The testicles are highly sensitive organs due to a dense concentration of nerve endings, meaning pain upon touching them is often an amplified response. Because they are exposed outside the body, they are susceptible to irritation and injury that can trigger discomfort. While many causes of testicular pain are minor and resolve on their own, pain upon contact can also signal a serious underlying medical problem. This article provides general information about potential causes, but it is not a substitute for professional medical advice. Sudden, severe, or persistent pain requires immediate consultation with a healthcare provider.
The Baseline: Normal Sensitivity and Minor Irritation
The inherent sensitivity of the testicles is a direct consequence of their extensive sensory nerve supply. This means even a light touch can register as significant discomfort, making it difficult to distinguish between harmless irritation and a serious issue.
Minor, non-pathological causes often account for temporary tenderness exacerbated by touch. This includes slight trauma, such as a minor bump or accidental compression, which can result in temporary aching. Friction from tight clothing, especially during exercise, can also irritate the scrotal skin and underlying structures, causing temporary soreness that fades quickly. Some individuals also experience a dull ache or temporary post-ejaculatory discomfort, which is typically a transient sensation.
Pain Due to Inflammation and Infection
Pain accompanied by warmth, swelling, or a gradual increase in severity may indicate inflammation or infection within the scrotal structures. Two common infectious causes are Epididymitis and Orchitis, which often occur together as epididymo-orchitis.
Epididymitis is the inflammation of the epididymis, the coiled tube located at the back of the testicle that stores and transports sperm. This inflammation is most often caused by a bacterial infection, sometimes stemming from a sexually transmitted infection (like chlamydia or gonorrhea) or a urinary tract infection. The pain and tenderness onset is usually gradual, worsening over days, and is accompanied by noticeable swelling, redness, and warmth of the scrotum.
Orchitis involves the inflammation of the testicle itself and is often caused by a virus, such as the mumps virus. The pain from these conditions is localized and makes even light touch uncomfortable due to swollen tissues pressing against nerve endings. Symptoms may also include a low-grade fever, a burning sensation during urination, or a discharge from the penis. Treatment for bacterial infections involves a course of antibiotics.
Structural and Mechanical Causes
Pain that is sudden, severe, or associated with a palpable change in structure often results from a mechanical issue. The most time-sensitive of these is Testicular Torsion, a medical emergency where the spermatic cord twists, cutting off the blood supply to the testicle. This twisting causes acute, excruciating pain that is immediately exacerbated by touch or movement, often presenting with accompanying nausea and vomiting.
Structural changes can also be caused by Varicoceles, which are abnormally enlarged veins within the scrotum, sometimes described as feeling like a “bag of worms.” While varicoceles often cause a dull, chronic ache that worsens with standing, the blood congestion can lead to localized tenderness. Hydroceles involve the accumulation of clear fluid within the thin sheath surrounding the testicle, causing swelling, heaviness, and discomfort.
An Inguinal Hernia occurs when a portion of the intestine pushes through a weak spot in the abdominal wall and descends into the groin or scrotum. This protrusion causes an aching pain that radiates to the testicle. The tissue mass itself can be tender when touched or when straining, such as during lifting or coughing. If the hernia becomes trapped, it can compromise blood flow, requiring emergency intervention.
When to Seek Emergency Medical Care
Certain symptoms associated with testicular pain demand immediate evaluation, as delayed treatment can lead to irreversible damage or loss of the testicle. You should seek emergency care immediately if you experience sudden, excruciating pain that begins without warning. This is the classic sign of Testicular Torsion, where the blood supply is cut off and tissue death can begin within hours.
Immediate emergency care is also required if the pain is accompanied by severe systemic symptoms, such as nausea and vomiting. Other red flags include visible changes to the scrotum, such as severe swelling, noticeable bruising, or a dark or purplish color change. A testicle positioned higher than normal or at an unusual angle within the scrotum is also highly suggestive of torsion. If severe pain persists for more than an hour, regardless of other symptoms, seek medical attention without delay.