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Testicular pain - What is it?

Pain in the scrotum is a relatively common condition occurring mainly in young men. It can either be of sudden onset which is usually severe or long-standing intermittent and rather aching.

Sudden (acute) scrotal pain

There are two main causes

  • Testicle infection 
  • Twisting (torsion) of the testes.

Infection, commonly known as epididymo-orchitis, can affect one or both testes. There is usually significant swelling and a lot of tenderness. The infecting organism can be sexually transmitted (Chlamydia) or have spread from the bladder. Diagnostic tests would include swabs from the urethra and urine samples. Treatment is with antibiotics, and a course of several weeks is usually necessary. Don't be alarmed if things don't settle immediately - it can take several weeks to completely resolve.

Torsion can happen because of the way some testes hang in the scrotum. This allows them to twist on the cord of blood vessels which are then occluded and the testis loses its blood supply. If it stays twisted for more than a few hours then the testis can die. The highest incidence of this condition is in children and teenagers.

Characteristically there is quite sudden onset of severe pain and tenderness. There are no helpful diagnostic tests and surgical exploration is the only way to make a diagnosis and to untwist the testis or remove it if it has already died.

What to do if you get acute scrotal pain

Because it is often very difficult to tell infection from torsion you need to seek urgent medical advice and shouldn’t hesitate to go to the Accident & Emergency Department.

Chronic scrotal pain

There are quite a lot of causes of long-standing pain.

  • Hydroceles or epididymal cysts can give discomfort.
  • Testis cancer is usually painless but can cause discomfort or occasionally quite severe pain.
  • A varicocele is dilated veins usually above the left testis. This usually begins in teenage years and can give aching discomfort towards the end of the day.
  • Some patients get episodes of pain after vasectomy due to sperm congestion or leakage.
  • Occasionally groin hernias can give pain that goes into the scrotum.

This leaves a group of patients for whom no cause for the pains can be found. Often the testes and sperm sac feel completely normal and scans likewise don’t show any abnormality. This is a frustrating condition that can get patients very anxious or depressed.

There are treatments that can help with chronic testicular pain though, and your specialist will help to guide you through your options.