There is one type of pain that adolescent boys and their parents should never ignore – testicle pain.
Sudden onset of severe pain in the testicles or scrotum can indicate that an adolescent or teenaged boy has a condition called testicular torsion. And it needs immediate medical attention.
Testicular torsion is a condition where the testicle twists around the spermatic cord – the structure from which the testicle hangs – within the scrotum. The spermatic cord contains the sperm ducts and blood vessels that supply the testicle. When the testicle twists, so do the blood vessels. This can cut off circulation to the testicle and can lead to permanent damage or death of the testicle in as little as 4-6 hours.
Along with sudden, severe pain, many patients who have testicular torsion also have abdominal pain and nausea or vomiting. The testicle is also usually elevated in the scrotum and extremely tender. The scrotum may also appear red, swollen and very firm to the touch.
If your son complains of testicle pain
First: Ask him when the pain started and what he was doing just before it began. It is important to know if there was an injury, pain with urination or nausea/vomiting.
Then: As uncomfortable as it may be for both of you – it is important to have the child show you his scrotum and testicle. . It can be easier to do this if they are able to stand up. Look for redness and swelling. Touch the area to gauge how firm and/or tender it is.
If the scrotum and testicle within are firm swollen and extremely tender: Call your child’s primary care physician and plan to go to the emergency department – preferably, pediatric – without delay.
If the pain is mild or comes and goes: Call your child’s primary care physician for an appointment to have it checked in the office.
Bottom line: Always seek the advice of a medical professional if an adolescent boy suddenly develops testicular pain.
What to expect in the Emergency Department
If you see symptoms that warrant a trip to the ED, you can expect the patient to be assessed quickly by a physician. The diagnosis of testicular torsion may be made based on the patient’s history and examination alone or in conjunction with an ultrasound of the scrotum or testicles. The patient may also be asked to provide a urine sample to help determine the cause of the pain.
If a diagnosis of testicular torsion is made the emergency department staff will immediately consult with a urologist, as an operation called detorsion and orchiopexy, will be necessary to treat the condition.
Surgical Treatment
The detorsion procedure will be performed by a urologist and will involve twisting the testicle back into its normal position. Both the affected and unaffected testicles will then also be “tacked down” (orchiopexy) in a manner which prevents another torsion in the future.
Detorsion within 4-6 hours of onset of pain assures near 100% viability of the testicle. After 12 hours, that rate drops to 20%. Detorsion after 24 hours is almost never successful.
If a torsion has gone untreated for too long and the testicle is found to be too damaged to be saved, the affected testicle would be removed as part of the procedure as well.
This condition comes on quickly and without warning. There isn’t anything to do to prevent it, so it’s incredibly important that families talk about this type of pain and what to do if it happens.
We’ve seen too many cases where kids are too embarrassed to talk to a parent about what’s going on with their testicles and we don’t see the patient until it is too late.
Please, talk to your sons about the importance of telling you if they have this type of pain.
u003cspan style=u0022font-weight: 400;u0022u003eIf you’re concerned about your child’s pain, please contact your pediatrician as soon as possible. If you are unable to reach your pediatrician, we recommend making a trip to your local emergency room to have the pain assessed. We can see your child 24/7 at our u003ca href=u0022hyperlink: https://www.cincinnatichildrens.org/patients/visit/directionsu0022u003eBurnet or Liberty Campus emergency roomsu003c/au003e.u003c/spanu003e
What about chronic testicular pain? Negative ultrasound for torsion or other abnormalities and labs normal. 9 year old, intermittent complaints.
Chronic testicular pain can be quite frustrating and vexing. Sometimes pain from the abdomen can be referred to the scrotum – that is a source other than the testicle is causing the pain even though your son “feels” it in the scrotum. If you haven’t already done so it would be wise to discuss these symptoms with your primary care doctor and also make an appointment with a pediatric urologist.
Thank you
This post was the first I read when my 4 year old told me of pain ‘down there’
We went straight to a&e and they saved his left testical just in time.
I had never heard of testicular torsion before – I am now telling everyone I know!
My 13 year old son has been having Testicle pain off and on since he was 12 years old. We took him to Er and have obtained several ultrasounds, blood work, and Urinalysis. He has missed school because of this he is an athlete and they said it was nothing we can do they haven’t diagnosed him with anything! It goes from his testicular to pelvis to stomach. I need help he is in pain and everyone is telling us there is nothing wrong
Testicular pain that comes and goes can be quite frustrating. Sometimes pain from the abdomen can be referred to the scrotum – meaning the pain is not coming from an issue in that area, even though your son “feels” it in the scrotum. If you haven’t already done so it would be wise to discuss these symptoms with your son’s primary care doctor and also make an appointment with a pediatric urologist.
My son is experiencing the same symptoms, if you find any answers, please reply, and I will do the same. I am experiencing the same answers you are, and my son is so frustrated with the pain. I hope you find relief for your son too. AT
Maybe ask his doctor about peritoneal cysts. Many Doctors dont consider this possibility because it is rare. Rare as it is it is most common in males. Hope this helps!
My son is 13 and he plays baseball. He plays catcher and gets hit by foul tips in the groin. He says that his testicles still hurt even though he wears a cup. Is this normal?
The testicle, just like any part of the body, can be injured. A testicular hematoma or fracture is a more significant version of this and patients will have a very painful testicle, and a swollen, and discolored scrotum. Wearing a cup, especially for a catcher, is ALWAYS recommended!
My 13 year old Grandson commented that his one testicle was achy and he had slight pain once in a while, this happened a few times. I know boys go through growth spurts and often have aches and pains. I raised girls, and have tried looking up puberty and slight aches and pains… every link went straight to testicular tension and didn’t even mention that boys may have little pains or aches in their testicles. Should my Grandson be concerned every time he has an ache? My Son in Law says it’s normal for pains, but sites say otherwise.
Sometimes teenagers have mild testicular or scrotal pain and do not have any other symptoms. This can be temporary, and relieved with rest and medicines like acetaminophen or ibuprofen. Patients can develop infections of the testicle and epididymis, both from viruses and bacteria. Generally these are associated with discomfort with urination and other symptoms such as swelling and pain to the touch. Remember that testicular torsion is abrupt and very severe pain. Patients should be immediately evaluated if the pain increases in severity or is associated with testicular swelling.
My ten year old son just told me his testicle where hurts when he threw up should I worry or is that normal
Hi Kim,
We reached out to Dr. Sobolewski and here is his reply:
If the pain was only associated with a single episode of forceful vomiting and resolved quickly, I would not be concerned. If the pain preceded the vomiting, is persistent and/or worsening, is associated with pain while urinating, is associated with a swollen or firm testicle, or recurs without vomiting it is recommended to have him evaluated by his doctor. Abrupt onset of severe testicular pain is always an emergency.