Testicle Pain Causes and Treatment

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It’s quite common to have pain in your testicles or scrotum at some point in your life. It’s why many men see a urologist, a doctor who specializes in diseases of the urinary tract and a man's reproductive system.

Long-term testicle pain is called orchialgia. It can affect one testicle or both, and the pain can range from mild and dull to severe and debilitating. Pain may move toward the groin or abdomen.

Testicle pain can be caused by trauma, inflammation, and other more serious health conditions. Sometimes it happens for reasons that are unknown.

This article explores different causes of testicle pain. It also explains how doctors may diagnose a related health condition and what treatments may help.

testicle pain causes

Verywell / Alexandra Gordon

Causes

Short-term testicle pain has many possible causes, some of which may be immediately obvious.

Pinpointing the cause of chronic orchialgia is harder. This is defined as testicle pain that is constant or comes and goes for three months or longer.

Such pain can come from irritated nerves, a pulled groin muscle, or pelvic floor spasms. This condition is diagnosed by ruling out other causes first.

Sometimes testing can identify the cause. In other cases, the root cause can't be confirmed. Experts say the exact cause of testicle pain remains unknown in up to 50% of men.

1:27

Click Play to Learn How to Handle Testicular Pain Treatment at Home

This video has been medically reviewed by Anju Goel, MD, MPH.

Common Causes

People with these conditions often have pain in their testicles.

Epididymitis

Epididymitis is inflammation of a duct at the back of the testes. It causes swelling and in severe, rare cases, fever and chills.

Most of the time, this condition comes from a urinary tract infection or sexually transmitted disease. It can also occur as a result of trauma or an autoimmune condition, in which the body attacks healthy cells.

Trauma

Trauma to the testicle is usually mild. It often comes from a direct blow to the testicle or from a straddle injury, which can occur after an incident like a motorcycle accident.

Most of the time, injuries like these don't cause permanent damage.

Inguinal Hernia

Testicle pain may occur when a part of your intestines squeezes into the scrotum with the testicles—a condition known as an inguinal hernia.

An inguinal hernia may look like a groin bulge when a person coughs or lifts something heavy. A healthcare provider can confirm it with a physical exam or an imaging test.

Post-Vasectomy

After a vasectomy—surgery that closes off the tubes that carry sperm—some people have swelling, firmness, or painful places in the scrotum.

In some cases, it's because sperm has leaked into the testicles. This is called a sperm granuloma.

In other cases, it's because of inflammation in the coiled tube that holds sperm. This condition is known as congestive epididymitis. Both conditions can cause pain.

If a nerve becomes compressed and restricted (entrapped) after a vasectomy, testicle pain could occur. In rare cases, post-vasectomy pain syndrome can occur.

Swelling Without Pain

Some men develop painless swelling of the scrotum with no known cause or other symptoms. This is called acute idiopathic scrotal edema.

It can happen if you're not able to walk or move enough, or if there's a buildup of fluid in your body from another health condition such as heart failure.

This condition usually resolves on its own within two to three days of at-home care, like elevating the scrotum and taking an anti-inflammatory medication.

Testicular Torsion

Testicular torsion is an emergency that usually requires surgery. It happens when the cord that carries blood to the testicles twists.

Testicular torsion causes sudden pain on one side of the testicles. It can also cause swelling, nausea, and vomiting.

While testicular torsion is more common in infants and young boys, it can occur at any age.

Rare Causes

More serious causes of testicle pain are rare. Because some causes of testicle pain are serious, it's important to listen to your body and get medical care if you're in pain.

Tumor

Most testicular cancers do not cause pain. Instead, you might notice painless nodules or lumps.

However, some rapidly growing tumors may bleed or cut off blood flow to the testicle. If that happens, it can lead to groin pain.

Fournier's Gangrene

Fournier's gangrene is a severe bacterial infection. It begins in the abdomen and spreads to the scrotum and penis. The infection causes gangrene, which is tissue death. It is a rare, but potentially life-threatening.

This photo contains content that some people may find graphic or disturbing.

fournier gangrene

DermNet / CC BY-NC-ND

Besides pain, symptoms of Fournier's gangrene may include:

  • Skin blisters
  • Crepitus (a crackling or popping sensation)
  • Fever
  • High heart rate
  • Low blood pressure

The most common risk factor for developing Fournier's gangrene is diabetes.

Recap

Pain has lots of common causes. Infection, trauma, hernia, torsion, and problems after vasectomy can all lead to pain. Rarely, pain is caused by tumors or tissue death.

Diagnosis

Finding the cause of your testicle pain is the first step to getting well. Your healthcare provider will do a physical exam and recommend tests if you need them.

Physical Examination

During the physical exam, your healthcare provider will look at and feel your testicles. They may press on them to check for swelling, tenderness, skin changes, and lumps.

The exam may include your abdomen and groin.

Labs and Tests

To check for infection, your healthcare provider will order a urine culture. You may also need a swab to screen for sexually transmitted infections such as chlamydia and gonorrhea.

If your doctor thinks a tumor may be causing pain, you may need blood tests to check for alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). These are tumor markers, or substances that only make their way into the blood if cancer is present.

Imaging

One of the most common tests for people with testicle pain is an ultrasound. This involves sound waves to create an image of the testicle and surrounding area that can be used to detect conditions like testicular cancer.

A color Doppler ultrasound translates those sound waves into colors that indicate the speed and direction of blood flow. This can be used to determine whether or not blood flow to the testicle has stopped or slowed due to testicular torsion.

If you have cancer, the following imaging tests will help your healthcare team learn what stage it is:

  • Computed tomography (CT) scan: X-ray images are combined by a computer to generate a 3D image
  • Magnetic resonance imaging (MRI): A strong magnetic field and radio waves produce images of the inside of the body

If your healthcare provider thinks your back may be causing testicle pain, you may need images of your back taken, too.

Differential Diagnoses

Not all pain in the testicle area starts there. You may have referred pain, or pain that originates somewhere else but is felt in the testicle.

For example, you may have pain in your testicle because a kidney stone became stuck in the lower ureter (the tube draining the kidney) or you have a pinched nerve in your back.

A urine test to look for blood and/or a CT scan of your urinary tract can detect a kidney stone. An MRI of your spine and a neurological exam can be used to locate a pinched nerve.

Recap

It isn't always possible to find out what's causing the pain. To diagnose the problem, you may need lab tests, imaging, and a physical exam.

Treatment

The most effective treatment to relieve the pain will depend on what's causing it. Here are a few options that might be part of your treatment plan.

At-Home Treatments

At-home therapies may help with some conditions. For instance, your healthcare provider may prescribe antibiotics to treat epididymitis. At home, you can elevate your scrotum, use ice, and take medications to help with pain.

For men with unexplained pain, other options may bring relief:

  • Rest: Don’t lift heavy objects or exercise too much. Try not to overwork sore muscles.
  • Heat: A heating pad or a hot bath can increase blood flow and soothe muscle aches.
  • Tight-fitting underwear: Snug underwear can keep you from discomfort that may come with too much movement.
  • Physical therapy: Home exercises and stretching may help strengthen pelvic floor muscles and ease spasms.

You'll need to be patient. It can take three months or more to recover.

Medications

Nonsteroidal anti-inflammatories (NSAIDs) like Motrin or Advil (ibuprofen) can reduce pain.

Antibiotics are used to treat infections, such as epididymitis or Fournier's gangrene.

Surgery

To treat some conditions, you may need surgery.

For example, with Fournier's gangrene, infected tissue has to be removed. Sometimes people also need surgery to repair or rebuild the damaged area.

Torsion surgery aims to restore the blood supply to the testicles. Most testicular cancers also involve surgery.

Nerve Block and Cord Dennervation

A nerve block may be used if the pain is chronic and at-home treatments don’t work.

With a nerve block, a urologist injects an anesthetic into the spermatic cord—a group of structures connected to the testicle that help keep it in place and funnel sperm to the penis. If the medication takes the pain away, it's likely that the source of the pain is in the testicle.

In some cases, a urologist may cut the nerves to the testicle to stop the pain. This is called microsurgical spermatic cord denervation. It is done in an outpatient surgical center and permanently relieves testicle pain in about 75% of men.

If the nerve block does not relieve the pain, your urologist may refer you to a pain management specialist to explore other treatments.

Recap

NSAIDs, ice, heat, rest, and gentle exercise can improve pain and swelling. Antibiotics may be needed to treat an infection. Persistent cases may warrant a nerve block to stop pain. You may also need surgery to open up the blood supply to the area or to remove tissue that's infected or cancerous.

Summary

Testicle pain can come from infection, injury, blocked fluids, or another health condition. Sometimes health professionals aren't able to find an exact cause.

Treatment depends on the source of the problem. Antibiotics and anti-inflammatory medications are often part of the plan. Surgery may be necessary in rare cases. Sometimes, the nerve supply to the testicles may be cut to stop the pain.

Much of the time, simple at-home treatments can ease pain as you recover.

A Word From Verywell

Testicle pain isn’t widely discussed, even by urologists. This is especially true when it comes to chronic orchialgia, in which the "why" behind pain is not typically clear.

In the vast majority of cases, testicle pain can be treated. Be open to discussing your concerns with your healthcare provider. And of course, seek immediate medical care for any sudden and severe testicle pain.

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