Causes of testicular pain

Primarily, it is most important to distinguish if the presenting complaint is actually acute testicular pain (which is potentially a surgical emergency) or scrotal swelling (which should be relatively painless)

The most common cause of acute testicular pain are:

Testicular Torsion

Definition: Twisting of the spermatic cord, cutting of the blood supply to the testicle, leading to ischaemia(5). This requires urgent detorsion and fixation (orchiopexy) before the testicle becomes ischaemic and needs removal (orchidectomy). Ideally surgery should be performed within 6 hours before the testis becomes unsalvageable(6)

Epididymo-orchitis

Definition: Inflammation of the epididymis +/- testes, leading to acute pain or swelling. It may be caused by a sexually transmitted infection or other urinary tract infection spreading along the urinary tract and should improve with antibiotics (7).

Torted appendages

Definition: Twisting of the vestigial appendages of the testis or epididymis. This can lead to pain and may mimic testicular torsion but does not cause damage to the testis and can be managed conservatively.

Learning Bite:

Testicular Torsion is an acute surgical emergency and must be confidently excluded before other diagnoses can be considered

Other causes of acute testicular pain include:

• Trauma
• Inguinal Hernias
• Fornier’s Gangrene
• Malignancy
• Oedema/Swelling
• Cysts/Hydroceles
• Referred Pain e.g. Renal Colic, AAA