Could be hundreds of reasons.
Testicular pain varies in intensity and duration, from a dull ache to a sudden surge, and from a twinge that comes and goes quickly to pain that recurs over several months. It occurs in or around one or both testicles. Pain is often the first sign that something is wrong, and you need to pay attention. It is not normal for testicles to hurt.
When to go to the emergency room
If your pain is sudden, and you didn’t just get kicked in the groin or have a vasectomy, go to the emergency room. Accompanying symptoms you should heed include blood in the urine, fever, or nausea.
When to make an appointment with your provider
On the other hand, if your pain is a dull ache that lasts over three months, make an appointment with your own personal doc who may refer you to a urologist.
If you discover a lump in your testicle, immediately make an appointment with your provider. Testicular cancer has a high cure rate when caught early.
A litany of pain
Swelling and pain are sure signs of many conditions. Don’t ignore them, hoping they will go away. The following alphabetized list is a reminder of how many ways testicles can hurt.
Brucellosis
If brucellosis sounds like a cow disease, that’s because it’s related. It is an extremely rare bacterial infection you get from ingesting raw dairy products from domestic or wild animals with brucellosis, from inhaling contaminated air, or from touching blood and body fluids from infected animals. People who work with animals, who hunt animals, and who study them under microscopes are at higher risk of getting it than people with other occupations. It causes inflammation in many organs, and by the time it causes painful, swollen testicles, you will probably know you have something serious. The treatment is antibiotics, but the condition may return and even become chronic. For prevention measures, go here.
Chronic orchialgia
Chronic orchialgia is testicular pain that comes and goes with no apparent cause; it occurs in an estimated 100,000 US men each year. This is a common condition and is usually a result of inflammation of the epididymis with an unknown source.
Epididymitis and orchitis
A coiled tube at the top rear of the testicles is the epididymis. It is where sperm go to mature, on their way through the vas deferens to the urethra and out the body. If it gets inflamed by bacteria, a virus, chemical irritation, a sexually transmitted infection, or other causes it swells, becomes red, and makes the scrotum feel warm.
Orchitis causes swelling or pain in the testicles because of a bacterial or viral infection.
Both cause pain.
Groin pain
Various testicular conditions can cause groin pain including
- Epididymitis
- Hydrocele
- Inguinal hernia
- Orchitis
- Retractile testicle
- Scrotal masses
- Spermatocele
- Testicular cancer
- Testicular torsion
- Varicocele
- Kidney stone
Hematocele
Hematocele is a buildup of blood around a testicle after injury or trauma to the testicles; it is one of a number of scrotal masses.
Hydrocele
Hydrocele is a buildup of fluid around the testicles; it can happen to infants, but also to adults and is usually not painful. There are different causes of hydrocele, but the most common is an inflammatory reaction after infection or trauma which leads to fluid building up around the testicle.
Inguinal hernia
Part of the intestine has pushed through a weak spot in the abdominal (groin) muscles; inguinal hernia can cause testicular pain.
Kidney stones
Kidney stones can cause referred pain in the testicles; it is accompanied by difficult urination, blood in the urine, nausea, or vomiting.
Irritation to the lumbar paravertebral nerve chains, hypogastric plexus, pudendal nerve, or ilioinguinal/genitofemoral nerves can cause testicular pain. This is most common after a hernia repair with mesh.
Prostatitis
Inflammation of the prostate gland can cause testicular pain, often accompanied by painful urination, cloudy urine, or blood in the urine. It is often treated with antibiotics.
Scrotal mass
A scrotal mass can show a variety of symptoms:
- A lump
- Sudden pain or a dull, aching pain; pain radiating through the groin, abdomen, or lower back
- A feeling of heaviness in the scrotum
- A hardened testicle that is tender or swollen
- Inflammation of the epididymis, the internal tube above and behind the testicle that stores and transports sperm
- Swelling or redness of the scrotum
- Nausea, vomiting
Many causes of scrotal masses exist. Even if the mass is not painful, it is important to see a doctor about it, because the presence of a scrotal mass early in life could increase the risk of other scrotal masses later.
Spermatocele
A spermatocele is a cyst that forms in the epididymis, the coiled tube at the top and rear of the testicle; it is usually not painful, unless it grows too large and exerts pressure.
Testicular cancer
Testicular cancer is highly treatable when caught early. It often starts as a scrotal mass. Any mass should be attended to; all masses are not cancerous. Many other testicular conditions begin with masses.
One of the four risk factors for testicular cancer is an undescended testicle.
Although it seems extreme, removal of the testicle suspected of being cancerous is recommended, rather than having a biopsy. Testicular cancer has a number of characteristics that make it one of the most treatable.
Testicular torsion
If you are between 12 and 18 and you experience sudden, severe testicular pain on one side (usually the left) of the scrotum in the middle of the night or after vigorous exercise, and one testicle is swollen and higher than the other or situated at an unusual angle, you might have testicular torsion. If so, blood flow is being stopped. Tissue without blood dies. This is an emergency and you should tell an adult and seek treatment immediately. If medical management isn’t started within six hours, you could lose that testicle.
It happens to about 1 in 4,000 males under age 25. It happens to babies and seniors, too. It’s important to know about it not because it’s so common, but because it’s so serious. Urology Care says that “4 out of 10 young men who have testicular torsion will lose the affected testicle.”
Testicular torsion is not well recognized by patients as an emergency; Indeed, many people have never heard of it.
Testicular torsion happens to newborns, too, and is usually discovered at birth or during a pediatric visit after birth.
Swollen and painful testicle(s)
Mild to sharp testicular pain in one or both testicles accompanied by swelling could mean an infection or a number of other conditions, including any in this list.
Varicocele
A varicocele is like a varicose vein in the leg, except this one is in the testicle. It’s a swollen blood vein. It is usually not painful, but can cause intermittent aching. Unlike in the leg, you can’t usually see this varicocele. But your urologist can feel it during an exam called the Valsalva maneuver. It’s often called a bag of worms because of the way it feels.
Varicoceles are common on the left side. If you have a varicocele on the right side, that is unusual and could be a sign of a larger problem so it will necessitate a visit to a Urologist.
Varicoceles can limit fertility. That’s because of heat. Ordinarily, sperm in the testicles and epididymis is several degrees cooler than normal body temperature. Blood flow, structures within the testicles, and the fact that the testicles are outside the body keep it that way. When blood veins enlarge, they don’t have the blood cooling capability to keep sperm at optimal temperature. That testicle with the varicocele might produce low quality sperm and diminish your fertility.
About 15 men in 100 have a varicocele. About four in 10 men tested for fertility problems have a varicocele and decreased sperm movement.
Medical treatment is usually over the counter pain relievers, but there are surgical treatments and a radiological treatment, as well.
Vasectomy
After a vasectomy 1-2% of men have post-vasectomy pain syndrome, a dull ache or fluid buildup in the testicles.
The canary in the coal mine?
Testicles are sensitive in their own right: that is, when problems occur in or on them, such as testicular torsion or scrotal masses. But they are often the site of referred pain, or the sign of something else going on in your body. It’s this other problem that causes your testicles to hurt.
They are the site of so much referred pain, in fact, that they provide a good way for you to use that pain to your advantage. A 2020 retrospective study of medical literature identified 245 rare causes of acute scrotal pain (besides torsion and epididymitis) from acute aortic syndrome to tuberculosis. Don’t ignore the pain.
Take matters into your own hands
Examine your testicles every month for changes (usually not a good sign). Use these instructions. Pay attention to lumps, pain, itching, bumps, or any other changes and see your doctor if you find any.