Scrotal/Testicular Pain

The testicles (or testes) are two small organs that are responsible for making sperm and helping to make the main male sex hormone testosterone. They are held in a bag of skin known as the scrotum behind the penis.

Sometimes, a man might feel pain in his testicles or scrotum. Scrotal or testicular pain could be due to a number of causes, ranging from mild to serious. Occasionally, this pain might be coming from the man’s stomach or groin, even though he feels it in his testicles. Regardless, it is a good idea for a man to see a health care provider if he is experiencing pain or swelling in one or both of his testicles to determine what might be causing it.

Testicular pain can be sudden and sharp or long-lasting and dull. Short-term testicular pain is known as an “acute” condition, and long-term pain is known as “chronic.” In addition to feeling pain in his testicles, a man might have one or more of the following symptoms:

• Swelling of the testicles
• Bruising of the testicles
• Difficulty urinating
• Nausea or vomiting
• Fever
• Abnormal warmth or redness in the testicles
• A lump in the testicles

The presence (or absence) of these other symptoms can help a provider identify the most likely cause of the pain.

Since the testicles are extremely sensitive, even a minor accident or blow to them can cause a lot of pain for a man. If a man experiences trauma or an injury to his testicles, the reason for the pain will be obvious. However, the cause of testicular pain is not always so easy to identify. Here are some causes of scrotal/testicular pain:

• Chronic orchialgia is intermittent or ongoing testicular pain that occurs in the absence of other specific causes of pain. It is estimated that 100,000 men in the United States seek medical attention each year for chronic orchialgia.
• Epididymitis is inflammation of the epididymis, or the tube where sperm are kept in the scrotum after leaving the testes. This often causes swelling, redness, and warmth in the scrotum. It may also result in painful urination, discharge from the penis, or blood in the semen. The specific cause of epididymitis is often unknown, but it may be the result of chemical irritation, trauma, viral or bacterial infections (including sexually transmitted infections), or other causes.
• Hernias occur when part of the intestine pushes through a weak spot in the abdominal muscles. An inguinal hernia is a hernia that occurs near the groin and can push into the scrotum, causing a painful bulge in the area.
• Hydrocele, or an abnormal buildup of fluid around the testicles, can cause the scrotum to swell. This is more common in infants and often goes away on its own, but it can also occur later in life due to injury or inflammation. Hydroceles rarely cause testicular pain.
• Injury or trauma to the testicles may cause intense pain at the time of the accident and a dull, aching pain later. A man who has injured his testicles should be aware that a hematocele, or a buildup of blood around the testicle could occur. If the pain does not subside and the scrotum begins to swell after the injury, it is a good idea to seek medical care.
• Kidney stones are hard accumulations of minerals and salts that form in the kidneys. If they begin to move around or leave the kidneys and enter the ureters (the tubes between the kidneys and the bladder), they can cause several symptoms such as painful/difficult urination, blood in the urine, nausea, vomiting, and pain that radiates to the testicles. Smaller kidney stones can be passed by drinking lots of water and managing pain with medication, but larger stones may need to be removed by surgery.
• Nerve-related pain can result from irritation of the lumbar paravertebral nerve chains, hypogastric plexus, pudendal nerve, or the ilioinguinal/genitofemoral nerves. Often, nerve-related pain may cause what feels like testicular or scrotal pain, even though the irritation may be further “upstream” and not actually located in the scrotum itself.
• Orchitis is the inflammation of the testicle(s) that can be caused by a bacterial or viral infection. The symptoms of orchitis are swelling and pain in the testicles, fever, nausea, and vomiting. It can occur as a result of the mumps virus or epididymitis that is left untreated.
• Post-vasectomy pain syndrome occurs in about 1-2% of men that have a vasectomy. After the surgery, a man with post-vasectomy pain syndrome might experience inflammation or fluid buildup that causes a dull ache in his testicles.
• Prostatitis, which is the inflammation or swelling of a man’s prostate gland, can cause painful urination, cloudy urine, blood in the urine, and pain in the testicles, pelvis, abdomen, groin, and/or lower back. This condition may be due to non-bacterial or bacterial causes and is often treated with antibiotics and pelvic physiotherapy.
• Spermatoceles are noncancerous sacs of fluid (cysts) that can form in the epididymis. Spermatoceles usually do not cause pain but may develop following a painful episode in the epididymis (i.e. result from whatever caused the pain). However, if it becomes too large, the increased pressure of a spermatocele can cause heaviness, pain, or discomfort in the testicle where it is located.
• Testicular cancer is most common in men between the ages of 15-35. A man with testicular cancer may notice a lump in one of his testicles. In most cases, these lumps are non-painful, however, if left untreated, testicular masses may continue to grow and cause pain, heaviness, or achiness in the scrotum. It is important for a man to immediately see his health care provider if he finds a lump in one of his testicles.
• Testicular torsion, or a twisted testicle, happens when the testicle rotates and the cord of blood vessels, nerves, and ducts that goes to the testicles (the spermatic cord) becomes twisted. This is a serious condition that can result in the loss of the testicle if it is not addressed quickly. The twisted spermatic cord can cut off the blood flow to the scrotum, which causes sudden, severe pain, swelling, fever, frequent urination, nausea, and vomiting. Any man who experiences intense testicular pain with a sudden onset like this should seek emergency care.
• Varicoceles are enlarged or twisted veins in the scrotum. Often, they do not show any symptoms, but they may cause pain or discomfort in the testicles that gets worse over time. Sometimes they do not require treatment, assuming that they are not negatively affecting a man’s life. However, they can impact a man’s fertility and might be discovered during fertility testing.

Due to the wide range of possible causes of scrotal/testicular pain, it is important for a man to know when to seek emergency medical attention and when to schedule an appointment with his health care provider. A man should seek immediate medical care if he has sudden, severe testicular pain, or if his pain is accompanied by blood in the urine, fever, or nausea. On the other hand, if he has a longer-lasting, dull, achy pain in his testicles, emergency care is usually not required, and he should make an appointment with his provider. Any lump in the testicles should be examined by a medical professional as it could be a tumor. Testicular cancer has a high cure rate when patients detect and treat it early.

To diagnose the cause of the pain, a health care professional will need to know the patient’s other symptoms (when applicable), the type of pain (sharp/dull/achy/heavy), the severity of the pain, and its exact location. The provider will ask the patient when the pain started and how long he has been experiencing it. It can also be helpful for the provider to know if the pain gets better or worse during certain activities like exercise, urination, or sex.

Once the provider has obtained this information, he or she may complete a physical exam, run blood or urine tests to check for infection, and/or require an ultrasound for a lump to determine if it is cancerous.

The treatment for testicular pain depends on its cause. Testicular pain caused by a bacterial infection may be treated with antibiotics. Surgery may be required to untwist the spermatic cord in testicular torsion cases, repair a hernia that cannot be pushed back into the abdomen, dislodge a kidney stone that is too big to pass, or remove a testicle that has a cancerous tumor.

Several home remedies can help alleviate pain as well, such as icing the area, taking warm baths, wearing supportive undergarments, and taking over-the-counter pain medication.

Resources:

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Cleveland Clinic. (2016, July 28). Testicular Pain. https://my.clevelandclinic.org/health/symptoms/16292-testicular-pain

Doerr, S., & Shiel, W.C. (2019, July 18). Testicular Pain (Pain in the Testicles). MedicineNet. https://www.medicinenet.com/testicular_disorders/article.htm

Johns Hopkins Medicine. (2021). Overview of the Male Anatomy. https://www.hopkinsmedicine.org/health/wellness-and-prevention/overview-of-the-male-anatomy

Leslie, S.W., Sajjad, H., & Siref, L.E. (2021, February 14). Chronic Testicular Pain. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482481/

Mayo Clinic. (2019, November 23). Testicle pain – Symptoms and Causes. https://www.mayoclinic.org/symptoms/testicle-pain/basics/definition/sym-20050942

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Mount Sinai. (2019, July 31). Testicle Pain. https://www.mountsinai.org/health-library/symptoms/testicle-pain

Nall, R. Medically reviewed by Elaine K. Luo, M.D. (2019, March 22). What causes pain in the testicles? Medical News Today. https://www.medicalnewstoday.com/articles/324776

Premier Medical Group – Urology Division. (2021). Testicular/Scrotal Pain. https://www.premiermedicalhv.com/divisions/services/testicular-scrotal-pain/