There are many possible reasons that a man may develop pain in the testicles. This symptom should be evaluated as soon as possible, since both infection and a more worrisome possibility, testicular cancer, require prompt treatment.

Epididymitis. Infection of the epididymis usually affects only one side of the scrotum. The most common symptom is a swollen, hot, red, and very painful half of the scrotum. There may be discharge from the penis, if the infection that is causing epididymitis is also causing urethral infection—a common combination. The onset of pain is usually more gradual than that experienced with testicular torsion.

Orchitis. Orchitis is an infection of the testicle that is usually caused by the mumps virus. Other causes are infection with bacteria {gonorrhea, tuberculosis, syphilis) or with a virus other than mumps. If orchitis occurs in an adult male, permanent testicular scarring and failure may result. There is usually severe pain and swelling in one or both testicles; other symptoms associated with mumps (such as parotid gland enlargement) and bacterial or viral infections may also be present.

Testicular cancer. More common among young men, this is a completely treatable cancer if detected early. To make early detection more likely, men must perform monthly testicular self-examinations, just as women do monthly breast self-examinations. Testicular cancer produces a swelling or bump on the testicle itself, not above the testicle in the epididymis or spermatic cords. It may cause testicular discomfort as well. A health care provider can distinguish this disease from benign causes of swelling in the scrotum, such as spermatocoeles (which are temporary swellings in the spermatic cords) or cysts in the epididymis. An ultrasound study (in which sound waves are bounced off an internal structure to allow that structure to be visualized) may be ordered to help with the diagnosis.

Torsion of the testicle. Torsion of the testicle is a medical emergency. It is a twisting of the spermatic cords and blood vessels to the testicle, which can kill the testicle unless it is repaired quickly by surgery. The primary symptom is severe pain and swelling on one side of the scrotum that often comes on rapidly. It is more common among adolescent men.

*35\213\8*