Testicular and scrotal pain is cause for concern for males of all ages. A wide range of conditions and injuries can cause pain in the testicles or the scrotum. Some may simply require explanation or reassurance to the patient, whereas others may require quick and extensive diagnosis and treatment. Nevertheless, a general understanding of the male reproductive system can be helpful in understanding sources of testicular and scrotal pain.  

Testicles (testes) first form in the womb inside the fetal abdominal cavity. At somewhere between 32 and 40 weeks of gestation, they descend from the abdomen into the scrotum, the external sac containing the testicles. When fully developed, the testicles are oval-shaped with one on the left side and one on the right side of the scrotum. The two central functions of the testicles are to produce sperm (male reproductive cell) and testosterone (male sex hormone).

The scrotum serves a number of functions, including regulating testicular temperature for the best possible sperm and testosterone production by being separate from the rest of the body. The temperature of the scrotal sac is about 2 degrees Fahrenheit below the body temperature. The cremasteric muscles (muscles in the scrotum) move the testicles within the scrotum according to the surrounding temperature. After sperm is produced in the testicles, it exits through a coiled, tube-like structure (epididymis) before traveling through a connector tube (vas deferens) and eventually out of the body. 

Injury or infection to these and other anatomical structures (e.g., prostate gland, urethra [tube that discharges urine and semen from the body]) can lead to testicular and scrotal pain in certain cases. Testicular and scrotal pain can range from moderate and short-lived (e.g., minor trauma) to severe with long-term aftereffects.   

There are several specific symptoms associated with testicular and scrotal pain. Many of these occur as a result of trauma, infection or physical activity. These related symptoms include:

• Swelling in the testicles or scrotum
• Tenderness in one or both testicles
• Abdominal pain or pelvic pain
• Pain when urinating (dysuria)
• Pain during sexual intercourse (dyspareunia) or ejaculation
• Testicular pain while sleeping (tends to occur in boys)
• Blood in the semen (hematospermia)
• Blood in the urine (hematuria)
• Penile discharge
• Nausea
• Vomiting
• Fever