Testicular Disease

Includes Torsion & Epididymitis-Orchitis.

Ask men with lower abdominal pain, “Are you sure it’s not your testicles?”

  • Most calmly insist “they’re OK.”
  • If in doubt, examine for scrotal swelling & testicular tenderness

Torsion — Presents with abrupt onset, severe pain, usually vomiting

  • Swollen scrotum, very tender testis
  • Absent Cremasteric reflex
  • Send to ER for stat surgery


  • Onset gradual
  • Varying degrees of swelling & tenderness
  • Cremasteric reflex present
  • Mild-moderate cases: Test for Gonorrhea & Chlamydia, treat empirically pending results
  • Severe cases — send to ER to R/O Torsion, or to admit for IV Tx against gangrene-causing anaerobes