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 example, patients with mumps may develop orchitis as a complication, presenting with testicular pain and swelling. Gonorrhea—a sexually transmitted infection with relatively high current prevalence—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 possess considerable mobility within the scrotum and are protected by a tough tunica albuginea, making closed (non-penetrating) 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, scrotal ecchymosis, and marked tenderness.

③ Torsion

Testicular torsion can occur at any age—from newborns to elderly individuals up to 70 years old—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 symptom onset. The hallmark initial symptom is sudden, severe testicular pain occurring during sleep or rest—this is also one of the primary diagnostic criteria. Some patients additionally present with nausea, vomiting, scrotal swelling, and marked tenderness on palpation.