When a teenage boy develops sudden testicular pain, it should always be treated as an emergency. The most urgent concern is testicular torsion, where the spermatic cord twists and cuts off blood supply to the testicle. In these cases, every hour counts; waiting too long can mean permanent damage, loss of the testicle, and even future fertility problems.

Torsion happens most often in boys and adolescents because the testicles grow quickly during these years, and in some cases their attachment inside the scrotum is looser, making twisting more likely. Another possible cause of testicular pain is epididymitis, a slower-developing infection or inflammation. While still uncomfortable and requiring treatment, it does not carry the same immediate risk of losing the testicle.

Testicular torsion: a surgical emergency

Testicular torsion occurs when the spermatic cord twists, cutting off blood supply to the testicle. Without circulation, the tissue begins to die, which is why torsion is considered a true urological emergency. The window for saving the testicle is short, usually 4-6 hours from the onset of pain. After that, the chances of preserving normal function drop sharply.

The symptoms often appear suddenly: severe, one-sided testicular pain, sometimes radiating to the groin or lower abdomen. Many teens also experience nausea, vomiting, or dizziness, and the affected testicle may look swollen, firm, or positioned higher than the other side.

If torsion is suspected, immediate evaluation is critical. In many cases, surgeons move straight to the operating room because delays can cost the testicle. Surgery both untwists the cord and secures the testicle in place to prevent future episodes.

Epididymitis in teenagers: a common infection

Not all testicular pain in teens is torsion. A frequent alternative diagnosis is epididymitis, an inflammation or infection of the epididymis, the coiled tube behind the testicle that stores and transports sperm. Unlike torsion, which strikes suddenly, epididymitis usually develops more gradually over hours or even days.

Symptoms may include increasing scrotal pain and swelling, tenderness on one side, and sometimes fever or burning with urination. In younger teens, epididymitis is often linked to urinary tract infections. In older adolescents, it may be caused by sexually transmitted infections such as chlamydia or gonorrhea.

Treatment is typically straightforward: antibiotics, rest, scrotal support, and anti-inflammatory medication. While epididymitis is not an immediate threat to testicular survival, it can still cause complications if untreated, including abscess formation or reduced fertility in severe cases.

Testicular torsion vs. epididymitis: Spotting the differences

For parents and teens, the challenge is that torsion and epididymitis can look alike in the beginning. Both cause testicular pain, swelling, and tenderness. But there are some important differences:

• Onset of pain: Torsion usually begins suddenly and severely, while epididymitis tends to worsen gradually.
• Associated symptoms: Torsion is often linked with nausea, vomiting, or dizziness. Epididymitis more often comes with fever, burning during urination, or urinary frequency.
• Position of the testicle: In torsion, the affected testicle may appear higher in the scrotum or sit at an unusual angle.

Despite these clues, it is not always possible to be certain without medical evaluation. That is why the golden rule is simple: Sudden, intense testicular pain should be assumed torsion until proven otherwise.

When to seek emergency care

The safest approach for any parent is clear: Do not wait when sudden testicular pain occurs. If your teenager has severe scrotal pain, especially if it started quickly, it’s time to go to the emergency department.

Warning signs that make torsion more likely include pain that begins abruptly, nausea or vomiting with the pain, a testicle that looks higher than the other, or swelling that appears suddenly.

Even if epididymitis turns out to be the cause, your child still needs treatment. But if torsion is responsible, those lost hours can mean the difference between saving or losing the testicle.

Diagnosis and treatment in the ER

When a teenager comes to the emergency department with sudden testicular pain, doctors act quickly. The first step is a careful physical exam, looking for swelling, tenderness, or a testicle that sits higher than normal. In many cases, an ultrasound with Doppler is used to check blood flow and help confirm the diagnosis.

If torsion is strongly suspected, surgery is performed right away to untwist the spermatic cord and restore circulation. During the operation, the testicle is secured in place, and the other side is usually fixed as well to prevent torsion from happening again.

When the cause is epididymitis, treatment is different but still important. Antibiotics are prescribed, often along with rest, anti-inflammatory medication, and scrotal support. While epididymitis does not require emergency surgery, it still needs proper care to avoid complications.

Long-term impact on teen health

The outcome after testicular pain depends on how quickly the right treatment is given. With torsion, if surgery is done within the first few hours, the chances of saving the testicle are high. But delays can lead to permanent damage, removal of the testicle, and possible effects on fertility. Even when one testicle is lost, most boys can still have normal hormone production and father children, but the emotional impact should not be underestimated.

Surgery for torsion also includes securing the opposite testicle to prevent future twisting. After recovery, regular check-ups may be recommended to monitor healing and reassure both parents and teens.

For epididymitis, the long-term risks are usually lower, but untreated or repeated infections can occasionally cause scarring and affect fertility. With proper antibiotics and follow-up, most teens recover fully without lasting problems.

Advice for parents and teen boys

One of the biggest challenges with testicular pain is that many teenagers feel embarrassed to talk about it. They may delay telling a parent or hope the pain will go away on its own. That hesitation can cost valuable time in an emergency. Parents can help by creating an environment where boys know it is safe to speak up about sensitive symptoms.

It is also important to teach teenagers that pain in the scrotum is never something to ignore. Just as chest pain makes adults think of the heart, sudden testicular pain should always raise concern for torsion. Clear communication and quick action are the best ways to protect long-term health.

For parents, the takeaway is simple: if your son mentions sudden testicular pain, listen carefully and act quickly. Even if it turns out to be an infection rather than torsion, getting timely medical care ensures the right treatment and peace of mind.

Quick action makes the difference.

Testicular pain in teenagers is not something to watch and wait. The most urgent cause, testicular torsion, can permanently damage a testicle if treatment is delayed beyond a few hours. Other causes, like epididymitis, also require medical attention but do not carry the same immediate risk.

Because the early symptoms can look so similar, the safest approach is always the same: treat sudden testicular pain as an emergency until proven otherwise. Acting quickly protects not only the testicle itself but also long-term health and fertility. For parents and teens, the message is clear; when pain strikes, do not delay.

Martina Ambardjieva is a dedicated urologist and medical educator with extensive experience in both clinical practice and academic instruction. She earned her MD from the University “Sv. Kiril i Metódij” in Skopje and is a PhD candidate in urological oncology, with a focus on bladder carcinoma. Her scholarly work includes numerous publications in oncologic urology, urinary calculosis, and men’s health.

Dr. Ambardjieva currently serves as a urologist at the PHI University Surgical Clinic “Naum Ohridski” and completed her residency training at the University Urology Clinic in Skopje. Earlier in her career, she practiced as a general medical doctor at Sante Plus General Hospital and completed a medical internship at the University of Ljubljana.

In addition to her clinical responsibilities, Dr. Ambardjieva is a teaching assistant at the Medical Faculty in Skopje. She works additionally as a collaborator for Dr. Telx. She has held leadership positions in the European Medical Students’ Association and actively participates in international medical education and policy. She has attended numerous congresses and workshops in France, Italy, Canada, and Turkey, and serves as a delegate for the European Association of Urology (EAU), contributing to cross-border initiatives in urology. Certified in laparoscopic surgery, she continues to integrate patient care, research, and education in her professional work.