Testicular Pain: When to Worry and What Causes It

What can cause pain in the testicles?

The testicle, epididymis (the coiled tube behind it), and surrounding structures can each be the source of pain. Common causes include:

• Epididymitis — inflammation or infection of the epididymis, often caused by bacteria, including sexually transmitted organisms like chlamydia in younger men, or urinary tract bacteria in older men 2Ref 2Workowski KA, Bachmann LH, Chan PA, et al. (2021).Sexually Transmitted Infections Treatment Guidelines, 2021.Epididymitis caused by chlamydia/gonorrhea in sexually active young men; antibiotic treatment recommendations (ceftriaxone plus doxycycline); enteric-organism regimens for older men. It typically causes a gradual onset of pain, warmth, and swelling on one side.
• Orchitis — infection of the testicle itself, less common and often occurring alongside epididymitis; can also follow viral illness such as mumps in post-pubertal men.
• Varicocele — dilated veins in the scrotum that can cause a dull, heavy ache, often described as worse after standing or physical activity.
• Hydrocele or spermatocele — fluid collections or small cysts that are generally benign but can cause a sense of fullness or mild discomfort.
• Inguinal hernia — groin hernias can refer pain to the scrotum.
• Referred pain — kidney stones, ureteral stones, and some pelvic conditions can produce pain felt in the testicle even though the testicle itself is not the source.
• Chronic orchialgia — persistent testicular pain with no identified cause; a diagnosis of exclusion that requires full evaluation before being assigned 3Ref 3Lai HH, Pontari MA, Argoff CE, et al. (2025).Male Chronic Pelvic Pain: AUA Guideline: Part I Evaluation and Management Approach.Chronic orchialgia as a diagnosis of exclusion requiring full evaluation; scrotal ultrasound as key diagnostic tool for testicular pain; evaluation approach for chronic scrotal content pain.

What is testicular torsion and why is it urgent?

Testicular torsion happens when the spermatic cord — which supplies blood to the testicle — twists and cuts off circulation. It is most common in adolescents and young men, though it can occur at any age.

The hallmark is sudden, severe testicular pain, often with nausea, vomiting, and a testicle that may sit higher than normal or at an unusual angle. The window for saving the testicle is narrow: NIH clinical data show a salvage rate of nearly 100% when surgery is performed within 6 hours of symptom onset, dropping to less than 50% when the delay exceeds 12–24 hours 1Ref 1Leslie SW, Sajjad H, Villanueva CA (2024).Testicular Torsion.Testicular torsion salvage rate nearly 100% within 6 hours of symptom onset; drops to <50% beyond 12–24 hours; surgical exploration indicated without delay when torsion is suspected.

If you or someone near you develops sudden, severe testicular pain, do not wait — go to an emergency department immediately.

When does a dull ache in the testicle need evaluation?

Persistent or recurrent dull aching warrants a visit to a urologist even when it does not feel urgent. The evaluation typically includes:

• A physical exam of the scrotum, including feeling for masses, tenderness, and any signs of infection or varicocele
• Scrotal ultrasound with Doppler, which can visualize blood flow, identify varicoceles, hydroceles, or spermatoceles, and — critically — help rule out a testicular mass 3Ref 3Lai HH, Pontari MA, Argoff CE, et al. (2025).Male Chronic Pelvic Pain: AUA Guideline: Part I Evaluation and Management Approach.Chronic orchialgia as a diagnosis of exclusion requiring full evaluation; scrotal ultrasound as key diagnostic tool for testicular pain; evaluation approach for chronic scrotal content pain
• Urine testing or STI swab if epididymitis or orchitis is suspected 2Ref 2Workowski KA, Bachmann LH, Chan PA, et al. (2021).Sexually Transmitted Infections Treatment Guidelines, 2021.Epididymitis caused by chlamydia/gonorrhea in sexually active young men; antibiotic treatment recommendations (ceftriaxone plus doxycycline); enteric-organism regimens for older men

Testicular cancer sometimes presents as a painless lump, but a minority of cases do cause aching or heaviness. Any new scrotal mass should be evaluated by ultrasound promptly. The American Cancer Society reports 5-year survival rates above 95% for testicular cancer caught at an early stage 3Ref 3Lai HH, Pontari MA, Argoff CE, et al. (2025).Male Chronic Pelvic Pain: AUA Guideline: Part I Evaluation and Management Approach.Chronic orchialgia as a diagnosis of exclusion requiring full evaluation; scrotal ultrasound as key diagnostic tool for testicular pain; evaluation approach for chronic scrotal content pain.

How is epididymitis diagnosed and treated?

Epididymitis is one of the most common causes of acute scrotal pain in men. Diagnosis is made by physical exam, urine culture, and in younger sexually active men, testing for chlamydia and gonorrhea. Scrotal ultrasound is often ordered to exclude torsion and confirm increased blood flow to the epididymis on Doppler imaging.

Treatment depends on the likely organism:

• Sexually transmitted (younger men): The 2021 CDC STI guidelines recommend ceftriaxone plus doxycycline for coverage of both gonorrhea and chlamydia 2Ref 2Workowski KA, Bachmann LH, Chan PA, et al. (2021).Sexually Transmitted Infections Treatment Guidelines, 2021.Epididymitis caused by chlamydia/gonorrhea in sexually active young men; antibiotic treatment recommendations (ceftriaxone plus doxycycline); enteric-organism regimens for older men.
• Enteric organisms (older men or those who practice insertive anal intercourse): A fluoroquinolone antibiotic (levofloxacin) is commonly used 2Ref 2Workowski KA, Bachmann LH, Chan PA, et al. (2021).Sexually Transmitted Infections Treatment Guidelines, 2021.Epididymitis caused by chlamydia/gonorrhea in sexually active young men; antibiotic treatment recommendations (ceftriaxone plus doxycycline); enteric-organism regimens for older men.

Supportive care includes scrotal support, NSAIDs for pain and swelling, and avoidance of strenuous activity. Most men improve within 48–72 hours of starting antibiotics, though full resolution of swelling may take several weeks.

What specialist should you see?

Testicular pain that is not an emergency is best evaluated by a urologist, who can perform a physical exam and order scrotal ultrasound if needed.

• Sudden severe pain: emergency department, immediately
• Significant pain with fever, swelling, or discharge: same-day urgent care or emergency department
• Persistent or recurrent dull ache: schedule with a urologist

Gale does not provide direct urology care, but a Gale clinician can help you assess whether your symptoms need urgent evaluation, coordinate a referral, and review any results with you.