Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

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 acute scrotal pain 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.


Evaluation of scrotal pain or swelling begins with a careful history and physical examination. Based upon these findings further ancillary studies, such as Doppler ultrasonography, and urine testing establish the diagnosis.

History — 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]:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 07, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.