Why do my Testicles Hurt?

Take-home points

• Infection and inflammation are the most common causes of testicular pain.
• While less common, testicular torsion is a cause of testicular pain that requires emergency surgery.
• Pain in the testicles is very rarely a symptom of testicular cancer.
• Severe or sudden pain, especially with other worrying symptoms, requires assessment by a doctor.

Why do my testicles hurt?

Testicular pain can arise from infections (like epididymitis or orchitis), trauma or injury, testicular torsion (a medical emergency), varicoceles (enlarged veins), fluid buildup (hydroceles or spermatoceles), hernias, kidney stones, or, rarely, testicular cancer. Severe or sudden pain, or new lumps, should prompt immediate medical attention. In this article we’ll discuss the different causes of testicular pain and when to seek medical help.

Trauma or injury

As your testicles are found outside of your body, they’re vulnerable and can easily be injured. Injuries or altercations in sports like football, rugby, and boxing are common causes of testicular injuries.

A study from the United States found that 18% of male athletes had experienced some type of testicle injury whilst playing sports.¹ Even non-contact sports like mountain biking can put pressure on the testicles and lead to injuries.

Other causes of trauma to the testicles include car and motorcycle accidents, gunshot and stab wounds, workplace injuries, and even rough sex.

When we’re referring to testicular injury, these injuries can be mild, with just bruising and swelling, or can be more severe and affect the blood supply to the testicles, cause areas of infection, or even lead to rupture.

Treatment for testicular trauma or injury

Regardless of the cause, testicle injuries need treatment from a medical professional. Make sure to visit your doctor soon after the injury happens, as untreated injuries can lead to more serious complications later on. Depending on how serious the injury is, rest, ice, and pain medication may be enough, or you may require surgery to repair the damage.

Inflammation and infection

Inflammation of the testicles and surrounding tissues is the most common cause of testicle pain.² The medical terms for this are epididymitis (inflammation of the epididymis, or the tube attached to the testicle), orchitis (inflammation of the testicle), or epididymo-orchitis (if both parts are affected).

Most often, epididymitis and orchitis are caused by bacterial infections, including sexually transmitted infections (STIs) like gonorrhoea and chlamydia.³ Bacteria from a urinary tract infection or prostate infection can also spread and cause inflammation in the testicles, as can viral infections like the mumps.

Signs and symptoms of epididymitis and orchitis:

• Sudden pain in one or both testicles.
• Gradual pain in one/both testicles.
• A warm, tender, or swollen scrotum.
• Fluid buildup or a soft lump around the testicle(s).
• Discharge from the penis.
• Difficulty going for a wee.

Treatment for epididymitis and orchitis

Treatment usually involves taking antibiotics, pain medication, and using an ice pack on the area (not directly on the skin though). If an STI is the cause, it’s important to let any sexual partners know and avoid sex until you’ve finished your treatment.

Testicular torsion

Testicular torsion is a serious medical emergency where one of the testicles twists around, cutting off its blood supply. If not treated quickly, the testicle may become permanently damaged, which can affect fertility.

The longer the blood supply is cut off, the more likely the testicle will need to be removed. However, if detected within 6 hours and operated on, the testicle can be saved in more than 90% of cases.⁴

Signs and symptoms of testicular torsion

Severe testicle pain that comes on quickly, often when playing sports or during the night, is the most common symptom. Men with torsion can also experience stomach pain, nausea, and vomiting. Men and boys aged 10-20 years are most at risk, but testicular torsion can happen in older men too.

Treatment for testicular torsion

If you or someone you know is experiencing these symptoms, it’s essential to visit A&E straight away. A surgical cut (incision) is often made into the scrotum to examine the testicle before untwisting it and assessing its blood supply and overall health. If the testicle is in good health, it will be stitched to stop it from twisting again. However, if it is deemed unhealthy or badly damaged, it may need to be removed.

Varicoceles

Testicle pain that feels like a “dull ache” or a throbbing pain may be due to a varicocele. A varicocele is an enlargement of the veins in the scrotum, similar to varicose veins in the legs, that happens more commonly in the left testicle.

Varicoceles are usually caused by faulty valves in the veins of the scrotum. Normally, valves help the blood flow back through the veins to the heart. If the valves aren’t working properly, blood begins to pool, causing the veins to become enlarged.

Signs and symptoms of varicoceles

Many men with varicoceles don’t know they have them. In fact, only 2-10% of men with varicoceles experience pain.⁵ There may also be swelling, discomfort when standing or exercising, and some men experience a "bag of worms" feeling in their scrotum due to the enlarged veins.

Varicoceles treatment

Varicoceles often don’t need treatment, and supportive undergarments may be enough to deal with any mild discomfort. If you’re experiencing pain or significant discomfort, you can discuss other treatment options, like surgery, with your doctor. Surgery may also be suggested if you’re trying to start a family, as varicoceles can affect male fertility.

Fluid buildup

If fluid builds up around the testicles, it can lead to pain and discomfort. Hydroceles and spermatoceles are two common causes.

A hydrocele is a sack of fluid that forms around the testicle.⁶ It happens when the body doesn’t properly absorb the fluid produced between the two membranes covering the testicles. Hydroceles are most common in infants but can also develop later in life due to injury, inflammation, or infection.

Hydroceles are usually described as a painless lump, but large ones can be uncomfortable due to the size of the swelling.

Spermatoceles, also known as spermatic cysts, are fluid-filled cysts that form in the epididymis – the tube connected to the testicle mentioned earlier. Small spermatoceles often cause no symptoms, but larger ones can cause a heavy, aching feeling in the affected testicle, and swelling.

Both hydroceles and spermatoceles often don’t need treatment but may be surgically removed if they’re causing pain or other symptoms.

Other causes

Although less common, several other conditions can cause testicular pain. Hernias can cause pain when tissue or organs push through a weak spot in the muscles of the abdomen and into the scrotum. Kidney stones may lead to referred pain in the testicles, as the pain from the stones can radiate down into the groin and scrotum.

Finally, while testicular cancer is relatively rare, it’s something to be aware of. It’s not usually painful in the first stages, but rarely some men with testicular cancer experience sharp pain in the testicle or scrotum, or a heaviness.⁷

Read more about testicular cancer and the signs to look out for here.

If in doubt, visit your healthcare professional

If you experience severe or sudden pain in your testicles, or are worried about a new lump, make sure to visit your doctor. They’ll be able to investigate and make sure you get any necessary treatment.

References

1. Bieniek JM, Sumfest JM. Sports-related testicular injuries and the use of protective equipment among young male athletes. Urology. 2014;84(6):1485–9.
2. Gossman W, Boniface MP, Mohseni M. Acute Scrotum Pain. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470335/.
3. NHS Choices. Epididymitis. NHS. 2019. Available from: https://www.nhs.uk/conditions/epididymitis/.
4. Patient.info. Torsion of the testis. Available from: https://patient.info/doctor/torsion-of-the-testis-pro#management.
5. Paick S, Choi WS. Varicocele and Testicular Pain: A Review. The World Journal of Men’s Health. 2019;37(1):4.
6. Patient.info. Hydrocele in Adults | Fluid in the Scrotum | Tests & Treatment. Available from: https://patient.info/mens-health/scrotal-lumps-pain-and-swelling/hydrocele-in-adults.
7. Cancer Research UK. Symptoms | Testicular cancer | ww.cancerresearchuk.org. Available from: https://www.cancerresearchuk.org/about-cancer/testicular-cancer/symptoms.