Testicular pain can have many causes. This type of pain is categorized as either acute or chronic. Acute pain refers to pain that has lasted less than three months. Chronic pain refers to pain that has lasted longer than three months. Acute testicular pain can be an emergency and require immediate treatment.
Acute Testicular Pain (Orchialgia)
Acute Orchalgia is pain in one or both testicles that occurs suddenly, rises sharply, and lasts a relatively short period of time. It may also sometimes be called scrotal pain.
Symptoms of Acute Testicular Pain
- Sudden sharp pain in the testicle(s)
- The pain may radiate into the groin, lower abdomen, or back
- Swelling, redness, or tenderness of the testicle(s)
- Nausea and vomiting (in severe cases, like testicular torsion)
- Fever and chills (in cases of infection)
Causes of Acute Testicular Pain
- Testicular Torsion: This is an emergency! It is most common in infants and young boys but can occur at any age. Symptoms include sudden severe pain on one side of the scrotum, lower abdominal pain on the same side, scrotal swelling and redness, nausea, and vomiting. It is caused by a twisting of the cord that supplies blood to the testicle and must be corrected within six hours to avoid loss of the testicle.
- Trauma or injury: Physical trauma or injury may cause immediate pain, swelling and bruising.
- Infection: Epididymitis (inflammation of the coiled tube at the back of the scrotum called an epididymis), this may be the result of a urinary tract infection or sexually transmitted infection.
- Inguinal hernia: A hernia located in your groin, you may also notice a bulge in the groin when lifting something heavy or coughing, swollen lymph nodes in the area, and a “dragging” sensation.
- Post-Surgical Pain: After a vasectomy, or other scrotal surgery, you may have pain in the testicle during the healing process.
- Referred Pain: Pain from a kidney stone that is stuck in your urinary tract, or a pinched nerve in your back may be felt in the testicle(s).
Acute Testicular Pain Evaluation
Finding the cause of your testicular pain is the first step towards treatment. Your provider will do a physical exam and recommend tests based on your specific situation. Some things that may be done include:
- An exam of the abdomen, groin, and scrotum/testicles.
- You may be asked to provide a urine specimen to test for infections.
- Testicular Ultrasound may be ordered, and rarely a CT or MRI.
Chronic Testicular Pain
Chronic testicular pain is pain in one or both testicles that is either constant, or comes and goes, for three months or longer. Chronic testicular pain may develop after someone experiences acute testicular pain due to trauma or infection. The pain sometimes originates from another part of your body (for example your stomach or groin) and will be felt in the testicles; this type of pain is called referred pain.
Symptoms of Chronic Testicular Pain
- The pain may be dull or sharp, aching or throbbing and located in one or both testicles.
- You may experience scrotal swelling or notice a lump in the scrotum or on one of your testicles.
- Feeling sick to your stomach, or vomiting can be a symptom of many conditions that cause testicular pain.
Causes of Chronic Testicular Pain
There are many benign causes of testicular pain. In many cases the cause may not be obvious. In fact, in up to 50% of cases no cause can be determined.
- Varicocele. A group of abnormally large veins in the scrotum.
- Spermatocele. A fluid filled cyst that can form inside the epididymis near the testicle.
- Post-vasectomy Pain. 1-6% of people may experience Post Vasectomy Pain Syndrome (PVPS) after a vasectomy. The cause of PVPS is unclear, but may be due to swelling in the epididymis, inflammation, sperm granuloma, nerve compression, or nerve damage.
- Infection
- Orchitis. When a bacterial or viral infection causes inflammation and swelling in one, or both, testicles.
- Epididymitis. The epididymis is a coiled group of tubes that carry sperm from the sperm ducts.
- Sexually Transmitted Infections (STIs). Some STIs can cause testicular pain.
- Hydrocele. A buildup of fluid in the scrotum that surrounds the testicle.
- Inguinal hernia. This occurs when a part of the intestines pushes through a weak spot in the abdominal muscles near the groin.
- Tumor. Testicular cancer is the most common cancer in people assigned male at birth between the ages of 15 and 35. Testicular cancer is generally not painful but may present as a dull ache or pain in the testicle or groin.
- Intermittent Torsion. Some people may experience intermittent torsion, where the spermatic cord twists and then untwists. This can cause intermittent sharp testicular pain and is more common in children than adults.
- Idiopathic (up to 50% of cases). Idiopathic means that the cause is not known. This is often the case with testicular pain, but even if a specific cause is not identified there are still treatment options.
Chronic Testicular Pain Evaluation
Finding the cause of your testicular pain is the first step towards treatment. Your provider will do a physical exam and recommend tests based on your specific situation. Some things that may be done include:
- An exam of the abdomen, groin, and scrotum/testicles.
- You may be asked to provide a urine specimen to test for infections.
- Testicular Ultrasound may be ordered, and rarely a CT or MRI.
Chronic Testicular Pain Treatment
Testicular pain often resolves with conservative treatments, but it may take several weeks.
The following treatments may help alleviate your pain, unless your provider advises otherwise:
- Rest: Avoid heavy lifting and strenuous exercise until your symptoms improve, these things can increase your pain.
- Ice: Apply ice wrapped in a towel for 20 minutes at a time and 20 minutes off (don’t place ice directly on skin). A bag of frozen peas or corn works as an inexpensive icepack.
- Elevate your scrotum: When possible, lie down and elevate the scrotum on a small pillow. This may help ease swelling and pain.
