Why testicles hurt
Testicles are one of the most sensitive parts of a man’s body. That’s because the entire region is packed with nerves. Testicle pain can range from sudden, intense pain to a dull ache. It can be an emergency, because it may mean that something is blocking blood flow to your testicles.
Common causes of testicle pain are a long bike ride or trauma to the groin, but other sources of testicle pain may be harder to diagnose.
Pain may come from the epididymitis, which is a curved tube that sits on each testicle to store sperm. Or it may come from the scrotum, the sack that holds the testicles. In some cases, the pain may start in other parts of the body like the kidney or bowel.
The most important thing is to rule out an emergency such as testicular torsion, which would require urgent surgery. As for other causes, the treatments are a stepwise process going from least invasive to most invasive and consist of behavior changes, medication, and even surgery. —Dr. Jason Chandrapal
- Swelling in one or both testicles
- Pain in testicles
- Painful urination
- Blood in urine
- Pain during intercourse
- Malaise (not feeling well)
The epididymis is the tube inside the testicle that stores sperm. Epididymitis is an infection of this area. A bacterial infection stemming from a sexually transmitted infection (STI) or a urinary tract infection (UTI) may be the cause. Trauma can also cause epididymitis.
Your doctor diagnoses epididymitis with a physical exam, urine or blood tests, and imaging tests to rule out other causes. In some cases, epididymitis can create an abscess that needs to be drained. Epididymitis is treated with antibiotics.
- Swelling in one or both testicles
- Groin pain
- Redness or warmth around the testicles
- Pain during intercourse
- Pain during urination
Orchitis is inflammation of one or both testicles. Orchitis can be bacterial or viral, and it is sometimes the cause of an STI or UTI. Orchitis can also develop from epididymitis, and often is referred to as epididymo-orchitis.
Doctors diagnose orchitis with urine tests and imaging tests to rule out other causes. You need antibiotics to treat orchitis.
Can a UTI cause testicle pain?
Yes, a urinary tract infection (UTI) can cause testicle pain. A UTI is an infection that can occur in the urethra (the tube for urine and semen in the penis), as well as the bladder, ureters (tubes connecting the bladder to the kidneys), and kidneys. Infection along the urethra can sometimes track backwards into the branch of the urethra that leads to the testicles.
3. Inguinal hernia
- Pain in the lower abdomen
- One-sided scrotal swelling that may come and go
- Groin pain
- Testicle pain
A groin hernia, also called an inguinal hernia, is when something in the lower abdomen, such as a loop of intestine or a section of fat, has pushed through the muscles of the abdominal wall. This creates a bulge, or hernia, that can be seen and felt in the groin.
A hernia is caused by a weak spot or opening in the abdominal wall muscles, which can separate during heavy lifting or other kinds of abdominal strain. The weakness may be inherited or be caused by a previous surgery or injury.
A hernia will not heal on its own. If the herniated organ becomes stuck or the blood supply decreases or stops, you can have serious complications.
A small hernia may not need to be treated if they are not bothersome. Larger hernias are repaired with surgery.
- Extreme swelling in one or both testicles
- Dull, achy testicle pain
- Large hydroceles may restrict movement.
A hydrocele is swelling that occurs when fluid collects inside a thin sheath of the scrotum. Testicles originally develop in the abdomen and move down to the scrotum, leaving a path for abdominal fluid to collect in the scrotum. A hydrocele is common in newborns and often goes away on its own, but sometimes the opening doesn’t close.
You may not have symptoms with hydroceles at first. But as they swell, they may become more uncomfortable. They may also become infected and very painful.
You will need surgery to drain and close the hydrocele.
5. Testicular torsion
- Sudden, severe testicle pain
- Groin swelling
- Nausea or vomiting
Torsion refers to abnormal twisting of the spermatic cord, which holds blood vessels, nerves, and ducts for transporting sperm between the abdomen and the testicle. Testicular torsion can be intermittent (where the testicle becomes untwisted on its own and symptoms go away) or complete (the testicular torsion does not go away).
Although the symptoms go away in intermittent cases, torsion nearly always returns and may continue to come and go. Eventually, testicular torsion can prevent blood from circulating, leading to tissue death and even loss of the testicle.
Any type of testicular torsion is a medical emergency. You may need emergency surgery to untwist the spermatic cord and anchor the testicle in its proper place within the scrotum.
If you are diagnosed with testicular torsion and the testicle is not salvageable, it will not affect your future fertility. There is also testicular prosthesis available that can be placed at a later date. —Dr. Chandrapal
6. Testicular cancer
- Dull, achy pain in one testicle with minimal swelling
- The testicle feels hard instead of soft and pliable.
- Unexplained weight loss
Unlike other causes of scrotal pain, testicular cancer usually doesn’t cause sudden swelling. It develops slowly over time and may be painless. A sign of testicular cancer is that the testicle feels hard instead of soft and pliable.
Doctors diagnose testicular cancer through ultrasound imaging and blood and urine tests. If you are diagnosed with it, you will need more imaging tests to see if—and where—it has spread to the rest of the body. You will need surgery to remove your testicle, and depending on the extent of the disease, you may also need chemotherapy or radiation.
7. Testicular rupture
- Sudden testicular pain following trauma
- Scrotal swelling and bruising
- Nausea and vomiting
Testicular rupture happens when the outer layer of the testicle is damaged, exposing the inside of the testicle. This disrupts the blood-testis barrier, a barrier between blood vessels and the tiny, coiled tubes in testicles where sperm is produced.
Testicular rupture generally occurs when there is trauma to the scrotum. It can lead to fertility issues if it is not addressed.
Ultrasound imaging and urine tests help doctors make the diagnosis. You will need surgery to repair the testicle.
Other possible causes
Testicular pain may be due to the other following causes:
When to call the doctor
Because the testicles are very sensitive and vulnerable to damage, you need to see a doctor when you have any type of testicular pain.
When the problem is testicular torsion, you could have irreversible damage and possibly even lose a testicle. To avoid this a doctor should see you within 6 hours of the start of the pain. The doctor will determine if the pain must be treated immediately or if you can deal with it at home with rest and medication.
As medical providers, we want to help you with this pain. Given the location, it can be perceived as embarrassing to seek help but rest assured everything is confidential and professional. —Dr. Chandrapal
Should I go to the ER?
Get immediate medical treatment if:
- Testicular pain is sudden or very severe.
- Testicular pain is accompanied by nausea or vomiting.
- There is blood in your urine.
- There was trauma to your testicles.
Frequently asked questions
Why do my testicles hurt after I ejaculate?
There are many reasons why your testicles may hurt after ejaculating. Following ejaculation, you may suffer from a muscle spasm of the muscles of your perineal region. This can lead to a cramp-like pain of the testicles. You may also be suffering from congestion of the vasculature of the pelvic region, which can lead to a dull, achy sensation.
Why does my testicle pain switch sides?
Testicular pain may be due to posture or physical activities. Biking, for example, can lead to testicular pain from friction between a poorly placed bike seat and the testicles. This can switch sides with different postures. Generally speaking, more dangerous forms of testicular damage are one-sided and cause pain on a single side of the testicles.
- Avoid strenuous activity. Heavy lifting or exercise can increase the pain and worsen symptoms like swelling.
- Wear supportive underwear. Briefs are better than boxers and can help reduce the pain and swelling that come with some testicular problems.
- Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can treat minor testicular pain.
- Gently apply ice packs for a few minutes at a time to reduce swelling. A frozen bag of peas works best in the groin area.
Other treatment options
- Antibiotics treat testicular pain caused by bacteria, such as chlamydia or gonorrhea, or a UTI.
- A doctor may perform an ultrasound test to make sure that the blood flow to your testicles is not blocked and to see if there is any fluid buildup in the area.
- If the blood flow to your testicle is blocked, you will need surgery right away. Testicular pain from things like fluid buildup can be treated with less urgent surgery.
Dr. Chandrapal is the current Interprofessional Advanced Clinical Simulation Fellow at the VA medical center in Durham, NC. Prior to his current position he was a urology resident at Duke University. Originally from Houston, TX he went to undergrad at the University of Texas in Austin, followed by a masters degree from the University of Texas Health Science Center in San Antonio, and medical school at Texas Tech Health Science Center. He interested in adult learning, emotional intelligence, systems thinking, and biotechnology/innovation. In his free time he enjoys fly fishing and playing tennis.