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Scrotal/testicular pain and/or lump/swelling (Children/Adults)

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Causes in Adults

Condition	Clinical Features	Tests	Management
Testicular Torsion	Sudden, intense scrotal pain. Swelling and erythema of the scrotum. High-riding testicle, absence of cremasteric reflex.	Emergency Doppler ultrasound to assess blood flow. Urgent clinical evaluation based on physical exam.	Emergency surgery (detorsion and orchiopexy). Orchiectomy if the testis is non-viable.
Epididymo-orchitis	Gradual onset of pain, usually unilateral. Fever, scrotal swelling, and erythema. Often associated with sexually transmitted infections (STIs) in younger men or UTIs in older men.	Urine culture and STI screening (e.g., gonorrhea, chlamydia). Scrotal ultrasound to rule out torsion.	Antibiotics (e.g., ceftriaxone, doxycycline for STIs; ciprofloxacin for UTI-related cases). Rest, scrotal elevation, and NSAIDs for pain relief.
Testicular Cancer	Painless, firm testicular lump. Occasional dull ache or heaviness in the scrotum. May be associated with back pain or weight loss in advanced cases.	Scrotal ultrasound to confirm solid mass. Serum tumour markers (AFP, beta-hCG, LDH). CT scan for staging if cancer is confirmed.	Radical orchiectomy for removal of the affected testicle. Chemotherapy or radiotherapy based on staging and tumour type.
Varicocele	Dull, aching pain in the scrotum, often worsening with standing. "Bag of worms" feel on palpation, typically on the left side. May be associated with infertility.	Scrotal ultrasound with Doppler to assess venous dilation.	Conservative management if asymptomatic (scrotal support, NSAIDs). Surgical repair (varicocelectomy) if causing pain, infertility, or testicular atrophy.
Inguinal Hernia	Intermittent scrotal or groin swelling, reducible lump. Pain worsens with straining or lifting. Incarcerated hernia may present with severe pain and signs of bowel obstruction.	Clinical diagnosis based on physical exam. Ultrasound if the diagnosis is uncertain.	Elective surgery for uncomplicated hernia (herniorrhaphy). Urgent surgery if incarcerated or strangulated.

Causes in Children

Condition	Clinical Features	Tests	Management
Testicular Torsion	Sudden, severe scrotal pain. Swelling and erythema of the scrotum. Absent cremasteric reflex. High-riding testicle.	Urgent Doppler ultrasound to assess blood flow. Clinical diagnosis often based on history and physical exam.	Emergency surgery (detorsion and orchiopexy) within 6 hours to save the testicle. Orchiectomy if the testicle is non-viable.
Epididymitis	Gradual onset of scrotal pain and swelling. Fever, scrotal erythema, tenderness of the epididymis. Associated with urinary tract infections (UTI).	Urinalysis and urine culture to rule out infection. Scrotal ultrasound to confirm diagnosis and exclude torsion.	Antibiotics (e.g., ceftriaxone, doxycycline) based on suspected infection. Rest, scrotal elevation, and NSAIDs for pain relief.
Hydrocele	Painless, smooth scrotal swelling. Transillumination of scrotum with light. May fluctuate in size.	Clinical examination and transillumination test. Ultrasound if diagnosis is unclear or if other pathology suspected.	Usually resolves spontaneously by age 1-2 years. Surgical repair (hydrocelectomy) if persistent beyond 2 years or symptomatic.
Inguinal Hernia	Intermittent, reducible lump in the groin or scrotum. Increases in size with crying or straining. Severe pain if hernia becomes incarcerated.	Clinical examination (palpable lump in the inguinal region). Ultrasound to differentiate from other conditions.	Surgical repair (herniorrhaphy) to prevent complications. Emergency surgery if hernia is incarcerated or strangulated.
Torsion of the Appendix Testis	Acute scrotal pain, often moderate. "Blue dot sign" on the scrotal skin (bluish discoloration). Localized tenderness at the upper pole of the testis.	Scrotal ultrasound to differentiate from testicular torsion. Doppler ultrasound shows normal testicular blood flow.	Conservative management: NSAIDs, scrotal elevation, and rest. Symptoms usually resolve within 1 week.
Varicocele	Dull, aching pain in the scrotum, worse with standing. Palpable "bag of worms" feel in the scrotum, typically on the left side. Can lead to testicular atrophy or infertility in severe cases.	Scrotal ultrasound with Doppler to assess venous dilation.	Conservative management if asymptomatic (scrotal support, NSAIDs). Surgical repair (varicocelectomy) if causing pain, infertility, or atrophy.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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