Possible Causes of Pain in the Testicles

Experiencing testicular pain can be taxing both physically and emotionally. If your testicles ("balls") hurt, you may be embarrassed to seek medical care and discuss your symptoms with a nurse or healthcare provider.

The problem is that there are some serious conditions that can cause testicular pain. This article looks at five such conditions, including one this is considered a true medical emergency.

Doctor talking to patient in medical practice
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Epididymitis

Epididymitis is the inflammation of the epididymis (the long, coiled tube that transports sperm from the testicle).

Symptoms of epididymitis include:

  • Pain that often improved when lifting the testicle
  • Swelling of the testicle
  • Burning with urination
  • Frequent urination

Epididymitis is usually caused by an infection. In sexually active people, the sexually transmitted diseases (STDs) gonorrhea and chlamydia are common causes. In older adults, bacterial infections (often transmitted during anal sex) can also lead to epididymitis.

Epididymitis is typically treated with antibiotics. Over-the-counter (OTC) pain relievers may be prescribed along with elevation of the testicle to help minimize the pain.

If left untreated, epididymitis can lead to chronic pain or infertility.

Recap

Epididymitis is the inflammation of the epididymis. It is often caused by gonorrhea, chlamydia, and other bacterial infections. Epididymitis causes pain that is often relieved by lifting the testicle.

Orchitis

Orchitis is inflammation of the testicles. The suffix "-itis" simply means inflammation, while "orches" means testicle.

Symptoms of orchitis include:

  • Testicular pain
  • Testicular swelling
  • Blood in urine
  • Blood in semen
  • Swollen lymph nodes in the groin

Orchitis is frequently related to an epididymis infection that has spread to the testicle. Orchitis can occur during adolescence due to the mumps virus. In sexually active adults, gonorrhea and chlamydia are common culprits.

The treatment often involves oral antibiotics. Mumps infections generally resolves on their own within a week or two, although OTC painkillers may be used to relieve pain.

Infertility and chronic pain are also possible complications of orchitis.

Recap

Orchitis is the inflammation of the testicles, often caused by the spread of an infection from the epididymis. Mumps is a common cause of orchitis in adolescents, while adults often get it from gonorrhea or chlamydia.

Epididymal Hypertension (Blue Balls)

"Blue balls" is slang for epididymal hypertension. This is a situation in which the testicles feel uncomfortable and even painful after a long period of arousal without ejaculation.

Symptoms of blue balls include:

  • Heaviness in the testicle
  • An aching sensation
  • Testicular pain (usually mild)
  • A slight bluish tinge in the testicles

Blue balls is rarely serious and can often be resolved by ejaculating. Other people find relief using the Valsalva maneuver in which you pinch your nose and lips while forcefully expelling air.

Even without treatment, blue balls will usually resolve on its own within several hours.

Recap

Blue halls (epididymal hypertension) is testicular pain or discomfort caused by prolonged sexual arousal without ejaculating. It is a non-serious condition that will typically resolve on its own within several hours.

Inguinal Hernia

A hernia occurs when a weak spot in muscle ruptures, allowing internal tissues or organs to protrude through the opening. When it occurs in the groin, it is called an inguinal hernia.

An inguinal hernia often starts with a visible bulging in the groin, particularly when coughing, straining, or standing up. There may also be discomfort or pain at the site of the hernia extending to the adjacent testicle. The tissue can often be pushed back through the opening in the groin.

As the hernia progresses, the bulge may be harder to push back in and the pain may become more severe. If the intestines bulge through the opening, it can cause intestinal blockage.

An inguinal hernia can become a medical emergency it becomes "stuck." This can lead to vascular strangulation in which the hernia becomes starved of adequate blood flow.

An inguinal hernia will not go away on its own and requires surgical repair.

Recap

An inguinal hernia is the bulging of tissues or organs through an abnormal opening in the muscles of the groin. An inguinal hernia requires surgery.

Testicular Torsion

Testicular torsion occurs when the spermatic cord (from which the testicle is suspended) suddenly twists, cutting off the blood supply to the testicle. It is a true medical emergency that requires immediate surgery.

Symptoms of testicular torsion include:

  • Sudden, severe testicular pain
  • Pain in the groin or lower abdomen
  • Worsening pain when the testicle is lifted
  • Testicular warmth and redness
  • Nausea and vomiting

The testicle may also lie higher in the scrotum due to the twisting of the spermatic cord.

People with testicular torsion often have no underlying medical condition. It can affect both adults and children but is most common between the ages of 10 and 20.

If testicular torsion is not treated immediately, the testicle may become strangulated and lost.

Recap

Testicular torsion is a medical emergency in which the spermatic cord suddenly twists, cutting off blood supply to the testicle. The pain will usually worsen when the ball is lifted. Immediate surgery is required.

Summary

Testicular pain is something you should never ignore. The cause is not always serious, but the majority of cases require treatment by a healthcare provider.

Five common causes of testicular pain are:

  • Epididymal hypertension: Mild testicular pain or discomfort caused by prolonged sexual arousal without ejaculation
  • Epididymitis: The inflammation of the epididymis usually caused by gonorrhea, chlamydia, or other bacterial infections
  • Orchitis: The inflammation of the testicle commonly caused by mump in adolescents or gonorrhea or chlamydia in adults
  • Inguinal hernia: The bulging of tissues or organs through an abnormal opening in the muscles of the groin
  • Testicular torsion: A true medical emergency in which the spermatic cord becomes twisted, cutting off blood flow to the testicle

Frequently Asked Questions

  • Can sperm buildup cause pain?

    Yes. Known medically as epididymal hypertension, blue balls can occur after a long period of arousal without ejaculation. Sperm buildup can actually cause your testicles to have a slight blue tinge. The good news is blue balls typically resolve after ejaculating. 

  • When should you see a doctor for testicle pain?

    Pain in the testicles can be concerning. You should seek immediate medical help if the pain is severe or sudden, you had an injury or trauma to the scrotum and still have pain or swelling after an hour, or the pain is accompanied by nausea and vomiting. 

    Call your healthcare provider if the pain is accompanied by a fever or lump in the scrotum, or if the scrotum is warm, red, or tender to the touch. 

  • Do sexually transmitted infections cause testicle pain?

    Yes. STIs gonorrhea and chlamydia can each cause two different conditions associated with testicle pain: epididymitis and orchitis. 

    Epididymitis is inflammation of the long, coiled tube that transports sperm from the testicles. Orchitis is an inflammation of the testicles. Both conditions can potentially lead to infertility and should be treated promptly. 

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Trojian TH, Lishnak TS, Heiman D. Epididymitis and Orchitis: An OverviewAmerican Family Physician. 2009;79(7):583-587.

  2. Cleveland Clinic. Hernia.

  3. The Official Foundation of the American Urological Association. Testicular torsion.

By Rod Brouhard, EMT-P
Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.