Testicle Pain in Children

Don’t Mess with Testicle Pain

father with two sons playing basketball

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. 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. In this case, the emergency department staff will immediately consult with a urologist, as an operation called detorsion, will be necessary to treat the condition.

If the patient’s pain is not severe or the examination does not immediately suggest torsion, the ED physician may order an ultrasound of the scrotum and urine tests to help determine the cause of the pain.

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” 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 scrotum 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.

If 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 Burnet or Liberty Campus emergency rooms.

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Brad Sobolewski, MD

About the Author: Brad Sobolewski, MD

Brad Sobolewski, MD, MEd is an Assistant Professor of Clinical Pediatrics at Cincinnati Children’s in the Division of Emergency Medicine. He is also an Assistant Program Director for the Pediatric Residency Training Program. In addition to providing care for children in the Emergency Department, Dr. Sobolewski is interested in enhancing online and multimedia education for medical professionals as well as patients and their families.

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Comments

  1. Nic February 14, 20:20
    What about chronic testicular pain? Negative ultrasound for torsion or other abnormalities and labs normal. 9 year old, intermittent complaints.
    • Brad Sobolewski, MD
      Brad Sobolewski, MD Author February 20, 17:06
      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.
  2. CJC February 16, 01:45
    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!
  3. Testicles pain March 09, 05:52
    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
    • Brad Sobolewski, MD
      Brad Sobolewski, MD Author March 15, 12:54
      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.