ConditionMen's health
Testicular Disorders
Testicular disorders are conditions affecting the testicles and the structures around them in the scrotum. They include emergencies such as testicular torsion, infections like epididymitis, benign swellings such as hydroceles and varicoceles, hormone problems like low testosterone, fertility problems and testicular cancer. Symptoms range from sudden severe pain to a painless lump or low sex drive. Sudden testicular pain is an emergency, and any new lump should be checked promptly.
Also called: Testicular disease, scrotal disorders, diseases of the testes, testicle problems
At a glance
- Emergencies
- Testicular torsion (sudden severe pain), trauma with rupture, Fournier's gangrene.
- Infections
- Epididymitis and orchitis.
- Benign swellings
- Hydrocele, varicocele, spermatocele, epididymal cyst, hernia.
- Cancer
- Testicular cancer, most common in men aged 15 to 35, very curable.
- Hormones and fertility
- Hypogonadism (low testosterone), undescended testicle, male infertility.
- Key test
- Scrotal ultrasound.
When to get help
Call 911 or go to the ER
- Sudden severe pain in one testicle, especially with nausea or vomiting, or a testicle sitting higher than normal. Torsion needs surgery within hours
- A red, hot, very swollen, painful scrotum with fever, or blackened skin, which can be Fournier's gangrene
- Severe testicular pain or swelling after an injury
See a doctor within a day or two
- Testicular pain and swelling developing over a day or two, with or without burning on urination or discharge
- Painful swelling of one or both testicles with mumps or fever
- A painful bulge in the groin that cannot be pushed back
Book a routine appointment
- A painless lump, hardness or change in size of a testicle
- A scrotal swelling that changes through the day or feels like a "bag of worms"
- Low sex drive, erectile problems, tiredness and reduced body hair, which may be low testosterone
- Difficulty conceiving after a year of trying
- A boy whose testicle cannot be felt in the scrotum
Overview of testicular disorders
| Condition | Main features | Urgency |
|---|---|---|
| Testicular torsion | Sudden severe pain, high-riding testicle, nausea. Peaks in teens | Emergency |
| Torsion of the appendix testis | Sudden pain at the top of the testicle in boys, "blue dot" | Urgent |
| Epididymitis | Gradual pain and swelling behind the testicle, urinary symptoms | Urgent |
| Orchitis | Testicular swelling and pain, often with mumps or epididymitis | Urgent |
| Testicular cancer | Painless firm lump, heaviness, ages 15 to 35 | Prompt |
| Hydrocele | Smooth painless swelling around the testicle, transilluminates | Routine |
| Varicocele | Enlarged veins above the testicle, usually left, dull ache | Routine |
| Spermatocele and epididymal cyst | Smooth lump separate from the testicle | Routine |
| Inguinal hernia | Groin or scrotal bulge that changes with coughing | Routine, urgent if painful and stuck |
| Hypogonadism | Low testosterone: low libido, fatigue, ED, small testes | Routine |
| Cryptorchidism | Undescended testicle in boys | Routine, surgery by 18 months |
| Testicular trauma | Pain, swelling, bruising after injury | Emergency if severe |
| Chronic testicular pain (orchialgia) | Pain lasting over 3 months, often no clear cause | Routine |
Common symptoms
- testicular pain: sudden (torsion, trauma) or gradual (infection, varicocele, referred pain from kidney stones or hernia)
- swelling: fluid, infection, hernia, tumor or injury
- a lump: cyst, varicocele, or a firm mass that may be cancer
- heaviness or dragging sensation in the scrotum
- changes in sexual function: low sex drive, erectile dysfunction
- infertility
Our scrotal mass page explains how to tell different lumps apart.
Diagnosis
- history and examination, including standing and lying, transillumination and the cremasteric reflex (absent in torsion)
- scrotal ultrasound with Doppler: the key test for lumps, swelling and blood flow
- urine tests and STI testing for infections
- tumor markers (AFP, beta-hCG, LDH) when cancer is suspected
- morning testosterone, LH and FSH for suspected hypogonadism
- semen analysis for fertility concerns
Suspected torsion often goes straight to surgery without waiting for imaging.
Treatment overview
- torsion: emergency surgery to untwist and fix both testicles
- infections: antibiotics, rest, scrotal support, pain relief. Partners treated for STIs
- cancer: removal of the testicle through the groin, then surveillance, chemotherapy or radiation. Sperm banking offered beforehand
- hydrocele, varicocele, cysts: often observation, with surgery for symptoms or fertility
- hypogonadism: testosterone replacement if confirmed and symptomatic, or treatments that preserve fertility when desired
- undescended testicle: surgery (orchiopexy) in infancy
Testicular self-examination
Check monthly after a warm shower. Gently roll each testicle between your fingers and thumb, feeling for lumps, hard areas or changes in size. The epididymis, a soft coiled tube at the back, is normal. Report any changes to a doctor.
Frequently asked questions
What are the most common testicular disorders?
Common ones include epididymitis, hydrocele, varicocele, epididymal cysts, inguinal hernia and low testosterone. Testicular torsion and testicular cancer are less common but important to recognize because they need urgent treatment.
When is testicular pain an emergency?
Sudden, severe testicular pain, especially with nausea, vomiting or a testicle sitting higher than usual, may be torsion and needs emergency surgery within hours. Severe pain after injury, or a hot, red, swollen scrotum with fever, also needs emergency care.
Is a lump on the testicle always cancer?
No. Most scrotal lumps are benign, such as cysts, hydroceles or varicoceles. However, a firm lump within the testicle itself can be cancer and should be checked promptly with an ultrasound.
Can testicular problems affect fertility?
Yes. Varicoceles, undescended testicles, infections such as mumps orchitis, torsion, cancer treatment and hormone problems can all reduce sperm production. A semen analysis and urology assessment can identify treatable causes.
What causes low testosterone?
Causes include testicular problems (injury, infection, undescended testicles, genetic conditions such as Klinefelter syndrome, chemotherapy), pituitary or brain problems, obesity, opioid use and aging. Diagnosis requires symptoms plus repeated low morning testosterone levels.
Sources
This guide was written from current patient and clinical guidance, including:
- American Urological Association (Urology Care Foundation): Testicular conditions
- American Academy of Family Physicians: Evaluation of Acute Scrotal Pain (2013) and Scrotal Masses (2014)
- National Cancer Institute: Testicular Cancer Treatment (PDQ)
- Endocrine Society: Testosterone Therapy in Men With Hypogonadism Guideline (2018)
- MedlinePlus: Testicular disorders