What Causes Testicular Pain?

As any guy who’s worn a jockstrap can tell you, the testicles are incredibly sensitive parts of the male anatomy, and pain in that region is nothing to sneeze at. But testicular pain comes from many causes and presents in a number of different ways; it’s important to know when you have a problem.

Board-certified in urology and men’s sexual health, Dr. William Brant has extensive knowledge of testicular pain and its causes, and he’s an expert in its treatment. He’s put together this guide to help you understand what might be at the root of your pain and what you can do about it.

What are the causes of testicular pain?

Testicular pain is discomfort felt in the testicles (testes) or the scrotum, the sac that surrounds them. It may start mildly, building in strength, or it can come on suddenly, depending on the cause. It’s caused by many different things, ranging from blunt trauma to infections to neurological disease to torsion. Let’s examine a few of these.

Trauma

The large majority (85%) of testicular injuries are caused by blunt force trauma, such as would be sustained by a direct kick or punch to the groin, sports injuries, and straddle injuries. Such a blow to the testicles can cause sudden, excruciating pain that may linger, as well as bruising and swelling. In addition, the testicle may rupture or develop a hematocele, where blood pools around the testicle and presses on it. Any disruption to blood flow can be serious, so if you’re experiencing pain and swelling after direct force, seek medical attention as soon as possible.

Epididymitis

Epididymitis is an infection of the epididymis, the organ in which sperm mature before leaving the body. The infection can come from a number of sources, such as sexually transmitted diseases, including chlamydia and gonorrhea, and urinary tract infections.

Symptoms may include:

• Pain that increases gradually
• A scrotum that’s hot to the touch
• Swelling

The doctor will usually treat the infection with antibiotics.

Kidney stones

Kidney stones are hard balls of calcium that get lodged in the organ responsible for excreting liquid waste, and they can cause pain that radiates to the testicles. This is known as referred pain — pain that occurs beyond the region causing the problem.

Some common symptoms of kidney stones include:

• Blood-tinged urine
• A burning sensation when urinating
• Pain at the top of the penis
• A sharp, cramping pain that radiates from the back to the groin
• Frequent urination
• Nausea and vomiting

If the stone is small, it may pass on its own. If the stone doesn’t pass, though, and you begin to experience symptoms of an infection, such as a fever or discharge, seek medical treatment as soon as you can. Treatment options usually include surgery to remove the stone, or shockwave lithotripsy, where shock waves aimed at the kidney break up the stones, which are then excreted.

Testicular torsion

Testicular torsion is a serious medical condition that’s most common in men under 25 years old. It occurs when the testicle twists around the spermatic cord, the duct that carries sperm from the testicles to the urethra. According to the American Urological Association, testicular torsion happens on the left side more so than on the right.

Symptoms that accompany torsion include:

• Sudden, severe pain on one side of the scrotum
• A red or darkening color on the scrotum
• Swelling in the scrotal sac
• Nausea and vomiting

The pain from the torsion may be sudden, but some men experience a pain that worsens slowly over several days.

Torsion is a life-threatening condition, as it cuts off the blood flow to the testicles and may result in testicular loss. Treatment almost always involves surgery to undo the twisting, but if the surgeon cannot repair the damage for some reason, he may have to remove the testicle. Since torsion usually affects just one testicle, removing it doesn’t impact the man’s fertility.

Hernias

A hernia is an event in which tissue pushes through a weak spot in the abdominal muscles. An inguinal hernia can push its way into the scrotum, causing testicular pain and swelling. Surgery to repair the hernia can lead to lingering pain, and the doctor may treat this with an anesthetic injection.