Pain in the testicles can be alarming, especially in kids and teens. While it may be due to something minor like testicular growing pains, it can also signal something more serious, such as testicular torsion or infection. Knowing when to take action can make all the difference in preventing long-term damage. Understanding the causes of testicular pain, recognizing key symptoms, and acting quickly when pain occurs are essential for parents and caregivers.

what is testicular torsion?

Testicular torsion is one of the most urgent causes of pain in the testicle and scrotum. It occurs when the spermatic cord, which supplies blood to the testicle, twists and cuts off circulation. This condition is a medical emergency. If left untreated for more than six hours, it can cause permanent damage or loss of the testicle.

This painful twisting can happen suddenly, often while the child is sleeping or at rest. It is estimated that around 1 in 400 boys under age 25 will experience testicular torsion, and it is one of the leading surgical emergencies in adolescent males.

signs of testicular torsion in kids

Identifying testicular torsion early can help save the testicle. Some of the most common signs and symptoms include:

• Sudden, severe pain in the testicle or scrotum
• Swelling and redness of the scrotum
• Pain in the affected testicle and abdomen
• Nausea or vomiting
• An affected testicle that appears higher than normal or at an unusual angle

Children often describe it as the worst pain they’ve ever felt. In some cases, especially with younger kids or toddlers, they may not be able to describe what they’re feeling clearly, so physical signs like swelling or excessive fussiness should raise concern.

testicular torsion in toddlers and infants

Although testicular torsion is more common in boys over age 10, it can also occur in newborns and toddlers. Testicular torsion in toddlers may be harder to detect, as they can’t verbalize what’s wrong. Look for signs like a firm, discolored scrotum, inconsolable crying or discomfort during diaper changes.

In newborns, torsion may occur before or shortly after birth. It’s often identified during a routine exam, but if you notice swelling or an unusual appearance of your baby’s scrotum, contact your pediatrician right away.

causes of testicular pain in childhood

There are several causes of testicular pain in children, ranging from minor to serious. Some of the most common causes of testicular pain include:

testicular torsion

As previously mentioned, this is the most serious cause and requires immediate intervention.

epididymitis or infection

Painful testicles may be caused by inflammation or infection of the epididymis (the tube that carries sperm). This may result from a urinary tract infection or sexually transmitted infection in older teens.

injury

Direct trauma to the testicles during sports or play can cause a sharp ache in the scrotum, though it’s usually temporary unless there’s significant damage.

hernia

An inguinal hernia occurs when a part of the intestine pushes into the groin or scrotum. This can cause intermittent or constant pain in the area.

testicular growing pains

Some kids may experience aching or discomfort during periods of rapid growth, especially during puberty. These “growing pains” may be mild and come and go without other symptoms.

torsion of a testicular appendage

This less serious condition happens when a small leftover part on the testicle twists, causing pain in one spot. It’s not as urgent or dangerous as true  testicular torsion.

how is testicular torsion diagnosed?

When a child presents with acute testicle pain, a thorough evaluation is necessary. Diagnosis typically involves:

• A physical exam of the scrotum and abdomen
• Reviewing the child’s history of pain and symptoms
• An ultrasound with Doppler imaging to assess blood flow to the testicle

However, if testicular torsion is strongly suspected, doctors may proceed directly to surgery without imaging to avoid delays in treatment.

treatment for swollen testicle with pain

Treatment depends on the underlying cause. Here’s how different testicular pain causes are managed:

testicular torsion

Surgery is required immediately to untwist the spermatic cord and restore blood flow. In most cases, both testicles are surgically fixed to the scrotum to prevent future torsion. If blood flow isn’t restored in time, the testicle may be removed.

infections

If the pain is due to an infection like epididymitis, antibiotics are prescribed. Supportive measures like scrotal elevation and pain relief can also help.

minor injuries or torsion of an appendage

Rest, ice packs and over-the-counter pain relievers are usually enough for milder causes.

what to tell your child

Testicular pain may be embarrassing for a child to discuss, especially as they get older. It’s important to encourage open communication and reassure them that reporting pain is always the right thing to do. Make sure your child understands that sudden pain, swelling or changes in how the scrotum looks or feels should be reported right away—waiting could result in serious harm.

can a bladder infection cause pain in testicles? 

Yes, bladder infections can sometimes spread and cause inflammation in nearby structures, such as the epididymis, leading to pain in testicles and surrounding areas. If your child has urinary symptoms along with testicular discomfort, medical evaluation is recommended.

does a kidney stone cause pain in testicles? 

In some cases, kidney stones can cause referred pain that radiates into the lower abdomen or testicles. This is more common in older kids or teens. The pain may be sharp and come in waves, often accompanied by back pain or difficulty urinating.

when to seek help

Go to the emergency department immediately if your child experiences:

• Sudden and severe pain in one or both testicles
• Scrotal swelling, redness or firmness
• Abdominal pain with testicle discomfort
• Nausea or vomiting along with scrotal pain

Even if the pain resolves on its own, it’s still important to have your child evaluated to rule out any serious underlying condition. At Dayton Children’s, our pediatric urology team understands how concerning testicular pain can be for both kids and parents. We’re here to provide accurate diagnosis, fast intervention and compassionate care tailored to your child’s needs. Schedule an appointment or call 937-641-4000.