Causes of Testicle Pain and Treatment Options

Everything you need to know about orchialgia

African American doctor talking to patient in office
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Some men may be reluctant to talk about it, but 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. Called orchialgia, long-term testicle pain can occur in men of any age, from adolescents to the elderly. It can affect one testicle or both, and the pain, which can range from mild and dull to severe and debilitating, may move toward the groin or abdomen. Causes range from trauma to inflammation to more serious concerns, and many cases occur for unknown reasons.

Causes

Though many things can give way to this kind of discomfort, experts suspect that the cause of chronic testicle pain is unknown in up to 50 percent of men. Known as chronic orchialgia, intermittent or constant testicle pain that lasts for three months or longer and is disruptive to daily life is diagnosed after other causes are ruled out. Doctors often suspect such pain is owed to irritated nerves, a pulled groin muscle, or pelvic floor spasms, but these cannot be confirmed.

Cases for which a cause is able to be identified are usually due to the following.

Common Causes

Testicle pain is often seen in men with these concerns.

Epididymitis

Epididymitis refers to inflammation of the epididymis, a duct located at the back of the testes. Along with testicular pain, epididymitis causes swelling and in severe, rare cases, a fever and chills. Most of the time, epididymitis results from a urinary tract infection or sexually transmitted disease, but it can also occur as a result of trauma or an autoimmune condition.

Trauma

Trauma to the testicle is usually mild, does not result in severe injury, and occurs from a direct blow to the testicle or from a straddle injury.

An Inguinal Hernia

Testicle pain may occur when a part of your intestines protrudes (herniates) into the scrotum with the testicles. An inguinal hernia may only be visualized as a groin bulge when a person coughs or lifts something heavy.

Post-Vasectomy

After a vasectomy, a person may notice firmness within the epididymis (called congestive epididymitis) or a painful nodule called a sperm granuloma, which represents sperm leakage in the testicle. Both conditions can cause discomfort. Nerve entrapment after a vasectomy surgery may also cause testicle pain.

Acute Idiopathic Scrotal Edema

Some men develop painless swelling only of the scrotum with no known cause or other symptoms. This condition usually resolves on its own within two to three days of conservative care, like scrotal elevation and taking an anti-inflammatory medication.

Testicular Torsion

Testicular torsion is a surgical emergency that results from twisting of the spermatic cord, the structure that carries nerves to the testicles. It results in the sudden onset of one-sided, severe testicular pain and swelling, along with nausea and vomiting. While testicular torsion is more common in infants and pubescent boys, it can occur at any age.

Rare Causes

Luckily, the more serious causes of testicle pain are rare. They do, however, highlight the importance of listening to your body and seeking the advice of a doctor.

Tumor

Most testicular cancers do not cause pain, but rather present as painless nodules or lumps. However, some rapidly growing tumors may bleed or cut off blood flow to the testicle, both of which can lead to testicle pain.

Fournier's Gangrene

Fournier's gangrene is a severe bacterial infection that begins on the abdominal wall, spreads to the scrotum and penis, and causes gangrene (death of tissue). It is a rare, but potentially life-threatening cause of scrotal pain and swelling.

Other symptoms may include skin blisters, crepitus (a crackling or popping sensation), and symptoms of septic shock like a fever, high heart rate, and low blood pressure. The most common risk factor for developing Fournier's gangrene is diabetes mellitus.

Diagnosis

Diagnosing the root cause of your testicle pain is the first step to getting better and feeling well. Your doctor will do a physical exam and recommend tests, as necessary.

Physical Examination

During the physical exam, your doctor will examine and then press on the testicles to check for swelling, tenderness, skin changes, and lumps or masses. He may also perform an abdominal exam and check for enlarged lymph nodes in the groin.

Labs and Tests

In order to rule out infection, like epididymitis, your doctor will order a urine culture, as well as a urethral swab to screen for sexually transmitted infections. If a tumor is suspected, blood tests that check for the tumor markers alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) may be ordered.

Imaging

The hallmark imaging test for examing testicle pain is an ultrasound, which can detect abnormalities like testicular cancer. With testicular torsion, a color Doppler ultrasound reveals decreased or absent blood flow to the testicle. 

Other imaging tests, like a computed tomography (CT) scan or magnetic resonance imaging (MRI), will be used for staging if testicular cancer is diagnosed.

Differential Diagnoses

Not all pain in the testicular area actually comes from the testicle. In fact, referred pain, or pain radiating from somewhere else, such as from a kidney stone or pinched nerve, may be the cause.

If your doctor suspects a kidney stone, a urine test to look for blood and/or a CT scan to evaluate your urinary tract system may be ordered. Likewise, imaging, often an MRI of your spine, and a thorough neurological exam can be used to diagnose a pinched nerve.

Treatment

Depending on the cause of your testicle pain, your doctor will recommend one of many therapies.

At-Home Treatments

Many causes of testicle pain can be treated or partially treated with at-home therapies. For instance, in addition to prescribed antibiotics, epididymitis can be treated with scrotal elevation, ice, and a nonsteroidal anti-inflammatory like ibuprofen to reduce pain.

For men with unexplained orchialgia, these options may bring relief, although beware that it may take three months or more for you to notice an improvement:

  • Rest: Don’t lift heavy objects or do strenuous exercise. Avoid aggravating sore muscles.
  • Heat: Using a heating pad or sitting in a hot bath can stimulate blood flow and soothe muscle aches.
  • Anti-inflammatories: Nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen can reduce pain.
  • Tight-fitting underwear: Wearing it helps restrain movement and the pain it can cause.
  • Physical Therapy: Home exercises and stretching may help strengthen pelvic floor muscles and ease spasms.

Medications

Besides anti-inflammatory medications, antibiotics are used to treat infectious-related causes of testicle pain, such as epididymitis or Fournier's gangrene.

Surgery

With certain causes of testicle pain, surgery is required. For example, Fournier's gangrene requires emergent surgical removal of the infected and dying tissue, as well as sometimes reconstructive surgery. Likewise, testicular torsion requires emergent surgery to promptly restore blood supply to the affected testicle.

Surgery is also the first treatment for almost all testicular cancers.

Nerve Block and Cord Dennervation

A nerve block may be used for chronic orchialgia when at-home treatments don’t work.

With a nerve block, a urologist injects an anesthetic into the spermatic cord. If the anesthetic does take away the pain, your urologist can deduce that the cause of pain is in the testicle.

A urologist may then suggest a procedure called cord denervation, in which a urologist cuts nerves to the testicle. This is done in an outpatient surgical center and permanently relieves testicle pain in about 75 percent of men.

Note that if the initial nerve block does not relieve the pain, your urologist will likely refer you to a pain management specialist to further access the origin of the pain.

A Word From Verywell

Testicle pain isn’t widely discussed—even by urologists—and this is especially true when it comes to chronic orchialgia, in which the "why" behind a man's pain is not always clear.

Rest assured, though, in the vast majority of cases, testicle pain can be treated. Be open to discussing your concerns with your doctor, and of course, seek immediate medical attention for any sudden and severe testicle pain.

Dr. Shoskes is a urologist at Cleveland Clinic Glickman Urological & Kidney Institute and is Director of the institute’s Novick Center for Clinical and Translational Research.

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