause include:

• Testicular de-torsion: This operation is done to untwist the spermatic cord and restore blood flow to the testicle(s). Your surgeon sews stitches around your testicle to prevent the twisting happening again. The opposite side of the testicle is also stitched to prevent future torsion.
• Hernia repair surgery: This corrective procedure is done if your hernia can’t be pushed back into your abdomen or otherwise made smaller.
• Epididymectomy: The epididymis is a tightly coiled group of thin tubes that carry sperm from the testicles to the sperm ducts. Surgeons may remove your epididymis if you have chronic pain. This is not commonly done, and medical treatments will be tried first.
• Vasovasostomy: Vasovasostomy is the reversal of a vasectomy in men who suffer from testicular pain after having a vasectomy. Vasectomies can cause testicular pain that can be cured by reversing the vasectomy. This is rarely needed and is done as outpatient surgery.
• Shockwave lithotripsy: This minimally invasive procedure uses shockwaves (force moving through air) to break up kidney stones.
• Microdenervation of the spermatic cord (MDSC): This operations is performed under anesthesia. The surgeon uses an operating microscope to dissect and cut the nerves passing through the spermatic cord, which often cures or relieves testicular pain.
• Orchiectomy: Rarely, if your testicle pain is not helped by medications or less invasive procedures, you may need to have the testicle removed (orchiectomy). This is an operation of last resort.
• Testicular cancer: In this case your doctor does an operation to remove your testicle. After the surgery, the testicle is examined under a microscope and the type of testicular cancer can be identified. This determines if you need any further treatment.

Remember whenever you have surgery, it’s important to take regular care of your wound to prevent infection. Follow your doctor’s advice on how to clean your wound. You’ll also be given warning signs to watch out for in case it becomes infected. Your wound will be checked at your follow-up appointment.

How long does it take for testicular pain to go away?

Testicular pain may or may not last, depending on whether it is acute or chronic. If your pain is caused by a simple injury like a sudden hit or a fall, it should only hurt for about an hour. If your pain lasts longer than that or if it gets worse, immediately seek medical attention.

Can I still have children after losing a testicle?

In the majority of cases, one healthy testicle can make enough sperm for you to have children. You should still be able to have and maintain erections normally. Your testosterone (hormone) levels should stay the same too. Men who have had surgery for testicular torsion sometimes have a lower sperm count. They might also have antibodies in their system affecting the sperm’s movement. If you have had testicular torsion when you were young, you might have a lower sperm count. In that case, you may need to have a sperm count checked if you have any difficulties having children.

How do I prevent testicular pain?

Remember to have regular checkups, and always wear an athletic cup before playing full-contact sports. You should also wear protective clothing before doing dangerous work to avoid injury.

When do I need to see a doctor?

You should immediately call your doctor if you have testicular pain or swelling, especially if the pain gets worse or if you feel sick. If you have any symptoms of testicular torsion, make sure to seek immediate medical attention.