Some Causes and Features of Scrotal Pain

Testicular torsion (twisting of a testis)

Severe, constant pain that begins suddenly in one testis

A testis that may be pulled up closer to the body than the other testis

Most often occurring in newborns and boys after puberty but sometimes in adults

Ultrasonography

Torsion of the testicular appendage (twisting of a small piece of tissue attached to the testis)

Pain that usually develops over several days and that occurs in the top part of the testis

Sometimes swelling around the testis

Typically occurring in boys aged 7–14 years

Ultrasonography

Epididymitis (inflammation of the epididymis) or epididymo-orchitis (inflammation of an epididymis and testis)

Pain that begins gradually or suddenly in the epididymis and sometimes the testis

Possibly frequent urination or pain or burning during urination

Possibly in men who have recently been doing heavy lifting or straining

Often swelling of the scrotum

Sometimes a discharge from the penis

Typically occurring in boys after puberty and in men

Urinalysis and urine culture

Sometimes tests for sexually transmitted infections

Injury

In men who have had an injury to the genitals

Often swelling of the scrotum

Ultrasonography

Inguinal hernia (a hernia in the groin)

Typically in men who have had a painless bulge in the groin for a long time, often in those already known to have a hernia

A bulge that

• Feels soft and balloonlike

• Typically enlarges when men are in an upright position or pressure within the abdomen increases (for example, when bearing down as if having a bowel movement or when doing heavy lifting)

• Sometimes disappears when lying down

• Can sometimes be pushed back into the abdomen

Pain that begins gradually or suddenly, typically when the bulge cannot be pushed back into the abdomen

A doctor's examination

Referred pain (for example, pain that comes from an abdominal aortic aneurysm, stones in the urinary tract, pressure on spinal nerve roots in the lower part of the spine, appendicitis, or a tumor or pain that occurs after a hernia is repaired)

Normal results detected during examination of the scrotum

Sometimes abdominal tenderness

Depends on examination findings and the suspected cause

Orchitis (infection of the testis), usually due to a virus, such as the mumps virus

Pain in the scrotum and abdomen, nausea, and fever

Swelling and sometimes redness of the scrotum

Repeated blood tests to measure antibodies to the virus suspected to be the cause

Necrotizing infection of the perineum (the area between the genitals and anus), called Fournier gangrene

Severe pain, an ill appearance, fever, and sometimes confusion, difficulty breathing, sweating, or dizziness

Redness of the scrotum or blistering or dead tissue in the genital area

Sometimes in men who have recently had abdominal surgery

More common among older men with diabetes, peripheral arterial disease, or both

Usually only a doctor's examination

Sometimes imaging tests