Testicular pain ranges from a minor ache that resolves on its own to a surgical emergency that needs treatment within hours. The single most important thing to know: sudden, severe pain that comes on quickly is an emergency. If that describes what you’re feeling right now, go to the ER. For everything else, here’s how to figure out what’s going on and what to do about it.
When to Go to the ER Immediately
Testicular torsion happens when the spermatic cord twists and cuts off blood flow to the testicle. It causes rapid, severe pain and swelling, often with nausea, vomiting, or lower abdominal pain. This is most common between ages 12 and 18, but it can happen at any age. A twisted testicle can die within hours if blood flow isn’t restored surgically, so this is genuinely time-sensitive. If you have sudden, intense scrotal pain, especially if one testicle looks higher than usual or is sitting at an odd angle, get to an emergency room.
Other emergencies that can mimic or accompany testicular pain include an incarcerated inguinal hernia, where part of the bowel gets trapped in the groin. This is a surgical emergency too. Rarely, a spreading skin infection of the scrotum and groin can develop. Signs of this include rapidly worsening redness, swelling that extends beyond the scrotum, skin that looks dark or discolored, or a crackling feeling under the skin when you press on it. Any of these warrant an immediate ER visit.
What to Do for Mild to Moderate Pain
If your pain came on gradually, isn’t severe, and you don’t have the emergency symptoms above, there are a few things you can do at home while you figure out next steps:
- Rest. Stop any activity that might be causing or worsening the pain, whether that’s exercise, heavy lifting, or long periods of standing.
- Ice the area. Apply a cold pack for 10 to 20 minutes at a time with a thin cloth between the ice and your skin.
- Wear supportive underwear. Briefs or compression shorts hold everything in place and reduce movement that aggravates pain. Switch away from boxers for now.
- Take an over-the-counter pain reliever. Ibuprofen or acetaminophen can help with both pain and inflammation.
These steps manage symptoms, but they don’t treat the underlying cause. If your pain doesn’t improve within a day or two, or if it keeps coming back, you need to see a doctor.
Common Causes of Testicular Pain
Epididymitis
This is one of the most frequent causes, especially in younger men. The epididymis is a coiled tube behind each testicle that stores and carries sperm. When it gets inflamed or infected, you feel a gradually worsening ache on one side, sometimes with swelling, warmth, or pain during urination. In sexually active men, the cause is often a sexually transmitted infection like chlamydia or gonorrhea. In older men, it’s more commonly caused by urinary tract bacteria. If the infection spreads to the testicle itself, that’s called epididymo-orchitis. Either way, it’s treated with antibiotics, typically a 10-day course. Left untreated, the infection can worsen and potentially affect fertility.
Varicocele
A varicocele is an enlargement of the veins inside the scrotum, similar to varicose veins in the legs. It usually develops on the left side. The hallmark symptom is a dull, aching discomfort that gets worse as the day goes on or after standing for a long time, and feels better when you lie down. A large varicocele can look or feel like a “bag of worms” above the testicle, and the affected testicle may be noticeably smaller. Many varicoceles don’t need treatment. If yours is painful or affecting fertility, a urologist can discuss repair options.
Pain Coming From Somewhere Else
Sometimes what feels like testicular pain actually originates outside the scrotum. Kidney stones are a classic example. The pain travels along shared nerve pathways from the kidney or ureter down into the groin and testicle. Inguinal hernias, where tissue pushes through a weak spot in the abdominal wall, can also send pain into the scrotum, especially during straining or lifting. Prostatitis (inflammation of the prostate), urinary tract infections, and even nerve damage from diabetes can all present as testicular pain. If a doctor examines your testicles and doesn’t find anything wrong, these “referred pain” sources are the next thing to investigate.
What Happens at the Doctor
A physical exam is the starting point. Your doctor will check for swelling, tenderness, lumps, and how the testicle sits. In most cases of acute scrotal pain, the next step is an ultrasound with Doppler imaging. This is the standard first-line test. It’s painless, uses no radiation, and shows blood flow to the testicle (critical for ruling out torsion), fluid collections, cysts, hernias, and masses. The ultrasound combined with your history and physical exam can diagnose the majority of scrotal conditions. MRI is sometimes used as a second step if ultrasound results are unclear, but that’s uncommon.
If an infection is suspected, you’ll likely also give a urine sample or get tested for STIs to guide antibiotic treatment.
Chronic Testicular Pain
Pain that lasts six weeks or longer is considered chronic. Chronic scrotal pain can be frustrating because it sometimes persists even after an initial cause has been treated, or no clear cause is ever found. This is more common than most people realize.
Treatment usually starts conservatively. Pelvic floor physical therapy is one option that can help, particularly if tight pelvic muscles are contributing to the pain. In one study of 30 men with chronic scrotal pain who had pelvic floor tightness, about 13% had complete pain resolution after physical therapy, and another 44% improved to only minor residual pain. The number of patients needing pain medication also dropped significantly.
If conservative measures don’t work, nerve blocks can be used both as a diagnostic tool and for temporary relief. A spermatic cord block numbs the nerve pathways running to the testicle. The relief is usually short-lived, but how well you respond predicts whether a more permanent procedure would help. Microsurgical denervation of the spermatic cord is a surgical option for men who responded well to a nerve block. Reported success rates for significant pain reduction range from 77% to 100%, though the procedure carries risks including, in rare cases, loss of the testicle. A newer, more targeted version of this surgery aims to reduce those risks by only cutting specific structures rather than everything in the cord.
Chronic testicular pain benefits from a stepwise approach, starting with the least invasive options and escalating only when needed. A urologist who specializes in this area can walk you through the options based on your specific situation.