A right testicle that hurts when you touch it is most commonly caused by inflammation of the epididymis, a tightly coiled tube that runs along the back of the testicle. Less often, the pain comes from an infection of the testicle itself, a fluid-filled cyst, or a structural problem like a twisted spermatic cord. The location, severity, and timing of the pain all point toward different causes, and some require urgent medical attention.
Normal Anatomy You Might Be Feeling
Before assuming something is wrong, it helps to know what’s supposed to be there. Each testicle is roughly egg-shaped and slightly smaller than a golf ball. Running along the back and top of each one is the epididymis, a narrow, coiled tube where sperm is stored and matures. It has a distinct head at the top, a body along the back, and a tail at the bottom that connects to the vas deferens (the tube that carries sperm upward).
The epididymis can feel like a soft ridge or cord behind the testicle, and it’s mildly tender even in healthy people if you press firmly. It’s also completely normal for one testicle to be slightly larger than the other or to hang a bit lower. If the soreness you’re feeling is mild and only noticeable with deliberate pressure along that back ridge, you may simply be pressing on normal anatomy.
Epididymitis: The Most Common Cause
Epididymitis is inflammation of the epididymis, and its hallmark is tenderness along the back and upper portion of the testicle when you press on it. In younger, sexually active men, it’s typically caused by sexually transmitted bacteria like chlamydia or gonorrhea. In older men or those who practice insertive anal sex, intestinal bacteria are more often responsible. You’ll usually notice a gradual buildup of pain over a day or two, sometimes with swelling, warmth, or redness on that side of the scrotum. Burning during urination or unusual discharge can accompany it.
One useful clue: if gently lifting the affected testicle provides some pain relief, that suggests epididymitis rather than something more serious like torsion. This is called Prehn’s sign. It’s not a definitive test, but it’s a quick way to get an initial sense of what’s going on. Treatment for bacterial epididymitis involves antibiotics, typically for about 10 days, and most people feel significant improvement within the first few days.
When the Testicle Itself Is Inflamed
If the tenderness is centered on the body of the testicle rather than the structure behind it, the inflammation may have spread to the testicle itself. This is called orchitis, or epididymo-orchitis when both structures are involved. Viral infections (most famously mumps) can cause orchitis on their own, but bacterial infections that start in the epididymis frequently spread to the testicle if untreated. The pain tends to be more diffuse, the swelling more pronounced, and you may feel generally unwell with a low fever.
Testicular Torsion: The Emergency
Testicular torsion happens when the spermatic cord twists, cutting off blood supply to the testicle. It causes sudden, severe pain that typically doesn’t improve with lifting or repositioning. While torsion occurs more often on the left side due to anatomical differences in how the cord attaches, it absolutely can happen on the right.
The timeline matters enormously. Salvage rates exceed 90% when surgery happens within 6 hours of the pain starting. By 12 hours, the chance of saving the testicle drops to about 50%. After 24 hours, it falls below 10%. Tissue begins to die within 8 to 10 hours. This is why sudden, intense testicular pain is treated as an emergency.
Torsion pain is usually too severe to describe as “hurts when I touch it.” If you’re calmly searching this topic online, torsion is less likely. But if the pain came on abruptly, is intense, and you feel nauseous, don’t wait to see if it improves.
Cysts, Fluid Collections, and Enlarged Veins
Several benign conditions can make a testicle tender to the touch:
- Spermatocele: A fluid-filled cyst that forms in the epididymis, usually near the head at the top of the testicle. Small ones are painless, but larger ones can cause a dull ache or tenderness when pressed. You might feel it as a small, smooth lump separate from the testicle itself.
- Hydrocele: A collection of fluid around the testicle. A tense hydrocele can make the whole scrotum feel firm and uncomfortable to touch. Smaller secondary hydroceles may allow you to partially feel the testicle underneath, while larger primary ones can make palpation difficult.
- Varicocele: Enlarged veins in the scrotum, often described as feeling like a “bag of worms.” Varicoceles are more common on the left side but can occur on the right. They tend to cause a heavy, aching sensation that worsens after standing for long periods.
None of these are emergencies, but they’re worth having evaluated if the discomfort persists or the lump is growing.
Why the Right Side Specifically
In most cases, having pain on the right rather than the left doesn’t change the diagnosis. The same conditions affect both sides. The main anatomical difference is that the left testicle’s vein drains at a sharper angle, which makes varicoceles more common on the left and torsion slightly more likely there as well. A new varicocele appearing on the right side alone can occasionally signal something deeper in the abdomen affecting venous drainage, so it’s worth mentioning to a doctor if that’s what you’re experiencing.
What Happens During an Evaluation
A physical exam comes first. Your doctor will feel the testicle, the epididymis, and the spermatic cord, checking for swelling, lumps, and the specific location of tenderness. One common test involves stroking the inner thigh to trigger a reflex that makes the testicle rise slightly. This reflex is typically absent in torsion, and the test carries about 88% sensitivity and 86% specificity in detecting it.
If the physical exam doesn’t give a clear answer, an ultrasound with color Doppler imaging is the standard next step. This is a painless scan that shows both the anatomy of the scrotum and the blood flow through it. An inflamed epididymis or testicle will show increased blood flow, while a twisted cord will show reduced or absent flow. The ultrasound can also clearly identify cysts, fluid collections, and masses. It has largely replaced all other imaging for scrotal problems because it’s fast, accurate, and noninvasive.
What to Pay Attention To
Mild tenderness that you only notice when pressing firmly, especially along the back of the testicle, is often nothing to worry about. But certain patterns warrant prompt attention: pain that came on suddenly and is severe, swelling that developed over hours or days, redness or warmth of the scrotal skin, fever, or pain that radiates into your lower abdomen or groin.
A painless, hard lump on the testicle itself is a different concern. Testicular cancer rarely causes pain, but it can cause a firm mass that you notice during self-examination. Any new lump that feels like it’s part of the testicle rather than attached to structures around it should be evaluated with an ultrasound.