Home › Testis & scrotal swelling

Testis & Scrotum · Imphal

Testis pain & swelling:
know when it's an emergency.

Sudden testicular pain can be torsion — an emergency where every hour counts. Most swellings, though, are harmless. Here is how to tell them apart, what tests are done, and how each is treated.

● Torsion: hours matter● Same-visit scrotal ultrasound● Testicular self-examination

💬 Say "Hi" to book Is it an emergency? ↓

Dr. Nameirakpam ShantajitMBBS (SPMC Bikaner) · MS Surgery & M.Ch Urology (RIMS Imphal) · MMC Reg. No. MNP 150

Illustration — in torsion the cord twists and the testis loses its blood supply within hours.

Torsion

Sudden testicular pain: go now

▶ Watch: what happens in torsion

A 40-second animation with voice — how the testis twists, why it is an emergency, and how surgery untwists and fixes both testes. Subtitles are shown in the video, so it works even without sound.

⬇ Download the video to share on WhatsApp with parents and schools.

Narration: synthetic voice (Piper text-to-speech, trained on the LibriTTS dataset, CC BY 4.0).

⚡

Sudden, severe pain in one testis

Often waking a boy or young man from sleep, sometimes after sport.

🤢

Nausea or vomiting

With testicular or lower-tummy pain.

⬆️

Testis sits higher, or lies sideways

And is very tender to touch.

🧒

A boy with tummy pain and vomiting

Boys may only complain of tummy pain — always check the testes.

Within 6 habout 9 in 10 testes can be saved

12 hthe chance falls to about half

After 24 hthe testis is rarely saved

🚑

Don't wait for the morning — or for a scan

Go straight to the nearest hospital emergency. Don't give food or drink (surgery may be needed). If torsion is likely, surgeons operate without waiting for an ultrasound: the cord is untwisted and both testes are stitched in place so it cannot happen again. Approximate salvage figures are from published studies.

🩺 For doctors: the TWIST score

Testicular Workup for Ischemia and Suspected Torsion — a bedside score in the acute scrotum.

Finding	Points
Testicular swelling	2
Hard testis	2
Absent cremasteric reflex	1
Nausea / vomiting	1
High-riding testis	1

0–2 low risk · 3–4 intermediate — urgent Doppler ultrasound · 5–7 high risk — straight to scrotal exploration without waiting for imaging.

A low score does not exclude torsion. When in doubt, explore — please WhatsApp us before sending: 81328 57130.

Differential diagnosis

Acute painful scrotum: what else could it be?

Condition	Typical age	Onset	Key features	Treatment
Testicular torsionEmergency	Mostly 12–18 yrs; also newborns and young men	Sudden, severe; often wakes from sleep	Severe pain, nausea/vomiting, testis high and lying sideways, cremasteric reflex usually absent	Emergency surgery — untwist and fix both testes
Torsion of a testicular appendageUrgent	Boys 7–12 yrs	Gradual over hours to a day	Pain at the top of the testis, a tender small lump — sometimes a "blue dot" under the skin; reflex present	Rest and pain relief; settles in about a week
Epididymo-orchitisUrgent	Young men (often sexually transmitted) and older men (urine infection)	Gradual over 1–2 days	Fever, burning urine, swollen tender epididymis; lifting the testis may ease pain	Antibiotics for 10–14 days, scrotal support; partner treatment if STI
Mumps orchitisReview	After puberty	4–8 days after mumps (parotid swelling)	Swollen, painful testis with recent face swelling	Rest, pain relief, support
Injury (trauma)Emergency	Any age	After a blow, fall or sports injury	Pain, swelling, bruising — possible rupture of the testis	Urgent ultrasound; surgery if ruptured
Strangulated inguinal herniaEmergency	Any age, including babies	Sudden or after straining	Groin-to-scrotum lump that will not go back, vomiting	Emergency surgery
Fournier's gangreneEmergency	Adults, especially with diabetes	Over hours to days	Rapidly spreading redness, swelling, dark skin, fever, very unwell	Emergency — antibiotics and urgent surgery
Idiopathic scrotal oedema / HSPReview	Young boys	Hours	Red, swollen scrotal skin, often little pain; HSP has a rash on legs	Usually settles; HSP needs paediatric review

Doppler ultrasound helps tell these apart: blood flow is reduced or absent in torsion and increased in epididymo-orchitis. In suspected torsion, surgery must not be delayed for imaging.

Painless swellings

Lumps and swellings in the scrotum

💧

Hydrocele

Fluid around the testis. Smooth, painless, can get large; light shines through it. In babies it often goes by 1–2 years. In adults, surgery if it is large or bothersome.

🫧

Epididymal cyst (spermatocele)

A smooth lump felt separately above or behind the testis. Harmless — removed only if large or painful.

🪱

Varicocele

Swollen veins, like a "bag of worms", usually on the left, more obvious when standing. Linked to infertility and ache. Varicocele guide →

➰

Inguinal hernia

A swelling coming down from the groin — you cannot feel above it, and it may enlarge on coughing. Needs surgical repair; one that will not go back is an emergency.

🎯

Testicular tumour

A hard, painless lump in the testis itself, most often at age 15–40. Needs an ultrasound and blood tumour markers soon. Testicular cancer is one of the most curable cancers when treated early.

🧒

Undescended testis

A testis not in the scrotum since birth. Best treated by surgery between 6 and 18 months of age. Children's urology →

How doctors tell them apart

Sudden severe pain?Yes → Emergency — go now (torsion until proven otherwise)

No — a painless or slowly-appearing swelling ↓

Can you feel the top of the swelling (get above it)?No → probably an inguinal hernia

Yes ↓

Separate from the testisSmooth → epididymal cyst
"Bag of worms" → varicocele

Surrounds the testis, light shines through→ hydrocele

Part of the testis itself, hard→ tumour until proven otherwise — ultrasound soon

A simple guide used by doctors — not for self-diagnosis. An ultrasound with Doppler confirms the cause.

Tests

How it is checked

Examination

Gentle examination lying and standing, including the groin; a light (transillumination) test for fluid.

Scrotal ultrasound with Doppler

Shows the testis, epididymis, fluid, veins and blood flow — done in the same visit.

Urine test

For infection when epididymo-orchitis is suspected; STI tests in young men.

Tumour markers

AFP, beta-hCG and LDH blood tests if a testicular lump is found.

Treatment

Treating each condition

Torsion

Emergency exploration

The cord is untwisted and both testes fixed (orchidopexy). A testis that has died is removed; a testicular implant can be offered later.

Swellings

Surgery when needed

Hydrocele and large epididymal cysts are removed through a small cut in the scrotum, usually as a day-care or short-stay procedure. Hernias are repaired.

Testicular tumour

Orchidectomy

Removal of the testis through a groin cut, with sperm banking offered beforehand; further treatment depends on the type and stage — cure rates are high.

Testicular self-examination — once a month

Warm bath or shower: Once a month, when the scrotal skin is relaxed.
One testis at a time: Roll it gently between thumb and fingers. It should feel smooth and firm, like a boiled egg without the shell.
Find the epididymis: The soft, rope-like tube at the back is normal — don't mistake it for a lump.
Notice changes: A hard lump, change in size or a heavy feeling — see a doctor within 2 weeks. It is normal for one testis to be slightly larger.

Good to know

Most scrotal lumps are not cancer
Torsion in one testis means the other is fixed too
Epididymo-orchitis in young men may be sexually transmitted — partners need treatment
After torsion or orchidectomy, fertility and hormones are usually normal with one healthy testis

🚑

Go to the nearest hospital emergency if you have

Sudden severe testicular pain — especially in a boy or young man
A boy with tummy pain and vomiting — check the testes
Swelling and pain after an injury
A groin or scrotal lump that will not go back, with vomiting
Rapidly spreading redness, swelling or dark skin of the scrotum with fever

WhatsApp numbers and the chatbot are not emergency services.

Questions

Frequently asked questions

What is testicular torsion?

Twisting of the spermatic cord that cuts off the blood supply to the testis. It causes sudden, severe pain and is a surgical emergency — the testis can usually be saved if surgery is done within about 6 hours.

How can I tell torsion from an infection?

Torsion usually starts suddenly with severe pain and often vomiting, mostly in boys and young men. Epididymo-orchitis comes on over a day or two, often with fever and burning urine. Only a doctor can tell reliably — sudden pain should always be treated as an emergency.

Should we wait for an ultrasound if torsion is suspected?

No. If torsion is likely, the surgeon operates without waiting for a scan, because delay can cost the testis. Ultrasound is useful when the diagnosis is uncertain.

Is a painless lump in the testis serious?

Most scrotal lumps are harmless — hydroceles, cysts or varicoceles. But a hard lump in the testis itself can be a tumour and should be checked with an ultrasound within about 2 weeks. Testicular cancer is very curable when found early.

Does a hydrocele need surgery?

Not always. In babies it often disappears by 1–2 years. In adults, surgery is advised if it is large, uncomfortable or growing.

Can I still father children with one testis?

Usually yes. One healthy testis normally produces enough sperm and testosterone.

Book a consultation

NAM Consultants, Singjamei: mornings daily 6:00–9:30 AM (Mar–Oct) / 6:30–9:30 AM (Nov–Feb), evenings 4–6 PM Mon–Sat · Raj Medicity Hospital: Mon–Sat 11 AM–1 PM

💬 Say "Hi" to book Book online

Medically reviewed by Dr. Nameirakpam Shantajit, M.Ch Urology (MMC Reg. No. MNP 150) · Last reviewed: 10 October 2026

Testis pain & swelling:know when it's an emergency.

Sudden testicular pain: go now

Sudden, severe pain in one testis

Nausea or vomiting

Testis sits higher, or lies sideways

A boy with tummy pain and vomiting

Don't wait for the morning — or for a scan

Acute painful scrotum: what else could it be?

Lumps and swellings in the scrotum

Hydrocele

Epididymal cyst (spermatocele)

Varicocele

Inguinal hernia

Testicular tumour

Undescended testis

How doctors tell them apart

How it is checked

Examination

Scrotal ultrasound with Doppler

Urine test

Tumour markers

Treating each condition

Emergency exploration

Surgery when needed

Orchidectomy

Go to the nearest hospital emergency if you have

Frequently asked questions

Book a consultation

Testis pain & swelling:
know when it's an emergency.