Pain in one or both testicles can be worrisome, but only a few conditions require immediate medical attention.

Common causes of testicular pain

Trauma or injury

Since the testicles are so sensitive, a direct blow of any kind can cause pain. In many cases, even if the testicles swell and bruise, no serious or permanent damage will result. Sometimes, however, a testicle may rupture or develop a hematocele (a pooling of blood around the testicle). In these cases, a doctor should be seen right away.

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Testicular torsion

This is an emergency condition. The testicles sit inside the scrotum and are connected to the spermatic cord, which includes the blood vessels that feed and drain the testicles. When a testicle gets twisted inside the scrotum, its blood vessels are also twisted, which cuts off the blood supply to the testicle. Emergency surgery must be done in order to save the testicle.

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Pain from testicular torsion usually happens very suddenly, sometimes with nausea and vomiting. A man who has had torsion once is more likely to have it again.

Epididymitis

The epididymis is an organ next to the testicle, in which sperm matures on its way out. Most often, an infection causes the swelling and pain of the epididymis, not the testicle itself. The scrotum may be swelled up and feel hot, and the pain comes on gradually. These infections may come from a sexually transmitted disease, like chlamydia or gonorrhea, or from a urinary tract infection. Antibiotics are given to get rid of the infection.

Orchitis

Orchitis is a little different from epididymitis in that it involves inflammation of the testicle tissue itself. If a case of epididymitis is not treated soon enough, it can lead to orchitis. The mumps virus can cause orchitis, and while antibiotics do not work on a virus, other simple treatments, like pain relievers, rest, and scrotal support or elevation can help the pain and swelling.

Hernias

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A hernia occurs when a part of the wall of the abdomen gets weak and allows part of the intestine or other intra-abdominal contents to push through. If this happens near the scrotum, the hernia sac can push on the blood supply to the testicle or other areas of the scrotum. Usually, coughing or sneezing makes the pain worse.

Varicocele

This condition involves swelling of the veins draining the testicle, and usually appears on the left side. Larger varicoceles can be felt as a soft mass above the testicle, or even seen in the standing position. Varicoceles can also have a negative effect on male fertility. Varicocele repair may be considered in cases of severe pain that doesn’t go away, once other possible causes have been ruled out.

Testicular tumor

A cancerous tumor in the testicles rarely causes pain but can cause swelling or a hard nodule in the testicle. Testicular cancer can be treated and cured if caught early.

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