According to child health and reproductive specialists, while some causes of scrotal swelling may be relatively harmless, others can rapidly develop into medical emergencies capable of causing permanent damage, infertility, or even loss of a testicle if treatment is delayed.
Among the most dangerous conditions is testicular torsion, a situation in which the spermatic cord twists and cuts off blood supply to the testicle. Doctors say the condition demands urgent intervention within a narrow time frame to prevent irreversible complications.
The testicles are small, egg-shaped reproductive organs located inside the scrotum, a thin pouch of skin situated behind the penis. Most males have two testicles, one on each side of the scrotum. Because the testicles contain numerous sensitive nerves, pain affecting the area can be severe and distressing.
Speaking exclusively with PUNCH Healthwise, Consultant Paediatrician at the Federal Teaching Hospital, Katsina State, Dr. Abdurrazzaq Alege, cautioned parents against overlooking any complaint involving the testicles.
He warned that delayed diagnosis and treatment could have lifelong consequences.
According to Alege, several medical conditions can cause testicular pain in children, ranging from infections that can be treated with medication to surgical emergencies requiring immediate intervention.
He identified common causes as testicular torsion, orchitis, epididymitis, strangulated inguinal hernia, and injuries to the groin or scrotum.
Explaining the seriousness of the condition, he said testicular torsion remains the most urgent among them.
“Some children may develop testicular swelling, or what we call scrotal swelling, from infancy or shortly after birth. The swelling may occur on one side or both sides and, in many cases, may not initially be painful.
“However, once a child begins to complain of pain, several important conditions must be considered. One of the most common and serious causes of sudden testicular pain is testicular torsion, which is a medical emergency,” the child health expert said.
Alege noted that infections such as orchitis and epididymitis are often manageable with antibiotics and pain-relieving medications. However, emergency conditions like testicular torsion and strangulated hernias require urgent surgical evaluation to prevent lasting complications.
He further urged parents to pay close attention to injuries sustained during sports, playtime, or accidental falls, noting that trauma to the groin can sometimes result in severe pain and significant damage.
“Overall, testicular pain in a child should never be ignored. The cause may range from a treatable infection to a surgical emergency, and prompt medical assessment is essential to prevent complications,” he said.
Warning Signs Parents Should Watch For
The paediatrician advised that any sudden onset of testicular pain in an otherwise healthy child should be treated as an emergency.
“Typically, the warning signs that should prompt immediate medical attention are when a child who has otherwise been normal suddenly begins to complain of pain in the testicular area or repeatedly points to the testes while expressing discomfort. Once that happens, the child needs urgent evaluation,” he stated.
He explained that swelling, redness, or enlargement of the scrotum—whether affecting one side or both—should never be dismissed. Such symptoms could indicate a serious underlying condition that requires urgent medical review.
Alege added that younger children may not always be able to describe their discomfort. Instead, they may exhibit signs such as excessive crying, irritability, restlessness, nausea, or vomiting.
Other symptoms that should trigger an immediate hospital visit include fever, painful urination, difficulty passing urine, and the presence of pus-like particles in urine.
“There may also be more general symptoms. For example, the child may develop a fever, feel unusually hot, or continue pointing to the affected area. Another important concern is difficulty passing urine,” Alege said.
He further explained that testicular torsion often presents with sudden, intense, sharp pain, causing affected children to writhe in discomfort.
According to him, the condition can sometimes occur intermittently when the spermatic cord twists and then untwists on its own, causing episodes of severe pain that may temporarily disappear before returning.
“Therefore, whenever the child experiences such pain, that is the best time for medical evaluation and examination,” he advised.
Risk of Infertility and Loss of Testicle
Alege warned that one of the gravest consequences of untreated testicular torsion is permanent damage to the affected testicle, which may eventually require removal.
“Testicular torsion can lead to loss of the testis; it can also lead to what we call subfertility or even infertility,” he said.
While losing one testicle may still allow a person to retain fertility through the remaining testis, the specialist explained that overall sperm production may be reduced.
“If both testes are affected, the consequences can be much more severe and may result in permanent infertility,” he warned.
He added that other conditions, including inguinal hernias, orchitis, and epididymitis, may also threaten future fertility if they damage the testicles, spermatic cord, or structures responsible for sperm production and transportation.
“Ultimately, anything that damages the testis, the spermatic cord, or the structures attached to the testis has the potential to result in infertility,” he said.
Early Treatment Can Save the Testicle
Also speaking on the condition, Consultant Urologist Dr. Oluwaseun Akinola said testicular torsion occurs most frequently in adolescent boys aged 12 to 18 years, although infants can also be affected.
He explained that patients typically experience sudden and severe pain in one testicle, often accompanied by nausea, vomiting, and loss of appetite.
“Usually, patients with torsion develop severe, sudden-onset pain in the testicle. It may be associated with nausea and vomiting, and the patient usually has anorexia, which means they don’t want to eat.
“The patient may have had similar episodes that resolved on their own in the past. At the examination, they may notice a swollen scrotum on the involved side, and the testicle may feel like it is higher up in the scrotum than on the other side.”
Akinola stressed that time is critical in managing testicular torsion.
“It is critical that evaluation and correction be undertaken within six hours of onset to prevent loss of the testicle. Delay often leads to loss of the testicle and may result in infertility,” Akinola, a Consultant Urologist at Royan Hospital, said.
Health experts therefore advise parents to seek immediate medical attention whenever a boy complains of sudden testicular pain, swelling, redness, or unexplained discomfort in the groin area, emphasizing that early intervention can mean the difference between full recovery and lifelong complications.