Testicular pain that comes on suddenly and is severe is a medical emergency until testicular torsion is excluded. This page explains the causes of testicular pain, the 6-hour window for torsion, and what to do at Mascot Healthcare.
Testicular pain ranges from a minor infection to a time-critical surgical emergency. The key distinction — torsion vs infection — cannot be made safely by examination alone and requires a scrotal Doppler ultrasound.
Twisting of the spermatic cord — cuts off blood supply. Sudden, severe pain + swelling + nausea. SURGICAL EMERGENCY. Salvage rate > 90% if operated within 6 hours; < 10% after 24 hours.
Infection of the epididymis and/or testis — gradual-onset pain, swelling, warmth, fever. Often from STI (chlamydia, gonorrhoea) in young men or UTI in older men. Treated with antibiotics.
Dilated veins around the testis — a dull aching discomfort, often described as a "bag of worms" feeling. Associated with male infertility. Not an emergency.
Fluid accumulation around the testis — a smooth, non-tender scrotal swelling that transilluminates. Common in newborns; may develop after infection in adults.
A painless or mildly tender firm scrotal mass — most common in men 15–35. Painless testicular mass requires same-day scan.
Ureteric stone or inguinal hernia can refer pain to the testis without the testis itself being the source.
Scrotal Doppler Ultrasound — The essential test — confirms or excludes blood flow (torsion has absent/reduced flow; infection has increased flow). Results in 10–15 minutes.
Urine Dipstick + Culture — Checks for UTI as source of infection in epididymo-orchitis.
STI Screen (NAAT Chlamydia/Gonorrhoea) — In sexually active men — epididymitis is commonly STI-related.
Tumour Markers (AFP, hCG, LDH) — If a testicular mass is found on scan — tumour markers are measured before any surgical intervention.
Testicular torsion is a 6-hour emergency. Do not wait to see if the pain settles. Come in now.
Applying heat to a potentially torsed testis can worsen tissue damage. Cool compress only if anything.
Epididymo-orchitis requires antibiotics today — delay risks spread of infection and abscess formation.
A painless hard testicular lump requires a scrotal ultrasound the same week — do not delay.
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