Testicular pain: when it is an emergency and what else can cause it

Testicular torsion happens when a testicle twists inside the scrotum and cuts off its own blood supply. NHS Essex ICB describes it as a medical emergency in which, without blood flow, the testicle can be permanently damaged within hours. The NHS epididymitis page gives the same instruction in plain terms: call 999 or go to A&E if you get sudden, unbearable pain in the testicles or tummy, and do not drive yourself; ask someone to drive you or call an ambulance and bring any medicines you take.

NHS Essex lists the typical features: sudden severe pain in one testicle, swelling of the scrotum, abdominal pain, nausea or vomiting, a testicle sitting higher than normal, redness or tenderness of the scrotum, and pain that starts during sport, after injury or even during sleep. It stresses not waiting to see if the pain improves, not applying heat, and not delaying out of embarrassment.

The same source gives the timeline that explains the urgency: within 6 hours there is a high chance of saving the testicle, after 12 hours the risk of permanent damage rises significantly, and after 24 hours the testicle will usually need to be removed. These are the local ICB's figures, but the message that every hour counts is general.

A Guy's and St Thomas' NHS leaflet explains that doctors take a history, examine the scrotum and test a urine sample for infection and blood. More tests are not usually helpful because of the urgency, and it is difficult to be completely certain it is torsion. If it seems likely, an operation called scrotal exploration under general anaesthetic is recommended.

In surgery the testicle is examined, untwisted if twisted, and its blood supply checked. If healthy, it is stitched in place to stop it twisting again, and the other testicle is stitched in the same way. If it is too badly damaged to recover it may be removed. The leaflet says that in 1 in 10 people having this operation the testicle turns out not to be twisted, and that there are no safe alternatives for suspected torsion, since watching and waiting risks losing the testicle and a scan might delay surgery.

The leaflet describes most people going home the same day or the day after, discomfort for 7 to 10 days, avoiding vigorous exercise for 4 to 6 weeks, and an outpatient review at 6 to 8 weeks. It lists risks of up to 10 in 100 people, such as a palpable stitch, a collection of blood, infection or ongoing discomfort, and risks of less than 2 in 100, including testicular shrinkage and reduced fertility.

The NHS describes epididymitis as swelling and pain of the tube behind the testicles, often caused by infection. Pain may be sudden or gradual, the scrotum can be tender, warm and swollen, and fluid around the testicle (a hydrocele) may feel like a lump. You may also have difficulty passing urine or a white, yellow or green discharge from the penis.

The NHS says it is usually caused by a sexually transmitted infection such as chlamydia or gonorrhoea, more likely in men under 35, whereas in men over 35 it is usually a urine infection, especially if you have an enlarged prostate, a urinary catheter or recent groin, prostate or bladder surgery. Less common causes include mumps, tuberculosis, the medicine amiodarone, a groin injury and Behçet disease. If an STI is found, recent sexual partners from the past 6 months may need testing.

You can be seen by a GP or at a sexual health clinic, where many offer walk-in service. The NHS says you will usually need tests to find the cause: a groin examination, a swab from the urethra, urine and blood tests and sometimes a rectal examination. Treatment is usually antibiotics as injections, tablets or both, and the full course should be finished even if you feel better.

The NHS says you should start to feel better within a few days but full recovery can take up to 3 months, and that you may be referred for more tests if symptoms continue. Painkillers such as paracetamol or ibuprofen, a cold pack on the groin and supportive underwear help; if you have a history of seizures, ibuprofen should not be taken with some of the antibiotics used, so check with a pharmacist. Avoid sex if you have gonorrhoea or chlamydia until you have finished treatment, or for 7 days after.

Not all testicular pain is sudden. The NHS says to see a GP if you have a lump or swelling in a testicle, a change in shape or feel, one testicle becoming bigger than the other, or aching or discomfort in the testicles that does not go away. It adds that lumps can be a sign of testicular cancer, which is easier to treat if found early.

A GP will examine you and may arrange a scrotal ultrasound. Many causes of a lump or ache are harmless, such as fluid collections or cysts, but a swelling that is hard, painless and growing deserves prompt assessment. Regular self-checking, so you know what is normal for you, makes changes easier to recognise.

Suspected torsion belongs in an NHS emergency department with surgical cover, and local services differ in whether they can operate. NHS Essex notes that some hospitals can assess but may need to transfer for specialist treatment, which can cause delays, so ask the ambulance service or NHS 111 which hospital is best placed to receive you.

For non-emergency symptoms, private urology and ultrasound can offer same-week assessment of lumps, a long-standing ache or epididymitis that has not settled. Make sure any scan report reaches your GP, and do not use a private appointment to postpone emergency attendance when the pain is sudden and severe.