Why Do My Balls Hurt?

The 2006 Mike Judge movie "Idiocracy" has proved a bit prophetic. It got many things about the current era eerily correct. It's a little surprising then that in 2023, we still don't have a show called "Ow, My Balls" as they did in the movie.

In the film, the fictional TV show's character howled in pain as his crotch was repeatedly kicked, battered and bitten by dogs. In real life, however, it's not always so easy to identify the source of below-the-belt pain. Many men suffer various forms of testicular pain that are far less straightforward.

Here, we look at several types of pain down there, both acute and chronic. You will also find out why urologists are leaning into calling this "scrotal content pain" rather than testicular pain. (Hint: It's not always the testicle that's hurting you.)

"It's a very common issue," said Neel Parekh, M.D., a men's fertility and sexual health specialist with Cleveland Clinic. "Testicular pain or scrotal content pain accounts for like 2 to 5 percent of all new patient visits for a typical urologist."

Types of acute scrotal content pain

Acute scrotal content pain is usually sudden and intense and doesn't last very long, but it can still be a big deal. Here are some of the causes:

Trauma

Some short-term testicular or scrotal content pain comes from trauma, including obvious causes such as a football to the groin or zigging when you should have zagged at the company softball game.

While every guy is familiar with these awful moments, keep in mind that if the pain doesn't have a clear cause and is sudden, severe and doesn't go away after 30 minutes, you should see a doctor.

Testicular torsion

Speaking of sudden, intense scrotal content pain with no obvious cause, testicular torsion is a serious emergency condition that must be repaired by a doctor within hours or you risk losing the testicle.

It involves the testicle twisting on its spermatic cord and restricting blood flow. The results are intense pain, discoloration, nausea, a high-riding testicle that might be at an odd angle and sometimes even vomiting.

Don't hesitate to get treatment. Now. Even waiting as little as six hours may put the testicle at a higher risk of tissue death.

Epididymitis

Another common cause of acute scrotal content pain illustrates how other structures within the scrotum can have pain-causing complications.

Epididymitis is a condition that affects some 600,000 men per year. The epididymis, the long, coiled tube that stores sperm and sits at the upper back side of each testicle, becomes infected and inflamed. It can be caused by a sexually transmitted infection (STI) or disease (STD), such as chlamydia or gonorrhea, or E. coli or another type of bacterial infection.

Types of chronic scrotal content pain

Chronic scrotal content pain is pain that's long-lasting and gradual. Like acute scrotal pain, it can have many causes.

Two possible causes of chronic, ongoing scrotal pain are a spermatocele and a hydrocele. A spermatocele is a cyst that occurs in the epididymis but may cause pain that seems to emanate from the testicle. A hydrocele, on the other hand, is a fluid buildup within the scrotum, the thin sac that surrounds the testicles.

"Spermatocele is another name for an epididymal cyst, so it's just a sperm-filled cyst on the epididymis," Parekh said. "It's not cancerous, it's benign, but they can grow, and once they get to a certain size, they can cause pain. And hydroceles, once they grow, can cause pain."

Referred scrotal content pain

The causes of many types of scrotal content pain often can be identified through STI screening, urine tests, ultrasounds and focused patient histories. The causes of chronic scrotal content pain are often trickier to run down because, surprisingly, this kind of ongoing, long-term pain can originate from a variety of places in the body that may be quite distant from the scrotum.

The genitalia are situated at the bottom of a group of muscles called the pelvic floor muscles, which run from the belly button to the top of the thigh. They help protect organs such as the bladder, lower digestive tract and internal reproductive structures while helping you urinate, defecate and have sex. They're also involved in activities like walking, lifting, sneezing and coughing.

However, the nerves that connect the genitals to the spine and provide us with sensation all pass through this area.

"There are a lot of nerves that go to the scrotal content," said Amy Pearlman, M.D., a men's health specialist and co-founder of Prime Institute in Fort Lauderdale, Florida. "And those nerves originate from the back, from the thoric or lumbar spine, which is way higher than a lot of people realize. And the nerves have to glide through the muscle and fascia, so if those muscles or fascia are tight or they've been operated on, they can cause pain in that nerve and that then radiates to the scrotum."

Pearlman touched on what's called "referred pain." Hip problems and lower back problems—even everyday stress and muscle tension in the pelvic floor muscles—can irritate nearby nerves and transmit, or "refer," that pain to the scrotum.

Teasing out the underlying cause can be a challenge.

"It's not going to be solved in a single visit," Pearlman said. "Sometimes it takes several visits and several specialists. Not everyone who has a hip issue is going to have pain in their hip. It could be when they're tying their shoes or it could be pain when they are standing from sitting. You can't just ask if they have hip pain."

Conclusions

The phrase "scrotal content pain" may be a bit clumsier than simple "testicular pain," but it's actually a useful first step in understanding that not all pain in your scrotum is necessarily coming from the testes.

Know when to see your doctor right away, but also know that long-term pain isn't something you just have to live with—there are specialists who can help.

Whether you're looking for one of those specialists or just looking for a new doctor in general, Giddy Telehealth takes the difficulty out of the search. The easy-to-use online portal provides access to hundreds of healthcare professionals who have expertise across the full scope of medical care, including men's health.