Testicular Pain

Pain in a testicle is one of the most common reasons men ask to see a urologist, and one of the most worrying to live with. Most causes are treatable, some need nothing more than reassurance and time, and one — testicular torsion — is a surgical emergency. This page explains what causes testicular pain, which symptoms need urgent attention, how the problem is assessed and what treatment usually involves.

Understanding testicular pain

Testicular pain is discomfort felt in one or both testicles, or in the structures around them — the scrotal skin, the epididymis (the coiled tube behind each testicle) and the spermatic cord running up towards the groin. It can be sharp and sudden, or a dull ache that builds over days or weeks; some men describe heaviness or dragging rather than pain, often worse at the end of the day or after long periods of sitting.

Men often delay being seen because of what they fear will be found. Most testicular pain is not caused by cancer, and a good number of men turn out to have nothing structurally wrong. It is equally true that one cause — testicular torsion — is a surgical emergency, so pain that arrives suddenly and severely should never be waited out at home.

Symptoms that need urgent attention

Go straight to your nearest emergency department, rather than waiting for a clinic appointment, if you have:

• sudden, severe pain in one testicle, particularly if it woke you from sleep or began during exercise;
• testicular pain with nausea, vomiting or feeling faint;
• a testicle that sits higher than usual, lies horizontally, or is exquisitely tender to the lightest touch;
• pain after an injury, especially with marked swelling or bruising;
• fever, spreading redness of the scrotum, or feeling generally unwell;
• testicular pain with an inability to pass urine.

Testicular torsion, in which the cord twists and cuts off the blood supply, is most common in teenagers and men under 30 but can occur at any age. The testicle can usually be saved if surgery takes place within a few hours of the pain starting, so it is always better to be assessed and told nothing is wrong. If you are unsure, treat sudden severe pain as an emergency.

Common causes of testicular pain

Infection and inflammation

Epididymo-orchitis — inflammation of the epididymis, sometimes involving the testicle itself — is the most frequent cause of pain that develops over a day or two. The scrotum becomes tender, swollen and often warm, and there may be burning on passing urine, a discharge, or a need to pass urine more often. In younger men it is frequently related to a sexually transmitted infection; in men over 35 it more commonly follows a urinary tract infection or prostate inflammation.

Cysts, fluid and enlarged veins

A hydrocele (fluid collecting around the testicle), an epididymal cyst, or a varicocele (enlarged veins in the cord, often described as feeling like a small bag of worms) tend to cause aching and heaviness rather than sharp pain. Varicoceles are more common on the left and often ache more after a day on your feet.

Pain referred from elsewhere

Pain is sometimes felt in the testicle but arises elsewhere. A stone in the ureter classically causes loin pain radiating into the groin and testicle, occasionally with haematuria (blood in the urine). An inguinal hernia, hip or lower back problems, and irritation of nerves after groin surgery can all do the same. In these cases the testicle itself usually examines normally.

After surgery or injury

A small proportion of men develop persistent aching after vasectomy, hernia repair or scrotal surgery. Most direct injuries settle with rest and support, but a significant blow that leaves the scrotum very swollen or bruised needs same-day assessment to rule out rupture.

Testicular cancer

Testicular cancer usually appears as a painless lump, but a minority of men do have pain or a dull ache. Any new firm lump within the body of the testicle should be examined promptly, whether or not it hurts. It is an uncommon diagnosis, and outcomes are generally good when it is found early — a reason to be seen rather than to wait and watch.

How testicular pain is assessed

A consultation begins with the history: how the pain started, where it sits, whether it moves, what makes it better or worse, and whether there are urinary or sexual symptoms alongside it. Previous surgery, injury, infections and fertility plans all matter. Examination covers the scrotum, groin, abdomen and, where relevant, the prostate.

Investigations are chosen to answer a specific question, not run as a routine panel. They commonly include a urine test and culture, screening for sexually transmitted infection where that is a possibility, and a scrotal ultrasound scan with Doppler assessment of blood flow, the usual first-line imaging for the scrotum. If a lump is found within the testicle, blood tests for tumour markers are normally added. Where referred pain is suspected, imaging of the kidneys and ureters is often more useful than scanning the scrotum.

One point is worth making: in men with long-standing pain the scan is often normal. That is reassuring, and it does not mean the pain is imagined or that nothing can be done.

Treatment

Treatment follows the cause rather than the symptom.

• Epididymo-orchitis is treated with a course of antibiotics, usually for around two weeks and chosen according to the likely organism, along with rest, scrotal support and simple pain relief. Swelling and tenderness often take several weeks to settle after the infection has been treated; that is expected and not a sign that treatment has failed. Where a sexually transmitted infection is found, partners will need testing too.
• Hydroceles and epididymal cysts need no treatment when they are comfortable. Surgery is discussed only when size or discomfort genuinely interferes with daily life.
• Varicoceles may be treated when they cause persistent aching or are relevant to fertility, but many are simply monitored.
• Stones, hernias and nerve-related pain are managed as the underlying condition rather than as a scrotal problem.
• A suspicious lump within the testicle is managed urgently along established cancer pathways.

Chronic testicular pain

Pain present for three months or more, constantly or on and off, and interfering with work, exercise or sleep, is described as chronic scrotal pain. In many men no single structural cause is found. The nerves supplying the testicle share pathways with those from the lower abdomen and back, and can remain sensitised long after whatever first triggered them has settled.

Management is stepwise and usually begins conservatively: reviewing pain relief, considering medicines that act on nerve pain, addressing pelvic floor muscle tension with physiotherapy, and sometimes using a local anaesthetic block of the spermatic cord, which can help both to relieve pain and to clarify where it comes from. A small number of carefully selected men go on to discuss surgery. It is not a step taken lightly: results vary, no operation can be promised to remove the pain, and it is considered only after simpler measures have had a fair trial.

When no treatment is needed

Not every finding needs acting upon. Small epididymal cysts, small varicoceles that do not ache, and comfortable hydroceles can reasonably be left alone and reviewed if they change. Scrotal surgery carries its own risks, including making pain worse, so an honest recommendation is sometimes to do nothing. Mild aching after a long day that settles with rest is common and does not, on its own, indicate disease.

If you are advised that no treatment is needed, you should still be told what would bring you back: a new firm lump, a change in the size or feel of a testicle, fever, or pain that becomes steadily worse rather than better.

Seeing a urologist in London

The Andrology Centre is a consultant-led service. Its three consultants — Mr Maj Shabbir, Consultant Urological Surgeon, Clinical Lead of The Andrology Centre and past National Chair for Andrology at BAUS; Ms Raveen Kaur Sandher, Consultant Urological Surgeon; and Ms Elsie Mensah, Urology Specialist with an interest in bladder cancer, BPH and prostate diagnostics — all practise at Guy’s & St Thomas’, named by Newsweek in 2025 as the No.1 urology service in Europe.

Consultations are held at HCA at The Shard (SE1 9BS), HCA at Canary Wharf (E14 5NR) and HCA at Guy’s Hospital (SE1 9RT). If you are paying for your own care you do not need a GP referral; if you are using private medical insurance, your insurer will usually require one, so check with them before booking.

To arrange an appointment, call +44 7889 318584 (lines open Monday to Friday, 8am to 4pm) or email contact@theandrologycentre.co.uk. If your pain came on suddenly and severely, do not wait for an appointment — go to your nearest emergency department.

Frequently asked questions

References and further reading