Jan 13, 2020, 10:20:38 AM CST Jan 30, 2023, 12:40:30 PM CST

Common causes of testicular pain, swelling and lumps

A pediatric urologist discusses testicle health, symptoms to look for and when to see a doctor

Father and son on hike Father and son on hike

Experiencing pain, swelling or a lump in the testicle can be worrisome. The good news is, when caught early, many testicular problems and injuries can be fixed and cured.

It may feel embarrassing for a child or teen to talk about testicle health, but as a parent, you should emphasize the importance of communicating any concerns, pain or changes, and to seek care from a doctor.

"If your child notices something different or new, encourage him to tell someone right away so it can be looked at," says Craig Peters, M.D., Division Director of Pediatric Urology at Children's Health℠ and Professor at UT Southwestern. "Many testicular problems are treatable or curable if they are caught early."

What causes testicular pain and swelling?

Many testicular problems cause both pain and swelling. Sometimes, the pain can be dull or achy and worsen over time. Testicular pain can also be sudden and severe and can make a child's stomach upset.

If your child has sudden, severe pain in the testicles, it's important to see a medical provider right away. A doctor must treat certain conditions within hours to avoid long-term problems.

Causes of severe testicular pain can include:

  • Testicular torsion – A serious condition that happens when the spermatic cord twists and cuts off blood supply to the testicle.
  • Torsion of the appendix testis – A problem that occurs when a small piece of tissue on top of the testes twists and causes swelling and pain.

Other conditions that cause testicular pain and swelling include:

  • Infection (epididymitis) – A condition that can cause swelling in the epididymis, a tube behind the testicles that helps activate sperm.
  • Hernia – You may notice a hernia as a bulge above the testicle. The bulge can sometimes extend into the scrotum and cause mild, moderate or severe pain.
  • Varicocele – A condition that occurs when there is swelling in the vein that drains blood from the testicles. It can cause a dull ache and swelling and may feel like a bag of worms above the testicle.
  • Hydrocele – A condition where fluid gathers around the testicle. While it may not cause serious problems, it can result in uncomfortable swelling.
  • Summer scrotum or summer penis – A common summertime condition that causes the skin around the scrotum or penis to become red, swollen, itchy and painful. It may look and feel like an allergic reaction or bad bug bite.
  • Orchitis – An uncommon condition that causes the testicles to swell.

The treatment for testicular pain and swelling depends on the type of condition you have. Treatments can include antibiotics, surgery and careful monitoring.

What causes testicular lumps?

There are different types of testicular lumps. Non-cancerous (benign) lumps in the testicle are usually cysts. These lumps are typically the size of a marble, smooth and round, and may feel like fluid. Cysts can stick around for a while, but they usually don't need treatment.

Cancerous (malignant) lumps in the testicles are usually hard and feel very different from the surrounding testicle. These lumps may also be painful.

Regardless of how a testicular lump feels, it's important that your child is examined by a doctor. "A lump in the testicle requires an exam and possibly an ultrasound," Dr. Peters says. "Only an experienced doctor and diagnostic test can confirm the type of lump."

Importance of testicular self-exams

Starting when your child is a teenager, Dr. Peters recommends talking to your son about doing a testicular self-exam at least once a month.

"A lot of times, someone finds a lump but doesn't want to say anything, but it's important to bring it up and see a doctor," Dr. Peters says. "More than 95% of testicular cancers are curable if they are caught early."

For more information on how to do a testicular self-exam, read these instructions from the American Cancer Society.

Testicular injury and trauma

Although testicular trauma is rare, it most often affects athletes. In many cases, testicular trauma causes bruising and swelling around the scrotum. While painful, this bruising usually resolves on its own with time.

However, serious trauma to the testicles can sometimes cause testicular fractures. These injuries may require surgery to help relieve pain and limit damage to the testicle.

If a testicular injury occurs and results in bruising, consult a physician. If an injury results in no significant swelling, bruising, nausea or vomiting, the injury can be treated with ice and rest.

To prevent these injuries, Dr. Peters recommends children and teens wear a protective cup when playing sports like hockey, basketball, baseball, football, soccer, karate or lacrosse.

"It's extremely important for all boys to wear a hard, protective cup when playing any contact sport," Dr. Peters says. "No question about it, it's the best thing you can do to prevent testicular trauma."

Learn more

The Pediatric Urology department at Children's Health offers comprehensive care for the full range of urologic conditions, from simple problems such as bedwetting to the most complex conditions requiring advanced surgical intervention. Learn more about the Urology program and services.

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