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HealthInfo Canterbury

Sudden (acute) scrotum pain in boys

Important

Any severe pain in a boy's testicles is a medical emergency and needs to be checked urgently. Take your boy to your GP, to the after-hours surgery, or to the hospital's Emergency Department. Don't let your boy eat anything, in case he needs urgent surgery.

Sudden pain in a boy's scrotum is usually accompanied by swelling and redness. Often a boy will have lower tummy pain, feel sick, and may vomit. His testicles and scrotum will be very tender.

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.

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 his testis 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 babies less than 6 months and in boys going through puberty (aged 12 to 16).

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 can make his scrotum red, swollen, and painful. It's rare in children 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.

How is sudden scrotal pain treated?

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 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 is not 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 won't 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 paediatric surgeon, Canterbury DHB. Adapted by HealthInfo clinical advisers. Page created May 2018.

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