Testicle pain

The testicles are very sensitive. Even a minor injury can cause pain. In some conditions, abdominal pain may occur before testicle pain.

Common causes of testicle pain include:

• Injury.
• Infection or swelling of the sperm ducts (epididymitis) or testicles (orchitis).
• Twisting of the testicles that can cut off the blood supply (testicular torsion). It is most common in young men between 10 and 20 years old. It is a medical emergency that needs to be treated as soon as possible. If surgery is performed within 4 hours, most testicles can be saved.

Mild pain may be caused by fluid collection in the scrotum, such as:

• Enlarged veins in the scrotum (varicocele).
• Cyst in the epididymis that often contains dead sperm cells (spermatocele).
• Fluid surrounding the testicle (hydrocele).
• Pain in the testicles may also be caused by a hernia or kidney stone.
• Testicular cancer is almost always painless. But any testicle lump should be checked out by your health care provider, whether or not there is pain.

Non-urgent causes of testicle pain, such as minor injuries and fluid collection, can often be treated with home care. The following steps may reduce discomfort and swelling:

• Provide support to the scrotum by wearing an athletic supporter.
• Apply ice (wrapped in a cloth) to the scrotum.
• Take warm baths if there are signs of swelling.
• While lying down, place a rolled towel under your scrotum.
• Try over-the-counter pain relievers, such as acetaminophen or ibuprofen. Do NOT give aspirin to children.

Take the antibiotics your provider gives you if the pain is caused by infection. Preventive measures to take:

• Prevent injury by wearing an athletic supporter during contact sports.
• Follow safer sex practices. If you are diagnosed with chlamydia or another STD, all of your sexual partners need to be checked to see if they are infected or should take treatment.
• Make sure that children have received the MMR (mumps, measles, and rubella) vaccine.

Sudden, severe testicle pain needs immediate medical care.

Contact your provider right away or go to an emergency room if:

• Your pain is severe or sudden.
• You have had an injury or trauma to the scrotum, and you still have pain or swelling after 1 hour.
• Your pain is accompanied by nausea or vomiting.

Also call your provider right away if:

• You feel a lump in the scrotum.
• You have a fever.
• Your scrotum is warm, tender to the touch, or red.
• You have been in contact with someone who has the mumps.

Your provider will do an exam of your groin, testicles, and abdomen. Your provider will ask you questions about the pain such as:

• How long have you had testicular pain? Did it start suddenly or slowly?
• Is the testicle on one side higher than usual?
• Where do you feel the pain? Is it on one or both sides?
• How bad is the pain? Is it constant or does it come and go?
• Does the pain reach into your abdomen or back?
• Have you had any injuries?
• Have you ever had an infection spread by sexual contact?
• Do you have a urethral discharge?
• Do you have any other symptoms like swelling, redness, change in the color of your urine, fever, or unexpected weight loss?

The following tests may be performed:

• Ultrasound of the testicles
• Urinalysis and urine cultures
• Testing of prostate secretions
• CT scan or other imaging tests
• Urine test for sexually transmitted infections

Pain - testicle; Orchalgia; Epididymitis; Orchitis

Matsumoto AM, Anawalt BD. Testicular disorders. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 19.

McGowan CC. Prostatitis, epididymitis, and orchitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 110.

Pontari M. Inflammatory and pain conditions of the male genitourinary tract: prostatitis and related pain conditions, orchitis, and epididymitis. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 56.

Updated by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.