Pain in the scrotum (the sac that surrounds and protects the testes) can occur in males of any age, from newborns to older men. The testes are very sensitive, so even minor injuries may cause pain or discomfort.
(See Overview of Urinary Tract Symptoms.)
Causes of Scrotal Pain
Pain may be directly related to the testes or be caused by disorders in the scrotum, groin, or abdomen.
Common causes
The most common causes of sudden scrotal pain include
Twisting of a testis (testicular torsion)
Twisting of the testicular appendage (a small piece of tissue attached to the testis)
Inflammation of the epididymis (epididymitis)
Testicular torsion occurs when a testis twists on its spermatic cord. The twisting blocks blood flow to the testis, causing pain and sometimes death of the testis. Testicular torsion is more common in newborns and after puberty. Torsion can also occur in the testicular appendage, a small piece of basically functionless tissue that is left over from development of the embryo. Like testicular torsion, the twisting of the testicular appendage can block blood flow, causing pain. Torsion of the testicular appendage is more common among boys aged 7 to 14.
Epididymitis is inflammation of the coiled tube on top of the testis in which sperm mature. Epididymitis is the most common cause of scrotal pain in adults. Epididymitis is usually caused by an infection, typically a sexually transmitted one. However, sometimes there is no infection. In such cases, doctors believe the epididymis becomes inflamed by reverse flow of urine into the epididymis, perhaps because of straining (as when people lift something heavy).
Less common causes
There are a number of less common causes. Less common causes include
A hernia in the groin (inguinal hernia)
Infection of the testis (orchitis), usually caused by mumps or another virus
Pain from a disorder in the abdomen (such as a kidney stone or appendicitis)
Injury
Dangerous disorders that sometimes cause scrotal pain include a ruptured abdominal aortic aneurysm and necrotizing infection of the perineum—the area between the genitals and anus—called Fournier gangrene. Cancer of a testis only rarely causes pain.
Evaluation of Scrotal Pain
The following information can help people decide when immediate medical attention is necessary and help them know what to expect during the evaluation.
Warning signs
In men with pain in the scrotum, certain symptoms and characteristics are cause for concern. They include
Sudden, severe pain
Swelling in the scrotum or groin area, particularly one that cannot be pushed down and that is accompanied by severe pain or vomiting
Blisters and/or red or black discoloration of the scrotum or the area between the penis and the anus
Symptoms of severe illness, such as high fever, difficulty breathing, sweating, dizziness, or confusion
When to see a doctor
Men or boys who have warning signs or are in severe pain should see a doctor immediately because some causes of pain can lead to loss of a testis or other severe complications. People without warning signs should see a doctor in a day or two.
What the doctor does
Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What they find during the history and physical examination often suggests a cause of the scrotal pain and the tests that may need to be done (see table Some Causes and Features of Scrotal Pain).
Doctors ask
Where the pain is located
How long pain has been present
Whether there are injuries to the groin area
About the man's sexual history
Whether there are any problems urinating (such as burning or discharge)
Whether there are any disorders that may cause pain to travel to the groin
Although the physical examination concentrates on the genitals, the groin area, and the abdomen, doctors also look for signs of disorders elsewhere that may cause pain to be felt in the scrotum. Doctors first look to identify disorders that require immediate treatment. The onset and nature of the pain and the age of the person can provide clues to the cause.
Testing
The need for tests depends on what doctors find during the history and physical examination. However, some testing is typically done.
Testing for sexually transmitted infections
Color Doppler ultrasonography if testicular torsion seems possible
Timely surgery for testicular torsion is critical, so when doctors are very concerned about testicular torsion they may do surgery immediately instead of testing.
Treatment of Scrotal Pain
The best treatment of scrotal pain is treatment of the cause of pain. For example, testicular torsion, strangulated hernias, and necrotizing infection require prompt surgery.
Doctors may give analgesics, such as nonsteroidal anti-inflammatory drugs or opioids, to relieve severe pain.
Essentials for Older People: Scrotal Pain
Testicular torsion is uncommon in older men. When it occurs, the symptoms may be unusual, making the diagnosis more difficult. Epididymitis and orchitis are more common in older men. Sexually transmitted infections are less often the cause of epididymitis. Occasionally, inguinal hernia, perforation of the colon, or kidney stones (renal colic) may cause scrotal pain in older men.
Key Points
Testicular torsion is the first consideration in males with sudden onset of scrotal pain, particularly in children and adolescents.
Epididymitis is the most common cause of scrotal pain in men, particularly those with discharge or burning or pain during urination.
Doctors may do surgery instead of imaging tests if they are particularly concerned about testicular torsion.
Scrotal pain can be caused by pain that is referred from the abdomen.
