Someone experiencing severe testicular and scrotal pain may require care from a physician. Evaluation of acute (sharp or intense) pain begins with a medical history. This is usually followed by a physical examination of the patient, including one or a combination of the following testing procedures:

• Visual examination. A physician usually first visually examines the patient’s penis, abdomen, anus, pubic hair and groin region while the patient is standing. This allows the physician to take into account any physical characteristics (e.g., redness, swelling, piercings, tattoos, skin ulcers) as well as evaluate the position of the testicles.
  
  
• Palpation. This involves feeling for potential irregularities by hand. Palpation is usually painless and is helpful in detecting any swelling or tenderness in the testicular/scrotal area.
  
  
• Cremasteric reflex test. Stroking or pinching of the upper inner thigh will cause the testicles to elevate (cremasteric reflex) in healthy males. A normal response of the cremasteric reflex is usually absent in patients who have experienced testicular torsion (twisting of the testicles and spermatic cord inside the scrotum), which helps distinguish this condition from torsion of the appendix testis (a small piece of tissue attached to the testicle). 
  
  
• Rectal exam. A digital rectal examination (DRE) may be performed to check the prostate gland for prostatitis, benign prostatic hyperplasia or cancer.
  
  
• Urinalysis. Urine is examined for various cells and contents during a urine test. Certain abnormal bacteria may suggest an infection, such as epididymitis, prostatitis or a urinary tract infection.
  
  
• Blood testing. In cases where infection may be suspected, a physician may perform blood tests. Blood and urine tests can also help in in diagnosing kidney stones.
  
  
• Swab test. A swab may be taken from the urethra (tube that discharges urine and semen from the body) when penile discharge is present. A swab test is required to diagnose sexually transmitted infections.

  
  
• Ultrasound. An imaging technology that uses sound waves to produce images of the shape and outline of various tissues and organs in the body. This test is often useful in assessing the severity of certain testicular and scrotal injuries or diseases (e.g., testicular cancer). Ultrasound is used commonly to diagnose testicular torsion.
  
  
• X-ray. This common test may be used to help find the source of referred pain, such as a spine disorder or kidney stones.
  
  
• Radionuclide imaging. This minimally invasive imaging test involves an injection of radioactive dye into the bloodstream. A nuclear scan detects whether the dye is accumulating in the testicle in a healthy manner.

If a man has testicular cancer, imaging tests such as a CAT scan, MRI or PET scan may be used to reveal whether the cancer has spread elsewhere. A CAT scan may also be used in detection of kidney stones.