Testicular Pain: Epididymitis, Torsion, and When It's an Emergency

Sudden, severe pain in one testicle, especially with swelling, nausea or vomiting, can be testicular torsion: the testicle twisting and cutting off its blood supply. Go to the ER right away. It needs surgery within hours to save the testicle. Pain and swelling that builds over a day or more, often with burning when you pee or a fever, is more often epididymitis, an infection treated with antibiotics. Any new testicular pain or lump should be checked.

Testicular torsion: an emergency

• Sudden, severe pain in one testicle or the scrotum, often waking you up or starting after activity
• Swelling of the scrotum
• One testicle sitting higher than usual or at an odd angle
• Nausea and vomiting
• Belly pain, which can be the main symptom in boys

It's most common between ages 12 and 18, but can happen at any age, including in newborns. Don't wait to see if it goes away. Go to the ER, not urgent care, because it needs an ultrasound and a surgeon.

Epididymitis

The epididymis is the coiled tube at the back of the testicle. When it's inflamed or infected:

• Pain and swelling come on gradually, over hours to days, usually on one side
• The scrotum may be red, warm and tender
• Burning when you pee, or needing to go often
• Discharge from the penis
• Fever

In men under 35, it's often caused by a sexually transmitted infection like chlamydia or gonorrhea. In older men, it's more often from a urinary infection or prostate problem. It's treated with antibiotics, rest, scrotal support, ice and anti-inflammatory pain relievers. Partners may need treatment too if it's from an STI.

Prostatitis

Prostatitis is inflammation or infection of the prostate. It can cause pain between the scrotum and rectum, in the lower back or groin, burning or trouble when peeing, and, when caused by bacteria, fever and chills. A sudden bacterial prostatitis needs antibiotics promptly.

Other causes

• Injury to the testicle
• A hernia causing pain or a bulge in the groin
• A kidney stone, with pain spreading into the groin. See our kidney stone post.
• A fluid collection or enlarged veins, usually painless swelling
• Testicular cancer, usually a painless lump, most common between 15 and 35

When to get seen

Come in for testicle or scrotal pain and swelling that came on gradually, burning when you pee, discharge, or a fever. A clinician can examine you, test your urine and test for STIs, and start antibiotics. Our post on STD symptoms covers testing. Any painless lump in a testicle should be checked by a primary care provider soon. At an AfterOurs clinic, a standard self-pay visit is $175, and a self-pay in-clinic visit never costs more than $330. We contract with all major commercial and government plans, including Colorado Medicaid and Medicare. See our STI testing page and the cost and insurance page.

Go to the ER right away if testicle pain is sudden and severe, comes with nausea or vomiting, or one testicle sits higher than normal, or if a boy has sudden belly pain with scrotal pain. Also go to the ER for testicle pain with a high fever and feeling very unwell, or after a serious injury.

Where to find us

Four clinics across metro Denver, all ages welcome, se habla español:

• Hampden (Southeast Denver): 8 AM–11 PM daily
• Littleton: 8 AM–11 PM daily
• Thornton: 8 AM–11 PM daily
• Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM

Walk in, or book online.