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Scrotal Pain

By

Geetha Maddukuri

, MD, Saint Louis University

Last full review/revision May 2021| Content last modified May 2021
Click here for the Professional Version
Topic Resources

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.

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 Testicular Torsion Testicular torsion is the twisting of a testis on its spermatic cord so that the blood supply to the testis is blocked. Testicular torsion causes sudden, severe pain and later swelling of the... read more 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 Epididymitis and Epididymo-orchitis Epididymitis is inflammation of the epididymis (the coiled tube on top of the testis that provides the space and environment for sperm to mature), and epididymo-orchitis is inflammation of the... read more 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

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 Some Causes and Features of Scrotal Pain 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... read more ).

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.

Table
icon

Testing

Treatment of Scrotal Pain

Essentials for Older People

Testicular torsion Testicular Torsion Testicular torsion is the twisting of a testis on its spermatic cord so that the blood supply to the testis is blocked. Testicular torsion causes sudden, severe pain and later swelling of the... read more 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 diseases are less often the cause of epididymitis Epididymitis and Epididymo-orchitis Epididymitis is inflammation of the epididymis (the coiled tube on top of the testis that provides the space and environment for sperm to mature), and epididymo-orchitis is inflammation of the... read more . Occasionally, inguinal hernia Inguinal Hernia An inguinal hernia is a protrusion of a piece of intestine or another abdominal organ through an opening in the abdominal wall in the groin. People have a painless bulge in the groin or scrotum... read more Inguinal Hernia , perforation of the colon Perforation of the Digestive Tract Any of the hollow digestive organs may become perforated (punctured), which causes a release of gastrointestinal contents and can lead to sepsis (a life-threatening infection of the bloodstream)... read more , or kidney stones Stones in the Urinary Tract Stones (calculi) are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine. Tiny stones may cause no symptoms, but larger stones... read more Stones in the Urinary Tract (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.

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