Skip to main content
  1. BAUS Home
  2. Training & Trainees
  3. Urology SHO
  4. Testicular & Scrotal
  5. Acute Scrotal Pain

Please note: This page is intended for healthcare professionals only. It is designed as a general educational guide and does not replace local guidance, senior clinical advice, or individual clinical judgement. Patients should not use this page as medical advice and should seek advice from an appropriate healthcare professional.

Acute Scrotal Pain

Acute scrotal pain is a time-critical presentation.

The priority is to exclude testicular torsion, a surgical emergency where delays may lead to testicular loss.

A thorough and systematic assessment helps differentiate urgent pathology from benign or referred causes.

Differential Diagnoses

1Testicular Torsion – Surgical Emergency do not miss

  • Most common in adolescent boys 12–18 years (peak incidence)
  • Sudden severe pain, high-riding testis, absent cremasteric reflex
  • Immediate exploration required

View full details (HERE)

2Torsion of Testicular Appendage (Hydatid of Morgagni)

  • Most common in younger boys, typically: 7–12 years
  • Gradual onset pain, focal tenderness at upper pole, ± "blue dot sign"

View full details (HERE)

3Infection – Epididymo-Orchitis

  • Gradual onset, dysuria, fever, tender testis/epididymis
  • Consider STI screen (<35 years)

View full details (HERE)

4Scrotal Cellulitis

  • Erythema, warmth, superficial pain ± systemic symptoms

View full details (HERE)

5Fournier's Gangrene – Life-Threatening do not miss

  • Severe pain out of proportion, necrosis, crepitus
  • Urgent SpR review, IV antibiotics, emergency debridement

View full details (HERE)

6Trauma

  • Pain, swelling, haematoma after direct injury

View full details (HERE)

7Malignancy consider cancer pathway

  • ~20% of testicular cancers present with acute pain.
  • If a palpable lump is found on examination urgent USS testicles to confirm (next-day scan if out-of-hours)
  • If confirmed:
    1. Inform Urology SpR to break bad news
    2. Arrange CT TAP + tumour markers (LDH, β-hCG, AFP)
    3. If sperm banking indicated → bloods + referral via Urology CNS
    4. Book urgent radical orchidectomy
    5. Offer CNS presence or provide Macmillan support details

View full details (HERE)

Other Important Causes of Scrotal Pain or Swelling

8Inguinal Hernia do not miss

  • May descend into scrotum; tender, irreducible ± obstruction symptoms

9Referred Pain (Ureteric Stone)

  • Ipsilateral testicular/scrotal pain from T11–L2 nerve supply

10Varicocele

  • "Bag of worms", dull ache, worse standing/Valsalva
  • If a varicocele is confirmed clinically, patients will require USS kidneys to exclude renal tumours

11Hydrocele

  • Usually painless swelling; can cause dragging discomfort

12Spermatocele / Epididymal Cyst

  • Typically painless; may cause ache if large

13Post-Vasectomy Pain Syndrome

  • Chronic or intermittent testicular ache post-procedure

14Idiopathic Scrotal Pain

  • No clear cause despite complete assessment
  • Can be part of symptom for chronic pelvic pain syndrome (CPPS)

15Scrotal Oedema from other illnesses

  • This is usually caused by either fluid tracking into the scrotum, poor venous or lymphatic drainage or secondary to generalised oedema
  • Common conditions are:
    • Heart failure (anasarca)
    • Ascites
    • Post-operative
    • Pelvic malignancy
    • Other rare causes (filariasis etc.)
  • Painless, bilateral swelling; consider systemic signs
  • It is similar to lower limb oedema in heart failure and is compressible
  • Treatment treat the underlying cause and scrotal elevation