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Evaluation of scrotal pain or swelling in children and adolescents

Joel S Brenner, MD, MPH
Aderonke Ojo, MD
Section Editors
Amy B Middleman, MD, MPH, MS Ed
Gary R Fleisher, MD
Laurence S Baskin, MD, FAAP
Deputy Editor
James F Wiley, II, MD, MPH


The spectrum of conditions that affect the scrotum and its contents ranges from incidental findings to pathologic events that require expeditious diagnosis and treatment (eg, testicular torsion, testicular cancer). The evaluation of scrotal pain or swelling in children and adolescents will be discussed here. The causes of scrotal pain and swelling are discussed separately, as is the evaluation of the acute scrotum in adults. (See "Causes of scrotal pain in children and adolescents" and "Causes of painless scrotal swelling in children and adolescents" and "Evaluation of the acute scrotum in adults".)


The tunica vaginalis and the epididymis are two important landmarks for the testicular examination (figure 1). The tunica vaginalis is a structure containing a potential space that encompasses the anterior two-thirds of the testicle in which fluid from a variety of sources may accumulate. The epididymis usually is positioned posterolaterally to the testicle and must be differentiated from an abnormal mass. The spermatic cord, which consists of the testicular vessels and the vas deferens, is connected to the base of the epididymis.


A focused history in a boy with scrotal pain or swelling can help to narrow the differential diagnosis and lead to a more productive examination. The essential points include [1]:

Is there history of pain? If so, determine the onset and severity (remember that some adolescents may not report scrotal pain because of modesty or embarrassment) [2]. The major causes of acute scrotal pain in children and adolescents are testicular torsion, torsion of testicular or epididymal appendages, and epididymitis [3]. These and other causes of testicular and scrotal pain are discussed separately. (See "Causes of scrotal pain in children and adolescents".)

Is there a history of trauma? Blunt scrotal trauma is common in children and adolescents. Although severe injury is rare, it can cause unilateral testicular pain arising from testicular contusion, rupture, or traumatic testicular torsion. (See "Scrotal trauma in children and adolescents", section on 'Clinical features'.)


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Literature review current through: May 2017. | This topic last updated: Jul 21, 2015.
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