Sudden, severe pain in a testicle is an emergency until proven otherwise. Testicular torsion, where the testicle twists and cuts off its blood supply, needs surgery within hours to save it.
Imagine a 15-year-old waking in the night with sudden agonising pain in one testicle, feeling sick. He’s embarrassed and doesn’t want to tell anyone. His parent notices he’s pale and in pain and takes him straight to the emergency department. Surgery within the hour saves the testicle.
Emergency: testicular torsion
- Sudden severe pain in one testicle, sometimes spreading to the tummy
- Swelling and the testicle sitting higher than usual
- Nausea and vomiting
Most common in teenagers but possible at any age. Go to an emergency department immediately. Don’t wait to see if it settles.
Other causes
- Epididymitis or orchitis: infection or inflammation, often with gradual pain, swelling, fever, sometimes from STIs or urinary infections
- Injury
- Varicocele: enlarged veins, a dull ache, “bag of worms” feel
- Hydrocele or cysts
- Inguinal hernia
- Kidney stones, causing referred pain
But what about testicular cancer?
Testicular cancer is most common in men aged 15 to 49 and is usually a painless lump or swelling, a heavy feeling in the scrotum or a change in shape. It’s highly treatable, especially when found early. Check your testicles monthly after a warm shower and see a doctor about any new lump or change.
See a doctor within a day or two for gradual pain with swelling, fever or urinary symptoms, or pain that persists after an injury.
Your next step: If you have sons or brothers, tell them: sudden testicle pain means go to hospital immediately, no embarrassment.
Sources: NHS (Testicle pain), American Urological Association, Urology Care Foundation, American Cancer Society (Testicular cancer).
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