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Sudden (acute) scrotum pain in boys

Mamae tārū o te pūkoro raho ki ngā tama


Any severe pain in a boy's scrotum is a medical emergency and needs to be checked urgently. Take your boy to your general practice team, the after-hours surgery or the hospital's Emergency Department. Do not let your boy eat anything, in case he needs urgent surgery.

As well as pain in the scrotum, your boy may have lower tummy pain, feel sick and vomit. His testicles and scrotum will be very sore to touch and may be swollen and red.

This can be caused by several conditions. You need to get your boy checked immediately as he may need urgent surgery to prevent damage to his testicle.

Causes of sudden scrotal pain

There are several possible causes of sudden scrotum pain.

Twisting (torsion)

Sometimes a boy's testicle can twist, cutting off its blood supply. Unless the boy has surgery to return the blood supply, his testicle is likely to be damaged, and may even die. Because of this, a twisted testicle (also called torsion of the testis) is an emergency.

Torsion can happen at any age, but it's more common in pēpi (babies) less than 6 months old and in boys going through puberty (aged 12 to 16 years).

A small appendage of tissue near the top of a testicle can also become twisted and cause pain. This is called torsion of the testicular appendage. It can make the scrotum red, swollen and tender, and can look a lot like torsion of the testis. This is often treated by surgery to check that the testicle isn't twisted. The twisted tissue can be removed, and the pain goes away.

Infection (epididymo-orchitis)

An infection in a baby's testicle and epididymis (called epididymo-orchitis) can make his scrotum red, swollen and painful. It's rare in boys over 6 months of age, but it can often seem a lot like torsion of the testis. For this reason, a boy with possible epididymo-orchitis may need urgent surgery to rule out torsion.

Treating sudden scrotal pain

Boys with sudden and severe pain in the scrotum often need surgery, as it can otherwise be hard to know whether it's caused by a twisted testicle or something else. This is common surgery and happens under a general anaesthetic (meaning your boy will be asleep).

The surgeon will make a small cut in your boy's scrotum. If the testicle is twisted, the surgeon will untwist it so blood can flow into it again. If the testicle is still alive (viable) the surgeon will fix it with stitches within your boy's scrotum to make sure it doesn't twist again. Usually, the surgeon will also fix the other testicle with stitches to make sure it doesn't become twisted. If the blood supply has been cut off for too long and the testicle has died, the surgeon will remove it.

If your boy's testicle isn't twisted but there is a twisted appendage, the surgeon will remove the appendage. If an infection (epididymo-orchitis) is causing the pain, your boy will be given a course of antibiotics.

The surgeon will close the cut in your boy's scrotum with dissolvable stitches, which will not have to be removed.

Your boy will go home shortly after the surgery. He should recover quickly but may need some simple pain relief for a few days.

Written by HealthInfo clinical advisers. Last reviewed August 2022.


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Review key: HITSP-309438