What causes pain in the testicles?

Epididymitis is an infection of the epididymis, which is the organ where sperm matures before exiting the body.

Symptoms of epididymitis can include:

• pain that gradually increases
• a scrotum that feels hot to the touch
• swelling

Sexually transmitted infections, such as chlamydia and gonorrhea, can cause epididymitis. Urinary tract infections can also lead to epididymitis.

Doctors usually treat the condition with antibiotics.

Hernias occur when tissue pushes through a weak part of the abdominal muscles. An inguinal hernia is one type of hernia that can push into the scrotum, causing testicular pain and swelling.

Doctors may be able to reduce an inguinal hernia or push it back into place. However, a hernia will almost always require surgery (hernia repair).

Kidney stones can cause pain that radiates to the testicles. Doctors call this referred pain, when the pain occurs beyond the area that is causing the problem.

Other symptoms that doctors may associate with kidney stones include:

• blood-tinged urine
• burning when urinating
• nausea
• pain at the top of the penis
• sharp, cramping pain that may radiate from the back to the groin
• urinating frequently
• vomiting

Doctors may advise waiting for the kidney stones to pass. However, if a stone does not pass after some time or a person starts to experience symptoms of an infection, such as a fever or discharge, they should seek treatment as soon as possible.

Treatments can include surgery to remove the stone or shock-wave lithotripsy, which delivers shock waves to break up the stones.

Orchitis is an infection and inflammation of the testicles. Untreated epididymitis can lead to orchitis.

Symptoms of orchitis can include:

• fatigue
• fever
• nausea
• testicular pain
• swelling in one or both testicles
• vomiting

People should seek immediate treatment for orchitis. Sometimes the pain can be so severe that it is similar to testicular torsion, which is a medical emergency.

Treatments for orchitis depend upon the underlying cause. A doctor can prescribe antibiotics for bacterial infections. When a virus causes orchitis, they can recommend supportive treatments, such as over-the-counter pain relievers, rest, and elevating the scrotum.

People with orchitis may need to be evaluated with a scrotal ultrasound on an urgent basis in case the pain/swelling is from testicular torsion.

Testicular torsion is a serious medical condition that occurs when the spermatic cord twists, like a candy cane, and cuts off the blood supply to the testicle. The spermatic cord is the ‘stalk’ of the testicles that contains blood vessels and vas deferens. The vas deferens is the duct that transports sperm from the epididymis to the ejaculatory ducts before ejaculation.

Typically, testicular torsion is a condition that is more common in young men, usually those under 25.

Symptoms that doctors associate with testicular torsion include:

• nausea
• redness or darkening of the scrotum
• sudden, severe pain that occurs on one side of the scrotum
• swelling in the scrotum
• vomiting

The pain from testicular torsion is sometimes gradual. Some people with this condition experience pain that slowly worsens over several days.

According to the American Urological Association, testicular torsion typically occurs on the left side more than the right.

Treatment involves surgery to correct the testicular twisting. In rare cases where a surgeon cannot repair the torsion, they may remove the testicle.

Usually, testicular torsion only affects one testicle, so removing it does not normally affect a person’s fertility. However, although unlikely, this is possible.

A testicular tumor can cause pain and swelling in the testicular area. Other symptoms may include:

• a dull ache in the groin
• a lump in the testicle
• testicular swelling

Symptoms of a testicular tumor can resemble several other conditions that affect males, such as inguinal hernias and epididymitis. A doctor can help to diagnose the tumor or other underlying condition.

A blow to the testicles can cause bruising, pain, and swelling. A testicle can also rupture or develop a hematocele. A hematocele occurs when blood pools around the testicle and presses on it, affecting blood flow.

If a person has experienced a blow to the testicles and is having pain and swelling, it is best to seek urgent medical attention.

Varicoceles are abnormally large, dilated veins in the testicles. Sometimes, varicoceles do not cause any symptoms.

When they do, a person may notice testicular pain that gets worse with physical activity or over the day. Varicoceles may also affect a person’s fertility.

Doctors do not know what causes varicoceles, but they can usually treat them with surgery.

People should note that most varicoceles are asymptomatic, and therefore doctors often find varicoceles incidentally. If doctors do find them, they usually do not need treatment because the testicular pain is usually a result of something else.

Children may experience pain in the testicles from trauma, whether that be from engaging in sports or playing rough. However, testicular pain in teenagers and younger children can also have the same causes as in adults.

People should seek medical attention if their child is complaining of testicular pain. This is because it may sometimes be a medical emergency that requires immediate treatment. It is better to discuss this with healthcare professionals and be cautious than risk serious harm.

It is important to teach children to discuss testicular pain as they would pain in any other part of their body. It may feel like an uncomfortable conversation to have, but it could help them prevent a medical emergency from having a poor outcome.

Additional causes of testicle pain may include:

• Diabetic neuropathy: This nerve damage due to diabetes can also cause pain in the testicles. Managing the underlying diabetes can resolve the problem.
• Hydrocele: This is a fluid buildup that causes swelling of the scrotum. They typically affect babies but can impact males of any age. While they do not usually cause pain, there can be some pain from the swelling. In infants, the hydrocele will typically resolve on their own. In adults, surgery may be necessary.
• Idiopathic testicular pain: This is where the testicular pain is due to an unknown cause. Treatment may include pain management while doctors carry out further investigations.
• Mumps: Most people with mumps recover quickly. However, males who get mumps after puberty can develop complications such as inflammation of the testicles.
• Prostatitis: This is an infection or inflammation of the prostate. Treatment varies depending on the individual but can include nonsteroidal anti-inflammatory drugs, muscle relaxants, or warm baths.
• Scrotal masses: The treatment will vary depending on the cause of the mass. Some causes of scrotal masses include epididymitis and cancer.
• Spermatocele: This is where there is a fluid buildup in the testicle and is also known as a spermatic cyst. These may not require treatment, but if they become too large, medicines can ease the pain.
• Urinary tract infection: This is where bacteria enter the urinary tract, which includes the urethra, bladder, and kidneys. One symptom of the infection may be testicular pain. Sometimes, the infection may clear up by itself, but other times may need antibiotics.
• Back pain: Testicular pain may be the result of pinched nerves from slipped or herniated discs.
• Gastrointestinal issues: One example of a gastrointestinal issue that can cause testicular pain is diverticulitis. Diverticulitis is an inflammation of pouches in the intestines.

It is best to see a doctor if any of the following symptoms accompany testicular pain:

• discoloration of the testicles
• nausea
• unusual, bloody, or cloudy discharge from the penis
• testicular swelling
• vomiting
• pain that gets worse over time

Anyone with symptoms of testicular torsion should seek emergency medical attention. Without treatment, any condition that affects blood flow could result in loss of the testicle or surrounding parts.

If a person experiences swelling or pain in one or both testicles, it is best to see a doctor. If the pain is causing nausea and vomiting, they should seek immediate medical attention.

In cases of testicular torsion, the sooner a person seeks help, the more likely they can receive prompt attention for restoring blood flow.

Medical treatments are available for most causes of testicular pain.