Testicular Pain: Causes, Treatments, and What to Do

Testicular Pain Overview

It’s normal for any guy to worry about why his testicles may be hurting. Of course, it’s always a good idea to see your healthcare provider if you have unexplained pain, but testicular pain has many possible causes that range from relatively harmless to serious.

Your testicles are a sensitive area filled with many nerve endings, and even minor injuries can cause severe pain. Sudden testicular pain accounts for around 0.5 to 2.5 percent of all emergency room visits in the United States.

It’s natural to worry that pain in your testicles might be a sign of a tumor. But pain isn’t generally an early sign of testicular cancer.Most of the time, testicular cancer starts as a painless lump (more on that later).

However, other conditions that can cause sudden testicular pain, such as testicular torsion, can be serious and need prompt evaluation and treatment.

Testicular Pain Symptoms

Testicular pain can arise from a variety of causes. The type of pain and other associated symptoms you experience also depends on the underlying cause.

The discomfort might appear as a sudden, sharp pain or a dull ache that comes on slowly.

The pain might also radiate to your groin, abdomen, or lower back.

Sometimes, testicular pain doesn’t originate in your testicles but is referred from other locations. For example, kidney stones can sometimes cause pain that reaches your testicles.

Other symptoms commonly associated with testicular pain include:

• Testicular swelling or tenderness

• Redness or warmth in your scrotum

• Feeling of heaviness in your scrotum

• Nausea or vomiting 

• Fever or chills, if you have an infection

• Lump or mass in your testicle or scrotum

• Painful urination

• Painful erection or ejaculation

• Blood in your urine or semen

Causes of Testicular Pain

Testicle pain causes can include the following.

Epididymitis

Epididymitis is inflammation of the epididymis, the coiled tube attached to your testicle that stores and carries sperm. According to some estimates, more than 600,000 American men experience epididymitis each year. Most cases in men aged 14 to 35 are caused by bacterial infections.

Causes of epididymitis can include:

• Sexually transmitted infections (STIs) such as gonorrhea or chlamydia 

• Urinary tract infections (UTIs)

• Prostate infections

• Trauma or injury

• Use of catheters

Symptoms of epididymitis can include:

• Scrotal pain and swelling

• Redness and warmth in the scrotum

• Painful urination

• Fever and chills

• Discharge from the penis

Orchitis

Orchitis is inflammation of one or both testicles. It’s usually caused by viral or bacterial infections. The mumps virus is a very common cause, especially in teens. Bacterial orchitis usually happens when an infection spreads from the epididymis, often caused by sexually transmitted infections like chlamydia or gonorrhea.

Other causes of orchitis include:

• STIs

• UTIs

• Testicular trauma or injury

Symptoms of orchitis include:

• Sudden testicular pain

• Swelling in one or both testicles

• Fever and chills

• Nausea

• Pain during urination or ejaculation

Testicular Torsion

Testicular torsion is a medical emergency that occurs when the spermatic cord twists around itself, cutting off blood flow to your testicle. It most commonly affects men and boys under 25, but it can happen at any age. Testicular torsion typically causes severe, sudden pain that may be constant and worsen over time.

Testicular torsion requires immediate treatment to save the testicle and prevent complications. If treatment happens within 6 hours of your symptoms starting, there’s almost a 100 percent chance of saving your testicle. But after 12 to 24 hours, that chance drops to less than 50 percent.

Causes of testicular torsion include:

• Birth defect (often called a bell clapper deformity)

• Trauma to the testicles

• Sudden movement or physical activity

• Rapid growth during puberty

• Cold temperatures

Symptoms of testicular torsion can include:

• Sudden, severe scrotal pain

• Swelling of the testicle

• Abdominal pain

• Nausea or vomiting

• Testicles that move from their usual spot

Trauma or Injury

Testicular trauma occurs when one or both of your testicles are injured by a sudden force. Because the testicles are sensitive and not well-protected, trauma can result in significant pain and complications such as testicular rupture.

Causes of testicular trauma include:

• Sports injuries

• Direct blow or kick to the groin

• Motor vehicle accidents

• Penetrating injuries such as a stabbing, gunshot, or biting

• Falls

Symptoms of testicular trauma can include:

• Sudden, intense testicular pain

• Swelling or bruising

• Nausea or vomiting

• Blood in urine

• Bleeding

• Difficulty walking

Inguinal Hernia

An inguinal hernia occurs when part of your intestines or other tissue pushes through a weak spot in your abdominal wall near your groin. An estimated 800,000 inguinal hernia repairs are performed each year in the U.S.

Inguinal hernias are more common in men than women, and they can cause pain that radiates to your scrotum.

Causes and risk factors for inguinal hernia include:

• Heavy lifting

• Chronic coughing or straining

• Obesity

• Weakness in the abdominal wall

• Previous abdominal surgery

Symptoms of inguinal hernia include:

• Bulge in your groin or scrotum

• Testicular or groin pain

• Sensation of heaviness or pressure around your groin

• Pain when bending over or lifting heavy objects

• Swelling in the scrotum

Kidney Stones

Kidney stones are hard mineral deposits that form in your kidneys and cause intense pain as they travel through your urinary tract. As a stone moves, it can irritate nerves that cause referred testicular pain.

This pain may come and go, often radiating from your back or flank to your groin or scrotum.

Causes of kidney stones include:

• Dehydration

• High-salt or high-protein diet

• Family history

• Certain medications

• Underlying conditions like gout

Symptoms of kidney stones include:

• Sharp side or lower back pain

• Pain radiating to your testicles

• Blood in your urine

• Nausea or vomiting

• Frequent or painful urination

Varicocele

A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins in the legs. It occurs in about 15 to 20 percent of men at some point and is more common on the left side.

Pooling of blood can lead to dull, aching testicular pain, especially after standing or physical activity.

Causes of a varicocele can include:

• Malfunctioning valves in the scrotal veins

• Increased abdominal pressure

• Poor circulation

• Genetic predisposition

• Rapid growth during puberty

Symptoms of a varicocele can include:

• Dull, aching testicular pain

• Enlarged veins that you can feel or see

• Swelling in the scrotum

• Heaviness in the testicle

• Fertility issues

Hydrocele

A hydrocele is a fluid-filled sac around your testicle that can make your scrotum swollen. Hydroceles usually cause painless swelling but may lead to discomfort if they become large, as the excess fluid can put pressure on the testicle.

Causes of a hydrocele can include:

• Birth defect (in newborns)

• Injury or trauma to the scrotum

• Infections, like epididymitis or orchitis

• Inflammation of the testicles or scrotum

• Tumors (rare)

Symptoms of hydrocele can include:

• Swelling or bulging in the scrotum

• Mild testicular pain or discomfort

• Heaviness in the scrotum

• Pain that worsens with prolonged standing or physical activity

Testicular Tumors

Testicular tumors are abnormal growths on your testicles. These lumps may be cancerous or non-cancerous.

Early detection is important, as testicular cancer is highly treatable when caught early. About 1 in 250 males will develop testicular cancer, and it most often affects young men: The average age at diagnosis for testicular cancer is around 33 years old.

Along with testicular cancer, lumps may form due to cysts or other non-cancerous causes.

Symptoms of testicular tumors include:

• A painless lump or swelling in the testicle

• Testicular pain (rare) or discomfort

• Heaviness in the scrotum

• Breast tenderness (in rare cases)

• Lower abdominal or back pain

Post-Vasectomy Pain Syndrome

Post-vasectomy pain syndrome (PVPS) refers to chronic testicular pain that persists after a vasectomy. PVPS is relatively rare, occurring in about 1 to 2 percent of men after a vasectomy. A vasectomy is a procedure to block your vas deferens to make you infertile.

PVPS can develop months or even years after the procedure. Potential causes include:

• Damage to the spermatic cord

• Compression of nerves in the spermatic cord due to inflammation

• A blockage preventing sperm from advancing

• Immune response to the vasectomy

• Scarring

• Nerve entrapment

• Sperm granulomas, balls of sperm outside their usual locations

Symptoms of Post-Vasectomy Pain Syndrome may include:

• Persistent testicular pain or discomfort

• Pain during ejaculation or sexual activity

• Swelling in the scrotum

• Tenderness or heaviness in the testicle

Risk Factors for Testicular Pain

Risk factors for testicular pain depend on the underlying cause, but include the following:

• Age. Some conditions, such as STI-related epididymitis and orchitis are more common in young and sexually active males.

• Previous testicular trauma. Experiencing a testicular trauma can put you at risk of inflammation and pain in your testicles. 

• Sexually transmitted infections (STIs). STIs that spread to your testicles can cause orchitis or epididymitis.

• History of testicular surgery or procedures. Like with testicular trauma, previous surgery can cause inflammation in your testicles that can put pressure on nerves and cause pain.

• Family history of testicular cancer. A family history of testicular cancer may increase your risk of developing it, too.

• Smoking. Tobacco use is a risk factor for varicoceles.

• Vasectomy. Only men who have received a vasectomy are at risk of developing post-vasectomy pain syndrome.

• Obesity. Obesity is a risk factor for inguinal hernia and other health conditions linked to pain in the testicles.

Diagnosis of Testicular Pain

It’s a good idea to seek medical attention any time you have unexplained testicular pain. 

Receiving a diagnosis for testicular pain usually starts by visiting your primary healthcare provider. They will likely start by:

• Reviewing your personal medical history

• Reviewing your family medical history

• Reviewing your symptoms

• Performing a physical exam to inspect your testicles and scrotum

If they think additional testing is needed, they may refer you to a specialist in urology. Further exams may include:

• Urinalysis. A urine sample to check for UTIs or STIs.

• Ultrasound. A scrotal ultrasound to assess the testicles and surrounding structures for issues like testicular torsion, hydrocele, or tumors.

• Blood tests. In cases of suspected infection or inflammation, your doctor may order blood tests to check for elevated white blood cell levels or other markers of infection.

• Additional imaging. In rare cases, CT scans or MRIs may be used to evaluate conditions like hernias or tumors.

Early diagnosis is crucial because some causes of testicular pain are serious and require treatment as soon as possible.

Treatment for Testicular Pain

Treatment for testicular pain may include the following, depending on the underlying cause of your pain. 

• Pain-relief medications. Over-the-counter pain relievers like ibuprofen or acetaminophen can help relieve pain. 

• Cold compresses. Applying ice packs to the scrotum may help reduce swelling and ease pain. You can leave the cold compress on for about 15 to 20 minutes at a time. 

• Warm bath. Some people find a warm bath helps reduce dull testicular pain. 

• Rest and elevation. Elevating the scrotum by lying flat and avoiding physical activity that may worsen discomfort can potentially ease your pain. 

• Antibiotics. Your doctor might prescribe antibiotics for infections such as epididymitis or orchitis.

• Surgery. You may require surgery to treat conditions like testicular torsion or tumors. In the case of testicular cancer, the entire testicle is often removed. 

• Drainage. If you have a hydrocele or abscess (collection of pus), drainage or surgical removal of fluid may be necessary.

• Scrotal support. Wearing a scrotal support or athletic cup can help reduce movement of your testicles and lessen pain. It can also protect your testicles from future traumatic injury. 

• Vasectomy reversal. In cases of post-vasectomy pain syndrome, a vasectomy reversal may be an option.

• Cancer treatment. If you’re diagnosed with testicular cancer, you may need surgery and additional treatments such as chemotherapy or radiation therapy.

Preventing Testicular Pain

While some conditions are unavoidable, certain lifestyle choices and precautions can reduce the likelihood of testicular pain. Here are some preventive measures you can take:

• Wear protective gear. Use a protective cup or athletic supporter to shield your testicles from trauma when participating in activities with a high risk of testicular injury like contact sports. 

• Practice safe sex. You can reduce your risk of STIs by using condoms and engaging in safe sexual practices. Learn more about practicing safe sex. 

• Get regular health checkups. Routine appointments give you an opportunity to discuss any early signs of issues like a varicocele or testicular cancer with a healthcare provider.

• Maintain proper hygiene. Keeping your groin area clean and dry can reduce the risk of infections, such as epididymitis, which can cause swelling and pain.

• Avoid heavy lifting. Overexertion, especially lifting heavy objects, can increase the risk of inguinal hernia, a common cause of testicular pain. It’s always best to practice proper lifting technique and avoid straining too much.