Testicular Pain Causes and Treatment

What to Know About Orchialgia

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Testicular pain is a common symptom to have at some point in your life. However, chronic pain in your testicles, called orchialgia, may be cause for concern. Orchialgia can be caused by trauma, infection, and other more serious problems like testicular torsion that require immediate emergency care. Some causes of testicle pain are unknown.

Orchialgia can affect one or both testicles, and the pain can range from mild and dull to severe and debilitating. The pain might even extend into the groin or abdomen.

This article explores different causes of testicle pain, including an overview of how they are diagnosed and treated. It also offers tips on how to relieve pain and prevent future episodes.

testicle pain causes

Verywell / Alexandra Gordon

Causes

Acute testicle pain is pain that occurs suddenly and severely. It has many possible causes, some of which may be immediately obvious (such as getting hit in the groin during sports).

Chronic testicular pain, or orchialgia, is an entirely different issue. This is defined as testicle pain that is either constant or comes and goes for three months or longer.

Chronic testicular pain can come from an infection, injured nerves, a pulled groin muscle, or other underlying conditions that directly or indirectly trigger pain in the testicles or scrotum (the pouch of skin that houses the testicles).

Pinpointing the exact cause of orchialgia can be difficult. Studies suggest to 50% of cases of testicular pain are idiopathic (meaning of unknown origin). In cases like this, the pain may persist or resolve spontaneously on its own without treatment.

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

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

There are seven common causes that a healthcare provider might consider when faced with a case of chronic testicular pain.

Epididymitis

Epididymitis is inflammation of a coiled tube at the back of the testicle called the epididymis. This causes swelling, pain, and, in severe cases, fever and chills.

Most of the time, epididymitis is the result of a urinary tract infection (UTI) or sexually transmitted infection (STI). It can also occur as a result of trauma or, less commonly, an autoimmune disease like lupus in which the immune system attacks healthy cells and tissues.

Testicular Trauma

Trauma to the testicle is usually mild. It often comes from a direct blow to the testicle or a straddle injury (such as can occur with a motorcycle accident).

Testicular injuries are very common in contact sports and with extreme cycling or horse riding. Most of the time, injuries like these don't cause permanent damage.

Epididymal Hypertension

Epididymal hypertension, commonly known as "blue balls," is testicle pain caused by prolonged sexual arousal without orgasm. The condition is uncomfortable but not dangerous and is due to the buildup of pressure and sperm in the epididymis.

Masturbation with ejaculation can often help relieve the acute pain, although the condition usually resolves on its own without treatment.

Inguinal Hernia

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

An inguinal hernia may look like a groin bulge when a person coughs or lifts something heavy. In addition to pain, there may be a dragging sensation and swollen lymph nodes in the groin.

Post-Vasectomy Pain

After a vasectomy—a surgical form of birth control that closes off the tubes that carry sperm—some people may experience swelling, firmness, and pain in the scrotum.

In some cases, it is because sperm has leaked into the testicle and causes a painful nodule known as a sperm granuloma. In other cases, a type of epididymitis known as congestive epididymitis can cause pain due to the blocked flow of sperm.

If a nerve becomes compressed and trapped after a vasectomy, this can lead to an uncommon condition known as post-vasectomy pain syndrome.

Referred Pain

Not all pain in the testicle area starts there. You may have referred pain, meaning nerve pain that originates somewhere else but is felt elsewhere (such as the testicle).

For example, you may have pain in your testicle because a kidney stone is stuck in the urinary tract or you have a pinched nerve in your lower back that radiates pain signals to the groin.

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 as well as swelling, nausea, and vomiting.

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

When to Seek Medical Assistance

Testicular torsion is a medical emergency. If left untreated, the blockage of blood supply can cause testicular tissues to die (atrophy). Surgical repair must happen within six hours or the chances of losing the testicle are high.

Uncommon Causes

There are two rare causes of testicular pain that may be explored if an explanation cannot be found:

  • Testicular cancer: Most testicular cancers do not cause pain. However, some rapidly growing tumors may bleed or cut off blood flow to the testicle. If that happens, groin pain may develop.
  • Fournier's gangrene: This is a severe bacterial infection most commonly seen in people with diabetes that starts in the abdomen and spreads to the scrotum and penis. It is rare but potentially life-threatening, causing gangrene and massive tissue death.

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

fournier gangrene

DermNet / CC BY-NC-ND

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

Imaging

One of the most common tests for testicular pain is an ultrasound. This non-invasive device uses sound waves to create an image of the testicle that can detect injuries, abnormalities, nodules, and tumors. A color Doppler ultrasound can help detect blood circulation problems in cases of testicular torsion.

Other imaging tests may be ordered if more information is needed or in preparation for surgery:

  • Computed tomography (CT): These are a series of X-ray images that are combined by a computer to generate a three-dimensional image of internal organs and structures.
  • Magnetic resonance imaging (MRI): This uses strong magnetic and radio waves to produce highly detailed images of soft tissues.

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. People with mild testicular pain can try:

  • Rest: Don’t lift heavy objects or exercise too much. Try not to overwork sore muscles.
  • Elevation: Whenever possible, lie down. This reduces blood flow to the testicles and may help ease swelling and pain.
  • Ice application: With acute pain and swelling, a cold compress can help. Apply several days for no more than 15 minutes, moving it around constantly to prevent frostbite.
  • Heat: If there is pain without swelling, a heating pad or a hot bath can often help soothe aches.
  • Jockstrap: This can prevent any discomfort that may come with too much movement.

How to Prevent Testicle Pain

If you have a history of testicle pain, it helps to wear a jockstrap when you are engaging in sports or other physical activities. Practice good hygiene and use condoms to avoid getting an STI. It can also reduce the risk of UTIs if you engage in anal sex.

Medications

To help reduce pain, you can buy over-counter pain relievers like Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen).

Other prescription drugs may be prescribed to treat the underlying cause. This may involve antibiotics to treat certain STIs, UTIs, and other bacterial infections. The treatment of these infections will almost invariably relieve pain.

Nerve Block and Cord Denervation

A nerve block may be considered if the pain is chronic and does not respond to conservative treatment. With a nerve block, a specialist called a urologist injects an anesthetic into the spermatic cord (a group of vessels and nerves that service the testicle and holds it in place).

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

Surgery

To treat some conditions causing testicular pain, you may need surgery. Example include:

  • Testicular torsion repair: This surgery, typically performed by a urological surgeon aims to restore the blood supply to the testicles.
  • Orchiectomy: Most testicular cancers also involve surgery, removing both the tumor and testicle itself. The removal of a testicle is called orchiectomy.
  • Surgical debridement: This is the removal of damaged or dead tissue, such as occurs with Fournier's gangrene. Orchiectomy may also be used if gangrene affects the testicles.

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.

Frequently Asked Questions

  • Can testicle pain go away on its own?

    Sometimes it can. In fact, in up to 50% of cases, the cause of testicular pain is unknown. With that said, you should seek immediate care if the pain is severe and causes nausea or vomiting or the testicle to ride up in the scrotum. These are signs of a medical emergency known as testicular torsion.

  • Does testicular cancer cause testicle pain?

    Not typically. With testicular cancer, the tumor is most often painless. However, if the tumor is advanced, it can cause bleeding or block blood vessels or ducts, both of which can trigger pain.

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