Patient information · Urology and urgent care
Testicular pain and lumps
one of these is a six-hour emergency
Most testicular lumps are harmless and most aches have a simple explanation. But sudden severe testicular pain is a surgical emergency with a narrow window, and testicular cancer is the commonest cancer in men aged 15 to 45 and is close to universally curable when caught early. Both reward acting quickly and neither rewards embarrassment.
Go to an emergency department immediately if there is
- sudden severe pain in one testicle, often waking you from sleep
- pain with vomiting or feeling faint
- a testicle that is higher, lying horizontally, or looks different from the other
- swelling and redness of the scrotum coming on rapidly
- sudden testicular pain after an injury that is not settling
- pain with abdominal pain and vomiting in a boy or young man
This may be testicular torsion — the testicle twisting on its blood supply. It needs surgery within about six hours to save the testicle, and the clock starts when the pain does. Do not wait for a morning appointment, do not eat or drink in case surgery is needed, and go straight to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR. If you are wrong, no harm is done. If you wait and you were right, the testicle is lost.
Checking yourself
Once a month, after a warm bath or shower when the scrotum is relaxed. It takes a minute.
- Hold the scrotum in your palms and get a sense of the usual size and weight. One testicle being slightly larger or hanging lower is entirely normal.
- Roll each testicle between thumb and fingers, gently. The surface should feel smooth and firm, like a hard-boiled egg without the shell.
- Find the epididymis — the soft, slightly lumpy tube at the back and top. This is normal anatomy and is the structure most often mistaken for a lump.
- You are looking for change: a hard painless lump, a change in size or firmness, or a heavy dragging feeling. Knowing your own normal is the entire point.
What lumps usually turn out to be
- Epididymal cyst — smooth, fluid-filled, separate from the testicle itself. Harmless.
- Hydrocele — fluid around the testicle, giving a soft painless swelling. Common and benign.
- Varicocele — enlarged veins, often described as a bag of worms, usually on the left, sometimes with a dull ache. Occasionally relevant to fertility.
- Epididymo-orchitis — infection causing gradual pain, swelling and often fever. Needs antibiotics, and sometimes sexual health testing.
- Testicular cancer — usually a painless, hard, irregular lump on the testicle itself. Painless is the point: waiting for it to hurt is what causes delay.
Do not wait to see if a lump goes away
A hard, painless lump on the testicle is the classic presentation of testicular cancer, and the most common reason for late diagnosis is a young man deciding to keep an eye on it. Survival is above 95% when treated early. An ultrasound takes fifteen minutes and settles it. There is nothing embarrassing about being examined, and we see this routinely.
Aching without a lump
A dull ache in one or both testicles, worse at the end of the day or after standing, is common and often has no serious cause. Contributors include a varicocele, a small hernia, referred pain from the back or hip, previous infection, or nerve irritation after surgery. It still deserves an examination, particularly if it persists beyond a couple of weeks.
Protecting yourself
- Wear a properly fitted box or guard for contact and racquet sports, cricket and martial arts.
- Practise safer sex; chlamydia and gonorrhoea are common causes of epididymitis in younger men.
- Check monthly, and see someone about any change rather than deciding to watch it.
- If you had an undescended testicle as a child, your risk of testicular cancer is higher — checking matters more, not less.
Book an appointment if you have found a lump, have a persistent ache, or simply want to be examined and reassured. We can examine you discreetly and arrange a scrotal ultrasound on site, usually the same day — but if the pain came on suddenly and severely, go to an emergency department now instead of booking.
Same-day examination and scrotal ultrasound
Discreet appointments seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.