What Causes Testicular Pain?

Testicular pain is typically caused by pathological conditions affecting the testes, as detailed below:

① Inflammation

There are numerous causes of orchitis. For instance, patients with mumps may develop orchitis as a complication, presenting with testicular pain and swelling. Gonorrhea—a sexually transmitted infection with relatively high current incidence—can also lead to orchitis in severe cases, causing testicular pain and swelling. Chronic prostatitis may likewise cause testicular pain, usually unilateral, characterized by dull or pulling pain that is persistent. Microscopic examination of expressed prostatic secretions reveals a marked increase in white blood cells.

② Trauma

The testes have considerable mobility within the scrotum and are protected by a tough tunica albuginea, making closed injuries relatively uncommon. Most testicular injuries result from direct trauma, such as assault or motor vehicle accidents. Following injury, patients experience severe testicular pain accompanied by nausea, vomiting, and occasionally syncope or shock. Physical examination reveals testicular swelling, indistinct testicular contours, or scrotal ecchymosis, with marked tenderness.

③ Torsion

Testicular torsion can occur at any age—from newborns to elderly individuals aged up to 70 years—with 65% of cases occurring between ages 12 and 19. Typically, vigorous physical activity or external trauma to the testis occurs several hours prior to onset. Sudden, severe testicular pain during sleep or rest is the initial and hallmark symptom—and one of the primary diagnostic criteria—for this condition. Some patients also present with nausea, vomiting, scrotal swelling, and marked tenderness on palpation.