I’m not a huge fan of testicular pain. In general, the vast majority of the time, I can never really figure out what is causing it. Of course you rule out the bad (but rare) stuff like testicular torsion or cancer but with the exception of a hydrocoele, I can rarely tell exactly what the cause is.
The other day, a guy came in with this complaint. He looked normal enough and did not appear to be ill at all. The pain started about 5 days ago and he seemed like he considered it more of an irritation. So it was with immense dismay that when I peered under his gown I saw that his scrotum was about 5 sizes bigger than it should, it was deeply red and had boggy, peeling skin on it!
I immediately went from “OK, order the sonogram, check the urine, blah, blah, blah, to HOLY CRAP, call a surgeon, start some antibiotics!!!’
The guy had Fornier’s Gangrene and went rapidly to the OR where most of the skin off his testicles, perineum, and lower abdominal wall were excised. Luckily, he is still alive.