Testicular pain: causes, red flags and why sudden pain is an emergency

The testicle hangs on a cord containing its blood supply. If the cord twists, the blood supply is cut off and the testicle begins to die. The NHS says sudden, severe testicle pain can be caused by testicular torsion, that it is a serious problem that can lead to the loss of the testicle if it is not treated quickly, and that it needs treatment in hospital as soon as possible.

Torsion typically causes sudden, intense pain, often with a swollen, high-riding or tender testicle, nausea or vomiting and pain felt in the lower tummy. The pain may begin at night or after minor injury, but it can also begin without any trigger. It is more common in teenagers and young men, but can occur at any age. Because every hour counts, the advice is to go straight to A&E rather than wait for a GP appointment or see whether the pain eases.

• Go to A&E immediately or call 999 if you have sudden, severe pain in a testicle.

• Go to A&E immediately or call 999 if testicle pain comes with feeling sick, being sick or pain in the tummy.

• Go to A&E immediately or call 999 if testicle pain has lasted more than an hour or continues when you are resting; the NHS says these can be signs of a serious problem needing hospital treatment as soon as possible.

• Go to A&E or call 999 for sudden, unbearable pain in the testicles or tummy even if you have been diagnosed with epididymitis, as the NHS epididymitis page advises, because it could be a twisted testicle.

• Do not drive yourself; ask someone to drive you or call 999, and take your medicines with you.

• Ask for an urgent GP appointment or contact NHS 111 for aching or discomfort in the testicles you are worried about, a lump, swollen testicles, a change in shape or feel, or one testicle becoming bigger than the other.

• Delay is the main risk: a child or teenager with sudden testicular or lower tummy pain should be assessed urgently even if embarrassed to say where it hurts.

The NHS lists epididymitis, injury, an inguinal hernia, a build-up of fluid (cyst) and swollen veins in the testicles (varicocele) as other causes of testicle pain, in addition to torsion. Pain can also be referred from the back, kidney stones or the ureter and persists in some men without a clear cause.

The NHS describes epididymitis as swelling and pain in the epididymis, the tube behind the testicles, often caused by infection and usually treated with antibiotics. Symptoms may include sudden or gradual pain in one or both testicles, a scrotum that feels tender, warm and swollen, a fluid build-up around the testicle (a hydrocele) that feels like a lump, difficulty peeing, or a white, yellow or green discharge from the tip of the penis.

It is usually caused by a sexually transmitted infection such as chlamydia or gonorrhoea, which is more likely in men under 35. In men over 35 the main cause is usually a urine infection, more likely with an enlarged prostate, a urinary catheter or recent groin, prostate or bladder surgery. Less common causes include mumps, tuberculosis, the heart rhythm drug amiodarone, a groin injury and Behçet's disease. If a sexually transmitted infection is found, the NHS says your current or recent partners over the past 6 months may be advised to be tested.

Testicular pain is a common source of worry about cancer, but the NHS says pain by itself is not usually a sign of testicular cancer, which usually causes other symptoms such as a lump or swelling. Its list of symptoms of testicular cancer includes a lump or swelling in a testicle, the testicle getting bigger, an ache or pain in a testicle or scrotum, and the scrotum feeling heavy, firm or hard, with a back or lower tummy ache, unintentional weight loss, cough or breathing difficulty as other symptoms.

The NHS says it is important to check your testicles regularly so you know what is normal for you, which makes it easier to notice any change in size, look or feel, and that lumps are easier to treat if found early. The GP will check your testicles and the lymph nodes at the top of the legs, and you may get an urgent referral if cancer could be the cause, which does not mean you definitely have cancer.

Questions include when the pain started, how severe it is, whether it came on suddenly, one side or both, injury, nausea or vomiting, fever, urinary symptoms, discharge, recent sexual contacts, a groin bulge, previous episodes that settled by themselves and any lump. The examination checks the position and tenderness of each testicle, swelling, skin redness, the cord, the groin for a hernia and the tummy.

If torsion is suspected, the priority is surgery without delay, and imaging should not hold it up. Where the picture is less clear, a scrotal ultrasound with blood flow assessment helps separate torsion from epididymitis or a cyst. For epididymitis, the NHS says tests may include a groin examination and a swab of the urethra, with urine and sometimes blood tests. Treatment is antibiotics selected for the likely cause, rest, support for the scrotum and pain relief, and sexual health clinics can provide the same antibiotics as a GP and many offer a walk-in service.

An emergency department or an on-call urology service handles suspected torsion. A GP or sexual health clinic deals with suspected epididymitis, lumps and chronic aching, with referral to urology for scanning or surgery. Some men choose a private urology clinic for a rapid ultrasound of a non-emergency lump, but sudden severe pain should never be held for a private appointment.