A dull ache in one or both testicles is common, and most of the time it stems from something treatable: an infection, a swollen vein, a muscle problem, or even a issue somewhere else in your body that sends pain signals to your groin. That said, certain patterns of testicular pain need immediate attention, so understanding the difference between a nuisance ache and a warning sign matters.
When Testicular Pain Is an Emergency
Testicular torsion happens when the spermatic cord twists and cuts off blood flow to the testicle. It typically hits suddenly with severe, one-sided pain, often accompanied by nausea, vomiting, and a testicle that sits higher than normal or at an unusual angle. This is the one scenario where you should head to the emergency room without debating it.
The salvage rate for saving the testicle drops significantly after six hours. Animal research shows that after six hours without blood flow, the sperm-producing cells are destroyed, and after ten hours, hormone-producing cells begin to die as well. Clinically, ten hours of full torsion results in permanent damage for most patients. Torsion is most common in adolescents and young men but can occur at any age.
Infections That Cause a Gradual Ache
Epididymitis, an infection of the coiled tube behind the testicle, is one of the most frequent reasons for testicular aching in adults. It usually comes on over a day or two rather than all at once, and the pain tends to build from mild to moderate. You’ll often notice tenderness, swelling along the back of the testicle, and sometimes warmth or redness of the scrotal skin.
In sexually active men under 35, the most common culprits are sexually transmitted bacteria like chlamydia and gonorrhea. Many men with these infections also have urethritis (inflammation of the urethra) without realizing it, because it’s frequently silent. In men over 35, epididymitis more often traces back to urinary tract bacteria, especially in those with an enlarged prostate, recent catheter use, or a history of urinary surgery. The infection is treated with antibiotics, and the ache typically fades over one to two weeks, though mild tenderness can linger longer.
Orchitis, infection of the testicle itself, sometimes develops alongside epididymitis. It produces similar symptoms but with more diffuse swelling of the entire testicle rather than just the area behind it.
Varicoceles: The Most Common Structural Cause
A varicocele is an enlargement of the veins inside the scrotum, similar to a varicose vein in the leg. It affects roughly 10% to 20% of men and appears on the left side in most cases, because of how the veins drain differently on that side. The classic description is a mass that feels like a “bag of worms” above the testicle, and it’s usually more noticeable when you’re standing or after physical activity.
Many varicoceles cause no symptoms at all. When they do ache, the pain is typically a heavy, dragging sensation that worsens throughout the day or after exercise and improves when you lie down. Among men with fertility problems, about 40% have a varicocele, so it’s worth mentioning to a doctor if you’re trying to conceive.
Pain That Starts Somewhere Else
Your testicles share nerve pathways with several other structures, which means a problem in your back, hip, ureter, or groin can produce pain you feel in the scrotum. Two of the most common sources of this referred pain are inguinal hernias and kidney stones.
An inguinal hernia occurs when tissue pushes through a weak spot in the abdominal wall near the inguinal canal, the same passage the spermatic cord travels through. Large hernias can extend into the scrotum itself, producing pain and swelling that feel testicular. The discomfort is usually worse with lifting, coughing, or straining. Kidney stones, meanwhile, can send sharp, radiating pain from the flank down into the groin and testicle as the stone moves through the ureter.
Chronic Aching Without a Clear Cause
Some men deal with a low-grade testicular ache that lasts months without an obvious infection, injury, or structural problem. This is more common than many people realize, and it can be frustrating because imaging and lab work come back normal.
One underrecognized cause is pelvic floor overactivity, where the muscles of the pelvic floor stay chronically tense. This tension can create referred pain in the testicles, perineum, or lower abdomen. Men who sit for long periods, carry stress physically, or have a habit of clenching these muscles are more prone to it. Research supports treating this pattern with myofascial trigger point release (a form of targeted physical therapy) and specific relaxation training. Nerve entrapment of the small nerves running through the groin, specifically the ilioinguinal or genitofemoral nerves, can also produce chronic scrotal aching, sometimes after a prior surgery in the area.
Pain After a Vasectomy
If you’ve had a vasectomy and now have a persistent ache, you’re not imagining it. Studies report that about 11% of men still have some pain at three months post-procedure. The good news is that most of those cases resolve on their own, typically by four to five months after surgery. Only about 1% to 2% of men experience pain that significantly affects their quality of life long-term. The ache is usually dull, intermittent, and localized to the area where the procedure was performed.
Could It Be Testicular Cancer?
Testicular cancer most often shows up as a painless lump or swelling on the testicle rather than an ache. However, some men do experience a sharp pain or a dull heaviness as their first symptom. If you feel a hard, irregular lump on the testicle itself (not the softer structures behind it), get it checked promptly. Testicular cancer is highly treatable when caught early, and an ultrasound can usually distinguish it from a benign cyst or other harmless finding within minutes.
What You Can Do at Home
For a mild, non-emergency ache, a few simple steps can help while you figure out next steps:
- Ice: Apply a wrapped ice pack to your groin for 10 to 20 minutes every hour. Never place ice directly on the skin.
- Support: Snug, supportive underwear (briefs or a jock strap) reduces the dragging sensation that makes aching worse, especially with varicoceles.
- Anti-inflammatories: Over-the-counter options like ibuprofen can reduce swelling and take the edge off the pain.
- Rest: Avoid heavy lifting, long runs, or anything that increases pressure in the groin until the ache settles.
If the pain came on suddenly and is severe, is accompanied by swelling that’s getting worse, or hasn’t improved after a week of home care, it’s time for an in-person evaluation. An ultrasound and a urine test can rule out most serious causes quickly.