Possible causes of aching pain in the testicles

Aching pain in the testicles can arise from various factors and can affect all individuals with testicles, regardless of age. The intensity of the pain may range from mild to severe, and the discomfort can involve one or both testicles, occasionally radiating to the lower abdomen.

When to seek immediate medical attention

If you experience severe testicular pain accompanied by nausea, vomiting, or abdominal pain, it is crucial to call 999 immediately. This may indicate testicular torsion (twisted testicle) – a serious medical emergency that requires urgent treatment.

While testicular pain can be alarming, it is often not a cause for serious concern, as the testicles are highly sensitive, and even minor issues can lead to discomfort.

Common causes of testicular pain

The source of testicular ache may originate from within the testicle itself or from the epididymis, the coiled tube located at the back of the testicle where sperm matures.

Here are some common causes of testicular pain:

1. Epididymitis / Epididymo-orchitis – inflammation of the epididymis / inflammation of the one or both testicles – often caused by an infection, such as STIs or urinary tract infections (UTI). Symptoms typically include pain and swelling.¹ As the epididymis and testis lie next to each other, it is often difficult to tell if the inflammation is of the epididymis, the testis or both. Therefore, the term epididymo-orchitis is often used.²
2. Epididymal cysts – a harmless, build-up of fluid called a hydrocele, which causes scrotal swelling.³
3. Testicular torsion – a medical emergency where the testicle twists, cutting off its blood supply. This condition causes severe pain and requires immediate treatment.⁴
4. Inguinal hernia – this occurs when fatty tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles, potentially leading to pain in the groin and testicular area. This is the most common type of hernia and is often associated with ageing.⁵
5. Varicoceles – an enlargement of veins within the scrotum, which can cause discomfort and aching.⁶
6. Trauma or injury – any physical injury to the testicles can result in pain and tenderness.
7. Kidney stones – typically found in the kidneys or ureter (the tube that connects the kidneys to your bladder). They can cause significant pain and may lead to infections or impaired kidney function if untreated.⁷ 
8. Referred pain – pain originating from other areas of the body, such as the kidneys or back, can sometimes be felt in the testicles.
9. Testicular cancer – this is considered a less common cancer with around 2,400 men in the UK diagnosed each year.⁸

Symptoms can include:

• persistent pain,
• a lump or swelling,
• one testicle getting bigger than the other.

These symptoms can be similar to other conditions that affect the testicles, such as infections, so it’s important to get them checked out by a GP.⁹

>Read more about testicular cancer in our article on the symptoms and treatment.

Testing and treatment options

If the pain persists, the first step is to consult your GP. They will perform an examination of the testicles and may use a light to assess for fluid accumulation. They may also recommend:

• Blood tests
• Urine tests
• Ultrasound scan
• CT scan

These investigations can help identify the presence of fluid, inflammation, or hernias and provide a clearer understanding of your testicular health. Once diagnostics are complete, treatment options can be determined based on the underlying cause of the pain.

In certain cases, such as the presence of a cyst, surgery may be necessary. Alternatively, antibiotics may be prescribed for infections. Most cases can be effectively treated with appropriate medical care.

If you have any concerns about testicular pain, it is always best to consult with your GP rather than attempting self-diagnosis. Early evaluation and intervention can be vital in addressing potential underlying conditions.

References

1. Epididymitis – NHS
2. What is epididymo-orchitis? – Patient Info
3. Epididymal cyst – Patient Info
4. Testicular torsion – Patient Info
5. Inguinal hernia – NHS
6. Varicocele – Patient Info
7. Kidney stones – NHS
8. Testicular cancer – Cancer Research UK
9. Symptoms of testicular cancer – Cancer Research UK