Go to an emergency department now if
- Pain in a testis started suddenly and is severe
- There is swelling, nausea or vomiting with the pain
- The testis seems higher than usual or lies at an odd angle
- A boy has sudden pain low in the tummy and the scrotum is tender
Do not eat or drink on the way, in case an operation is needed, and do not take painkillers and wait to see if it passes.
Testicular torsion: the cause that cannot wait
Each testis hangs from a cord that carries its blood supply. In torsion, the testis twists on this cord and cuts off its own blood. Without blood, the testis starts to die within hours. Saving it is most likely when surgery happens within about six hours of the pain starting; after a day, it often cannot be saved.
Torsion is most common between the ages of 12 and 18, but it can happen in newborns and in men of any age. It often starts at night, or after exercise or a minor knock, and usually on one side.
How torsion usually feels
- Sudden, severe pain in one testis, sometimes spreading to the groin or lower tummy
- Swelling and redness of that side of the scrotum
- Nausea or vomiting
- The testis sitting higher than the other or lying sideways
- Often no fever and no burning urine at the start
An ultrasound with Doppler can show the blood flow, but when the story strongly suggests torsion, surgeons operate without waiting for a scan.
Other causes of sudden testicular pain
- Infection of the epididymis or testis (epididymo-orchitis). Pain and swelling build over a day or two, often with fever, burning urine or discharge. It is treated with antibiotics, but it still needs a doctor the same day, because it can look like torsion.
- Twisted appendix testis. A tiny tag of tissue on the testis twists. It is common in boys aged 7 to 14, the pain is often milder and at the top of the testis, and it settles with rest and pain relief once torsion has been ruled out.
- Injury. A blow from a ball, a fall from a bike or a kick. Pain that does not settle, or swelling, needs an emergency check.
- A stuck hernia. A tender swelling in the groin or scrotum that will not go back, often with vomiting, is an emergency.
- Mumps orchitis. Painful swelling of the testis a few days after swollen cheeks, mostly in teenagers and young men.
- A kidney stone. Pain from a stone in the ureter can be felt in the testis, usually with pain in the back or side that comes in waves.
Torsion or infection? Some differences
- Torsion starts suddenly, often within minutes; infection builds over hours to days
- Vomiting is common with torsion; fever and burning urine are more typical of infection
- Torsion is most common in boys and teenagers; infection is more common in sexually active men and older men
These are only tendencies. Nobody can be sure at home, which is why sudden pain always means the emergency department.
After the emergency
After an operation for torsion, the surgeon usually also fixes the other testis so it cannot twist. Follow-up with a urologist checks healing, and, where needed, hormones and fertility. After an infection, the doctor looks for the cause, such as a urine or prostate infection, and makes sure it has cleared.
Pain that has lasted weeks or months
Long-standing aching in the testis is a different problem from sudden pain, and it is usually seen in the OPD rather than the emergency department. Causes include past infection, a varicocele, a hydrocele, nerve irritation and pain that comes from the back or groin. Read more on our page on chronic testicular pain treatment in Gomti Nagar Extension.
Things parents can do
- Teach boys that sudden pain in the testis is a reason to tell an adult straight away, without embarrassment
- With sudden tummy pain and vomiting in a boy, check the scrotum
- Use a protective cup for cricket and contact sports
- Know the route to the nearest hospital emergency department before you need it
Follow-up care in Gomti Nagar Extension
Swastik Urology Clinic is in Sector-5, Gomti Nagar Extension, near Sadar Tehsil, a short ride from Gomti Nagar, Shaheed Path and Chinhat. The clinic runs a morning OPD only, Monday to Saturday, 9:30 AM to 11:30 AM, and is not an emergency service. Dr. Aditya P.S. Sengar (MBBS, MS (General Surgery), DNB (Urology)) sees men and boys there for follow-up after an emergency and for testicular pain that is not sudden, and speaks Hindi, English, Bhojpuri and Gujarati. Request an appointment.
This article gives general information and does not replace examination, diagnosis or treatment by a qualified doctor.
