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Everything Men Need to Know about Ball Pain, According to Urologists

Testicular pain is a lot more than a nut shot, urologists warn

Testicular pain can mean a lot of things for men beyond that it’s not going to be a great day. Whether your balls hurt as a result of a rogue baseball at little league practice or a serious underlying medical issue, discomfort, swelling, urologists confirm that pain in balls are no joke. So if you’re wondering “Why do my balls hurt?” Here are some of the reasons a man might experience discomfort in the family jewels.

1. Blunt Trauma

Blunt trauma causes about 85 percent of testicular injuries, as any middle school boy can attest, but the initial pain often resolves by itself, there are no physical changes, and men can get on with their lives — likely cuddling the same toddler that kicked them in the first place.

“Generally, if after the injury the pain resolves and the testicles feel normal it is unlikely there is a serious injury,” says Gregory Diorio, a urologist at DMC Harper University Hospital in Detroit. However, if the pain lingers or becomes more severe and there’s a change in the appearance or feel of the testicles, it could be a sign of a rupture or fracture, contusion, dislocation, all of which require medical attention to rule out testicle torsion. Testicular torsion occurs when balls rotate, twisting the spermatic cord, and scrotal pain is typically accompanied by abdomen pain, nausea or vomiting, frequent urination, and a fever.  This is a medical emergency that requires immediate surgery and, if untreated, could cause loss of a testicle and long-term fertility problems. 

2. Testicular Torsion Not Related to Blunt Trauma

Getting kicked in the balls is not the only way to end up with testicular torsion. It can even happen in your sleep. “Torsion can be spontaneous due to an anatomical variant which makes the testicle more prone to twisting,” Diorio explains. Translation: Sometimes, even when nothing happens, something has happened.

There’s also evidence that this might be a heritable trait, so the fathers who’ve endured testicular torsion in the past should be especially aware of their sons’ ball pain. “Torsion is considered a surgical emergency, as the blood supply is cut off.”

3. An Inflamed Epididymis

The epididymis is a coiled tube at the back of the testicles that stores and carries semen. It can end up inflamed due to bacterial contamination from such infections as STIs, urinary tract infections, or prostate infections. Men with epididymitis experience symptoms such as swelling, redness, and heat around the scrotum, painful urination combined with the urgent need to pee, discharge from the penis, blood in semen, and general testicular tenderness that comes on more gradually than torsion.

“If there is persistent testicular pain or swelling associated with urinary burning or discharge men should be evaluated for infectious etiology,” Diorio recommends. Epididymitis is usually treatable with antibiotics, but if left unattended men can develop pus-filled abscesses in the scrotum that need to be drained. The infection can spread to the testicle as well, a condition known as epididymo-orchitis. In severe cases, the epididymis may have to be removed altogether, leading to male infertility. If you’re at all in doubt about this condition as the culprit, your first visit should be to urgent care.

4. Swollen Testicle Veins

Much like varicose veins that swell in the legs, scrotal veins can also become enlarged and cause varicocele, or veiny lumps in the testicles that feel like worms or spaghetti. Most varicoceles form gradually and can go undetected.

“Rarely do these cause pain, but large ones can contribute to a dull, achy testicular pain,” Diorio explains. If left untreated, they may contribute to infertility. Men who want to have children should consult with their doctors if their scrotums feel like a bag of worms.

5. Other Scrotal Swelling

Infections in the epididymis and testicles can also lead to a hydrocele, where fluid collects in the testicle causing swelling, discomfort, feelings of heaviness, and occasional pain. Hydroceles are more common among newborn boys, but adult men can develop them as well. “Generally, they are benign and only need surgery if they are bothersome to the patient,” Diorio says. However, he notes that young men should consult with a physician to rule out testicular cancer, even if swelling is not accompanied by pain.  

6. Testicular Cancer

Ball pain from cancer is almost always accompanied by a physical mass or abnormality in the testicle, but there are exceptions. Testicular cancer can be harder to detect without a mass, but it does happen, occasionally accompanied by backaches and abdomen pain. Testicular cancer is the most common form of cancer in men ages 15 to 35 and could result in infertility and death. Lump or not, it’s important to take persistent ball pain seriously, Diorio says.

“Men with pain can have cancer without a mass though and all men, especially younger men in the appropriate risk groups should be evaluated by a medical professional,” he says.

7. Other Pain For No Real Reason at All

Like rain when it’s sunny outside and North Korean aggression, sometimes testicular pain can happen for no good reason at all.

There are muscular fibers within the cord that hold the testicles like a backache or muscle ache, and occasionally men can have intermittent pain in their testicles that is benign and self-limiting,” Diorio says. 

Still, men may not always know the difference between a harmless ache here and there and a problem, and some tend to err on the side of avoiding the doctor. It’s crucial for these men to realize that a quick trip to the urologist is more than a fair trade for peace of mind.

“All men should perform self-exams every month regardless if they have pain or not and any change or concern should be reported to a medical professional,” Diorio says.