Testicle pain

If pain in a testicle has come on suddenly and is severe, call an ambulance now — do not wait for morning and do not try a painkiller first. The commonest cause of pain like that is testicular torsion, in which the testicle twists along with its blood vessels and is left without a blood supply. It can be saved within a window of a few hours; after that it dies, and no operation undoes that. Everything else on this page is about pain that has built up over days or has been nagging for a long time; that needs a doctor too, but not in the same minute. Telling these two apart is the first thing to do.

Testicular torsion: the clock runs in hours

Torsion happens most often in teenagers and young men, but it is possible at any age, including the first months of life. It frequently starts at night, out of sleep, or after physical exertion, and sometimes for no reason at all. Occasionally a similar pain has happened before and settled on its own — that is not a reassuring detail, it is a warning.

Call an ambulance or get to hospital immediately if any of the following applies:

• pain in the testicle started suddenly and is severe;
• the pain comes with feeling sick or being sick;
• the lower abdomen hurts along with the testicle, sometimes more than the testicle itself;
• the testicle is drawn up higher than usual, or lies crosswise instead of vertically;
• the scrotum has become swollen and red within hours;
• the pain has lasted more than an hour or does not let up at rest;
• a boy has abdominal pain and vomiting for no obvious reason and is reluctant or too embarrassed to mention his testicles.

The diagnosis is made in hospital and decisions come fast: where torsion is suspected the testicle is untwisted surgically, sometimes without waiting for a scan, because waiting costs more than operating. While you are on your way, do not eat or drink anything — a general anaesthetic may be needed. Take any medicines you are on with you. Do not drive yourself: the pain can get worse en route.

Why “sitting it out until morning” is the main mistake here

Let us say it plainly: testicles are lost not because medicine cannot save them, but because the man waited. At night it is especially easy to persuade yourself that you can last until morning, that you “probably strained something”, that it is awkward to turn up at hospital with a complaint like this. Every one of those arguments costs hours, and here the hours are the whole of the treatment.

Heat deserves its own note: with sudden scrotal pain, nothing is warmed — no warm bath, no hot water bottle, no compress. Heat does not untwist a torsion, and where there is inflammation it makes the swelling worse; on top of that it gives the deceptive feeling that things have eased, and the man postpones again. A painkiller may be taken, but it settles nothing: it dulls the pain and does not restore the blood supply, and it matters that you say you have taken one. And do not try to untwist the testicle with your hands.

If the pain has gone on its own, that does not cancel the visit. A torsion sometimes untwists itself and then recurs, so an examination is still needed, and on the same day.

Torsion of the testicular appendage: similar, but milder

The testicle and the epididymis carry small appendages, and one of those can twist too. It happens mainly in boys of primary school age. The pain usually builds over hours rather than minutes, it is distinctly milder, there is more often no sickness or vomiting, a tender spot can be felt in one particular place, and a small bluish patch sometimes shows through the skin.

This condition is not dangerous and settles by itself over a few days. The problem is that it cannot be told from a true torsion by description, and sometimes not even on examination without a scan. So the rule stands: torsion is ruled out first, and reassurance comes second. A boy with scrotal pain is examined the same day, however calmly he is behaving.

Epididymo-orchitis: pain that builds over days

Here the picture is different. The pain does not arrive in an instant; it unfolds over a day or two and steadily worsens. The scrotum becomes red, swollen and hot on one side, the epididymis is tender, there is often a fever and sometimes shivering.

The cause depends on age, and that matters for treatment:

• in sexually active young men a sexually transmitted infection is the more likely cause — there may then be discharge from the urethra and stinging on passing urine, and both partners need testing and treatment;
• in older men and in boys an ordinary urinary infection is more usual, and then it is worth checking how well the bladder empties;
• sometimes the inflammation follows an operation or occurs in someone with a long-term urinary catheter.

Treatment is with antibiotics, and the choice is made by a doctor according to the likely cause; a urine sample and a swab are taken. A painkiller, rest and supportive underwear make the first few days bearable. You need to be seen the same day, not a week later: neglected inflammation forms pus, and then surgery is required. If the fever persists on treatment or the pain suddenly worsens, do not wait for the course to finish — get seen again.

Hernia, injury and other causes

• Inguinal hernia. A dragging pain and a swelling that runs from the groin into the scrotum, increases on coughing and lifting and usually settles on lying down. It becomes worrying when the hernia can no longer be pushed back, turns sharply painful, and sickness and vomiting appear: that is strangulation, and there too you call an ambulance.
• Injury. After a blow, pain and bruising are normal and ease off over hours. It is not normal for the pain to stay the same, for the scrotum to enlarge quickly or for it to become tense and purple: the testicle may be ruptured or blood may be collecting, and that is examined urgently.
• A stone in the ureter. A stone travelling down the ureter refers pain into the scrotum, and the man is convinced the problem is his testicle. The clues: pain in waves from the loin downwards, an inability to find a comfortable position, blood in the urine, and a testicle that is not tender when felt.
• Mumps. Mumps in teenagers and adults can cause orchitis, usually a few days after the salivary glands in front of the ear swell up. Hence a practical point: the mumps vaccine protects more than the cheeks.
• Long-standing dull ache. A varicocele, an epididymal cyst or the aftermath of past inflammation or surgery cause a dragging feeling at the end of the day and after exertion. That is dealt with on a planned basis, but it is dealt with: there is no need to put up with it for months.

Pain, lumps and testicular cancer

Pain on its own is an unusual way for a testicular tumour to announce itself. Far more often it shows up as a painless hard nodule, a change in the shape of the testicle, a feeling of heaviness, or a dull ache low in the abdomen. That is precisely why an absence of pain should not be reassuring: a painless finding is investigated exactly like a painful one.

So if, while dealing with pain, you have felt a firm area in the testicle or noticed that one side of the scrotum has become larger, that is a separate reason to be seen and to have a scrotal ultrasound scan, even if the pain has gone by then. This site has a separate page on testicle lumps and swellings, and it sets out how to examine yourself properly. Here it is enough to remember the pairing: pain decides the question of urgency, a lump decides the question of investigation, and neither cancels the other.

What you can do before you are seen

Everything below applies only where the pain is not sudden and severe. With sudden pain none of this is done: you call an ambulance.

• A painkiller at the usual dose — paracetamol, or a non-steroidal anti-inflammatory if it is not unsuitable for you; check the choice and the dose with a pharmacist or a doctor.
• Close-fitting supportive underwear: it reduces the pull and noticeably eases the pain when there is inflammation.
• Rest for the first few days, with no sport and no heavy lifting.
• A cool pack over your underwear for short spells after injury or with inflammation — but never warmth.
• If you suspect a sexually transmitted infection, no sex until treatment is finished, and testing for your partner.

What not to do: do not apply heat, do not massage, do not try to push anything back or untwist it, do not take a leftover antibiotic from the cupboard on spec — it muddies the picture and does not treat the cause — and do not wait for it to “sort itself out” if the pain is still building on the second day.

Online consultation

The main question with testicle pain is how urgent it is, and that can be answered without leaving home. An Oladoctor doctor will ask how the pain started, how long it took to develop, whether there is sickness, fever or discharge and what the scrotum looks like, and will tell you plainly: call an ambulance now, make your own way to hospital, be seen today, or calmly book a scan. They will explain which tests make sense when there is inflammation, help you make sense of an ultrasound report you already have, and tell you what your partner should do if an infection is involved. And if what you describe sounds like a torsion, you will be told straight away and nothing will be prescribed in place of hospital.

This material is for information only and does not replace medical advice.