The scrotum can hurt or swell for several different reasons — some are minor infections, some are lumps that need checking, and one (testicular torsion) is a true emergency where the testicle's blood supply gets cut off. Because causes range from “see a doctor this week” to “get to an ER right now,” any new testicle pain or lump should never be ignored.
Testicular torsion affects about 1 in 4,000 males under 25 each year, most often between ages 12–18. Testicular cancer is rare but is the most common cancer in young men, with a lifetime risk of about 1 in 250 (American Cancer Society). Epididymitis is the most frequent cause of scrotal pain in adult men overall.
Causes & risk factors
- Undescended testicle — raises testicular cancer risk several-fold
- Family history of testicular cancer (father/brother)
- Sexually transmitted infections — the leading cause of epididymitis
- Urinary tract or prostate infection, or urinary catheter use
- Vigorous exercise, physical trauma, or cold weather, linked to torsion
- A congenital “bell-clapper deformity” of the testicle predisposes to torsion
Symptoms to watch for
- Sudden, severe one-sided testicle pain, swelling, nausea/vomiting, or a testicle sitting higher/twisted — testicular torsion, a surgical emergency
- Any testicle pain lasting more than an hour warrants same-day medical care
- Gradual pain/swelling with fever, warmth, redness — suggests epididymitis or infection
- A painless lump, hardness, or heaviness in a testicle — needs prompt cancer workup
- A dull ache or dragging sensation in the scrotum or groin
How it's diagnosed
- Physical examination of the scrotum and testicles
- Scrotal Doppler ultrasound — checks blood flow and looks at any lump
- Urine test and STI screening for suspected epididymitis
- Blood tumour markers (AFP, hCG, LDH) if cancer is suspected
- Urgent surgical exploration if torsion cannot be ruled out quickly
Treatment options
- Emergency surgery (detorsion + fixation): the only option for torsion; both testicles are stitched in place to prevent recurrence.
- Antibiotics: first-line for epididymitis or bacterial infection.
- Pain relief, scrotal support, ice: supportive care for epididymitis.
- Radical orchiectomy: surgical removal of the affected testicle — the standard first step for testicular cancer.
- Chemotherapy or radiotherapy: added after surgery depending on cancer stage.
- Surveillance: active monitoring for early-stage cancer in select cases.
Outlook & prevention
Torsion is highly time-sensitive: damage begins after 6 hours, and nearly 3 in 4 testicles are lost if surgery is delayed past 12 hours. Testicular cancer, by contrast, is one of the most curable cancers when caught early. Monthly self-exams help catch lumps early.
- Sudden or severe testicle pain — go to the ER immediately, do not wait
- Any new lump, swelling, or heaviness in a testicle
- Pain, fever, or discharge lasting more than a few hours to a day