Managing Chronic Testicular Pain

Chronic Testicular PainPain is an unpleasant feeling, physical suffering or discomfort caused by disease or wound. Pain is a common phenomenon with no discrimination, and simply, it hurts. Men are very aware of their private parts, and testicular pain or scrotal pain is a very sensitive and important topic. Acute testicular pain can be of trauma and infection. Meanwhile, chronic testicular pain occurs as a result of long-term problems. Read on about what testicular pain is and how you can manage it using pain tracking apps such as CareClinic.

What are testicles? What do they do?

Testes or testicles are organs in the male reproductive system. They are covered by a sac of skin, the scrotum. The scrotum is located in the front of the pelvic region, closer to the upper thighs. The testes can be described as a factory where the production and storage of sperm take place. They are stored till maturity and ejaculation. On the other hand, the well-known hormone of testosterone is also a product of the testes. Testosterone is responsible for male physical features at puberty, sex drive, fertility, and plays a vital role in sperm production.

Testicular pain is the pain that is experienced in one or both testicles. It may be from the testicles themselves. Meanwhile, other conditions involving the scrotum, groin, or abdomen might cause testicular pain. Whatever the cause is, understanding the medical emergencies which summons medical treatment is a key to prevent loss of testicular functions. Most importantly, delay in seeking medical attention might end up in losing one or both testicles. Testicular pain may have a duration of short-term (acute) or long-term (chronic). Also, they occur as intermittent or constant in nature.

Acute testicular pain

Acute testicular pain is defined as the new-onset pain, swelling, and/or tenderness of the intrascrotal contents (R). Patients would describe the symptoms as occurring rapidly within minutes or up to 1 to 2 days. The term acute testicular pain includes a wide variety of unique diseases. Prompt evaluation and diagnosis are essential to save the testes from irreversible damage, for example, from acute testicular torsion.

Chronic testicular pain

Chronic testicular pain is described as pain that must be present for more than three months and interfere with activities of daily living (R). It is the cause of about 2.5% to 5% of all urology consultations and currently affects approximately 100,000 men in the United States each year (R).

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Causes for chronic testicular pain

Causes of scrotal pain can be classified into different categories. But this article classifies them as acute and chronic testicular pain and briefly explains the causes, features, diagnosis and treatment for all the causes of testicular pain.

  • Epididymitis
  • Orchitis
  • Hernias
  • Kidney stones
  • Trauma
  • Testicular rupture
  • Hematocele
  • Spermatocele
  • Varicoceles
  • Testicular tumor or Cancer


The epididymis is the part of the male genitalia. It performs as the storage of sperms until they mature. Epididymitis is the inflammation of the epididymis, and it is a cause of chronic testicular pain.


Gonorrhea and chlamydia are the infectious agents that cause epididymitis.

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The scrotum will be swollen, firm in consistency and very painful to touch. You might experience fever, bloody urine and painful urination or ejaculation as well.


Epididymitis needs medical attention. The testicular torsion is a medical emergency and also presents similar. Hence, proper diagnosis is essential for treatment. Immediate ultrasound scans and urine analysis will be needed.


Since this condition is associated with infection, it can be treated with a course of antibiotics.


Orchitis is an inflammation subsequent to the infection of one or both testicles. When epididymitis is not adequately taken care of, it can proceed to orchitis.

Orchitis - Symptom EntryCauses

Infections, mumps, or sexually transmitted diseases are the causes of orchitis.


The following symptoms are present in orchitis.

  • Red, swollen and painful testicles
  • Dragging feeling in the testicles
  • Fever
  • Bloody semen
  • Nausea and vomiting
  • Painful intercourse
  • Painful urination and bowel movements


Similar to epididymitis, orchitis also needs instant management. Rarely the pain from orchitis will be similar to testicular torsion. As mentioned in the previous section, testicular torsion is a medical emergency. Proper diagnosis is essential for treatment. Immediate ultrasound scans will be helpful in excluding torsion. Your physician will confirm the infection and will commence the antibiotic course. Do not hesitate to seek medical advice as soon as possible.


Since treatments for orchitis depend upon the cause, identifying the reason is the priority to treat orchitis. Your physician can prescribe antibiotics for bacterial infections. A virus causing orchitis will require supportive treatments to relieve symptoms—for example, over-the-counter pain relievers and elevating the scrotum.


The human abdomen has fixed contents such as the liver, pancreas and kidneys. Similarly, it has considerably mobile contents such as intestines and fat as well. A hernia is a condition where the ‘mobile’ abdominal contents push the scrotum through a weaker spot in the abdominal muscles. There are several types of hernias. But, the one which usually presents as scrotal swelling and pain is the direct inguinal hernia.


The abdomen, if it has a weak area, can lead to hernias. Also, people who are straining a lot would have a risk of pushing the abdominal contents through such a weak spot. Long-standing cough, straining while urination, defecation or weightlifting are simple examples that can cause hernias.


Testicular pain that shocks or increases during coughing or lifting heavy objects is the possible indication of an inguinal hernia. However, an inguinal hernia is not a direct problem of the testicles. The contents of the hernia put pressure on the testicle to cause pain.

Swelling in the scrotum extending to the groin may be seen. The swelling will be soft to firm to touch. In the early stages, the swelling might disappear when you lie down. They might reappear when you stand up or when you strain again. and very painful for touch.


A proper history and physical examination are fundamental for the diagnosis of an inguinal hernia.


Most hernias need a surgical correction. A behavioral change, for example, smoking cessation and reduction of heavy lifting, should be considered. A physician can suggest the solution depending on the problem and also provide pain relief.

Kidney stones

As you know, kidneys are organs that produce urine. Kidneys filter the blood and excrete the waste in the urine. The ureter is the passage, which streams the urine to the bladder. Stones at any point of the passage of urine may cause pain in either penis or the testicles.

Pain felt in one area while the actual problem in another area is called referred pain. The nerve which supplies the ureter shares the supply with the testicles and scrotum too. Hence the pain is perceived in the testicles—however, most of the patients with ureteric stones present with loin pain.

Kidney stones – to be specific, ureteric stones cause testicular pain. These stones are condensed deposition of urinary crystals.


No definite, single cause is linked to kidney stones. However, a few factors may increase risk:

  • Family history –  if your family member has had kidney stones, you are more likely to develop stones.
  • Poor water intake – not drinking enough water per day can increase your risk of kidney stones.
  • Dietary ingredients – a diet rich in protein, salt and sugar increases the risk of some types of kidney stones.
  • Medical conditions-  such as hyperparathyroidism, renal tubular acidosis and cystinuria, increase the risk of kidney stones.
  • Digestive diseases and surgery – surgeries involving the stomach and inflammatory bowel diseases can affect the absorptive process of calcium and water.
  • Certain supplements and medications – vitamin C, dietary supplements, laxative abuse, calcium-based antacids, and can increase your risk of kidney stones.


The pain you feel in the scrotum is not due to a problem in the testicles or scrotum. Hence, you won’t notice any differences in the appearance of it. Apart from pain in the scrotum, the stones can present with the following features:

  • Sharp pain that may radiate from the back (loin) to the groin
  • Pain increases and decreases like a waveform with time
  • Blood or blood clots passed in the urine.
  • A burning sensation occurs during urination.
  • Nausea and vomiting
  • Pain at the top of the penis
  • Frequent urination


Simple urine analysis would give a clue of the presence of stones in the urinary passage. Once diagnosed, your physician will order further imaging tests to confirm the diagnosis. Ultrasound scans are predominant and less harmful compared to the x-rays. Depending on your complaints and examination findings, your physician might order additional blood work to determine the kidneys’ function.


Kidney stones usually don’t need treatment. Immediate treatment will include pain killers and adequate hydration. However, treatment options will vary depending on the size of the stone. Your physician may tell you to wait for the stones to pass. Drinking plenty of water helps you by flushing the stones down. Passage of stones from the kidney to the bladder through the ureter till it exits through the urethra is more painful. Testicular pain will occur at any stage during this passage.

However, if a stone is not passed or you start to experience symptoms of an infection, for example, fever, you should take treatment as soon as possible.

Treatments can also include surgery to remove the stone. Shockwave lithotripsy is another method that delivers shockwaves to break and remove the stones.


Varicoceles are abnormally dilated, tortuous or twisted veins in the testicles. Consequently, they are responsible for low sperm production and decreased sperm quality. Varicoceles can also prevent the testicles from developing the property or cause them to shrink. Hence varicoceles are one of the reasons that affect a person’s fertility.

On the other hand, varicoceles typically do not produce any apparent symptoms. A person may experience testicular pain that worsens with physical activity over the day. Not all cases require treatment, but any pain or discomfort in the testicles should prompt a doctor visit.


Causes are unknown; however, defects in the valves in the veins above the scrotum is considerable.


Pain varies from dull to sharp, with intensity worsening throughout the day and intensifying while standing and relieving when lying down.


Not all patients with varicoceles require treatment. But pain and discomfort in the testes would require medical advice. In such a case usually, surgical intervention is the definitive treatment.

Testicular Tumor or Cancer

Cancer is an outcome of the haphazard and rapid multiplication of body cells. Testicular cancer occurs when malignant cells multiply within your testicles. This multiplication commonly starts in the tubular testicle structures that produce sperm. Since cancer is possible, a more serious issue is at play. Men who experience testicular pain must seek medical attention. Although it is uncommon, pain in the testicles may be a symptom of testicular cancer. Symptoms of testicular cancer include:

  • Pain and discomfort in either the testicle or scrotum
  • Sudden fluid collection in the scrotum
  • enlargement of either testicle
  • Dragging feeling in the scrotum
  • Dull pain in the abdomen or groin
  • Back pain


The causes are not well defined. Risk factors increasing your risk of developing testicular cancer include:

  • family history of the disease
  • abnormal testicular development
  • being of Caucasian descent
  • undescended testicle (cryptorchidism) – undescended testis is a condition where one or both testicles stay inside the abdominal cavity or abdominal wall without descending into the scrotum. The testicle is a mobile part. During fetal development, it starts to descend to the scrotum and stays there almost permanently. In kids, it is normal to see the testes may not be in the scrotum at times. But, when the testicles stay somewhere other than the scrotum, they tend to become non-functional and malignant in later life.


Some men are asymptomatic until they get diagnosed with testicular Testicular Cancer - Symptomscancer. Symptoms of testicular cancer include:

  • swollen testicle
  • testicular pain or discomfort
  • heaviness in the scrotum
  • fluid in the scrotum
  • enlargement of breast tissue
  • lower abdominal or back pain


Sometimes, your doctor can suggest removing the affected tissue surgically. On the other hand, you may need to remove an entire testicle. Radiotherapy or chemotherapy will also help to eliminate the cancer cells.

Testicular torsion

Testicular torsion falls under acute testicular pain. The spermatic cord contains blood vessels that carry blood from and to testes. It also transports sperm from the testicles to the urethra. Testicular torsion is a severe medical condition that ensues when the testicle twists along with the spermatic cord. Since the spermatic cord is supplying blood, twisting of the cord results in restricted blood flow.

Consequently, it causes sudden and severe testicle pain and swelling. The torsion of the testes and associated spermatic cord is said to cause the most intense pain a man could ever experience. It can occur at any age. But it is common in young men, mostly less than 25 years of age.


No obvious causes have been identified. Trauma may be considered as a cause. But risk factors for testicular torsion include age, previous history of similar nature, and a family history of testicular torsion.


Symptoms associated with testicular torsion include:

  • severe, sudden pain that occurs on one testicle or one side of the scrotum
  • swelling in the scrotum
  • redness or darkening of the scrotum
  • nausea
  • vomiting

Testicular pain due to torsion is not always sudden. In some cases, this condition causes pain that exacerbates slowly over several days. The chances of testicular torsion to occur is higher on the left side than the right.


An ultrasound scan of the scrotum helps visualize the blood flow to the testes and confirm the diagnosis.


Anyone who experiences signs of testicular torsion should immediately seek emergency medical care. In other words, without treatment, a condition that affects blood flow to the testes could subsequently result in loss of the testicle.

Immediate management for pain and swelling could only help temporarily. Testicular torsion always summons emergency surgery. The scrotum is explored to correct the testicular twisting. If treatment is sought on time, the testicle can be saved. However, the longer the duration without blood flow to the testes, the higher the chances of irreversible damage. In cases with a prolonged period without a blood supply, the testes lose their viability. Then the surgeon would remove the testicle.

Generally, testicular torsion only involves one testicle. Hence removing one testicle does not affect a person’s fertility.


Trauma to the testicles can cause bruising, pain, and swelling. Consequently, the testicle can rupture or cause a hematocele. A hematocele occurs when blood collects around the testicle and pressurize on it, affecting blood flow. If a person had a blow to the testicles and is experiencing pain and swelling, it is best to seek urgent medical attention.

Testicular Rupture

Since the testicles and scrotum are very exposed to injury, getting blunt trauma to the groin or penetrating accidents can result in a testicular rupture. Any such injuries are damaging and cause extreme pain. A testicular rupture needs immediate medical attention. However, if the trauma is severe, the testicle may not be saved.


A hematocele is a scrotal mass — an abnormal collection of blood in the scrotum. It results from trauma and causes sensitivity, redness, and swelling to the entire scrotal area. Testicle pain may be dull and aching.


Often, an abnormal cyst develops within the epididymis. But the cyst is mostly not harmful like cancer. Epididymis holds a substance that might contain some sperm. Spermatoceles are common. They don’t usually necessitate treatment, but they can cause pain if they become enlarged.


In conclusion, if you are experiencing any combination of pain and swelling in one or both testicles, you should immediately see your physician. If the swelling and/or pain is associated with fever, nausea, vomiting, seek immediate medical attention. Since time plays a crucial role in some cases, for example, in testicular torsion, the quicker you seek help, the more likely the physician can find out the cause and provide prompt treatment.

Medical treatments with pain killers are available for a few causes of testicular pain. However, do not take seek medical advice when you experience testicular pain along with these conditions.

  • testicular swelling
  • discoloration of the testicles
  • bloody discharge from the penis
  • pain that gets worse over time
  • nausea
  • vomiting

As described above, there are several causes of chronic testicular pain. Each has its own symptomatic and definitive management. Moreover, there are no clear and established guidelines for the treatment of chronic testicular pain. But, a multi-disciplinary team (MDT) approach is recommended. Pain management specialists, urology, pelvic floor physical therapists, psychiatrists, and primary care physicians should be such MDT members.


CareClinic is a one-stop health app, provides several useful features to help you maintain a health record. Create a Self-Care Action Plan and add medications, supplements, diet, physical activities, and therapies you receive. Set your healthcare team who manages your chronic testicular pain and add your physician, RN  and family members.

Diary entry

The diary entry feature lets you make entries about your daily life. Use the diary entry feature of the app to track your pain episodes. It is useful to have an overall idea of how pain intervenes in your activities of daily life.

Symptom Tracker

The symptom tracker lets you add symptoms you are experiencing. You can track the symptoms to understand the worsening of your symptoms or the progress of your treatment. If you start tracking your symptoms before seeking medical attention, you can compare how well the treatment relieves you from symptoms after visiting the doctor’s office.

Medication & supplements

Never miss a pill anymore with the medication reminder. Add your medications to the medication and supplements tracker and set a reminder. Pill reminder helps you track your medications and doctor’s appointments.


CareClinic offers the nutrition tracker, which helps you maintain your diet log. In specific cases such as kidney stones, you can follow your diet accordingly to prevent risks of stones.


Use this feature to track any physical activity. Your activity tracker helps you identify any activities that worsen or relieves your symptoms.


Keep a record of any therapies you follow to get rid of the pain and other symptoms you experience during any of these conditions.


Reports are a great feature offered by CareClinic, can provide a lot of perception into your lifestyle change. It considers your logs in diary, nutrition, activities, symptoms etc. and subsequently generates reports that show the association between those entries.

In conclusion, with continuous updates, you can see the connections between your dietary habits, water intake and pain episodes in the app itself.

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Mariano R Kanagaratnam