Go to an emergency department immediately if any of these happen

• Sudden severe testicular or scrotal pain, even if it later settles
• Rapid swelling, redness, a high-riding or unusually positioned testicle
• Nausea or vomiting with the pain
• Fever, chills, burning urine, discharge from the penis, or inability to pass urine
• A painful groin bulge that does not reduce, especially with vomiting
• A new hard lump in the testicle

What to ask the doctor to check

• Scrotal ultrasound with Doppler to assess blood flow, epididymis, cysts, varicocele, and masses
• Urine test/culture
• STI testing if there has been any sexual exposure outside the marriage, or urethral symptoms
• Assessment for an inguinal hernia, especially because you sometimes feel groin pain

Until you are examined

• Avoid masturbation, heavy lifting, cycling, running, and prolonged standing for several days if they trigger pain.
• Wear supportive, non-tight underwear.
• Use a cold pack wrapped in cloth for 10-15 minutes at a time.
• If safe for you, take an over-the-counter pain reliever such as paracetamol/acetaminophen. Ibuprofen can help inflammation, but avoid it if you have kidney disease, stomach ulcer/bleeding, blood-thinner use, or an NSAID allergy.
• Do not start antibiotics without medical assessment.

Recent guidance

Recommended evaluation pathway

1. Confirm whether this qualifies as chronic scrotal content pain

• Localized to the scrotal contents
• Constant or intermittent
• Present for 3 months or longer
• Bothersome enough to interfere with activity, sexual function, work, or quality of life

2. Focused history

• Onset: sudden versus gradual, duration, frequency, severity
• Exact location: testis, upper testis/epididymis, cord, groin, perineum, lower abdomen
• Triggers: ejaculation, masturbation, exercise, prolonged standing, sitting, bowel movements, urination
• Swelling, lump, change in testicular size, trauma
• Urinary symptoms: burning, frequency, blood in urine, weak stream
• Fever, urethral discharge, past STI exposure, recent urinary infection
• Past surgery: vasectomy, hernia repair, scrotal surgery
• Back, hip, abdominal or flank pain, which can indicate referred pain
• Pelvic symptoms, painful ejaculation, erectile/sexual symptoms, anxiety, sleep and pain impact

3. Physical examination

• Each testicle, for mass or firmness
• Epididymis, particularly the upper/posterior area where you feel tenderness
• Vas deferens and spermatic cord
• Groin, for inguinal hernia
• Penis and urethra when indicated

• Abdomen and flanks
• Hip/spine and neurologic features if pain radiates
• A gentle digital rectal examination when appropriate to assess prostate tenderness and pelvic-floor muscle tenderness or trigger points

4. Basic tests

• Urinalysis
• Midstream urine culture if infection is possible
• STI testing when indicated by risk, discharge, urinary symptoms, or examination
• Further blood tests only if the history or exam suggests a particular issue

5. Ultrasound: useful selectively, not necessarily routine

• AUA 2025: scrotal ultrasound may be done, especially when diagnosis is uncertain or there is concern for torsion, mass, abscess, varicocele, or another structural problem. It may not be required when examination is clearly normal and unambiguous.
• EAU 2026: routine ultrasound has limited value for diagnosing a primary scrotal pain syndrome once other pathology has been excluded.
• Canadian guidance: ultrasound is indicated with an abnormal examination or when pain prevents an adequate examination, and optional when examination is normal. Canadian best-practice report

6. Consider pain outside the scrotum

• Inguinal hernia
• Ureteric stone or abdominal/retroperitoneal disorder
• Hip, lower back, or spinal nerve irritation
• Pelvic-floor muscle dysfunction
• Prior hernia surgery or vasectomy, via nerve-related pain

7. Diagnostic nerve block, only after initial work-up

What this means for you

“I have intermittent left testicular pain with upper epididymal tenderness and intermittent left groin pain, worse the day after ejaculation. Please examine for epididymal disease, varicocele, hernia, testicular mass and pelvic-floor tenderness; check urinalysis/culture and consider Doppler scrotal ultrasound.”

How it could relate to your symptoms

• Saddle pressure: A narrow or upward-tilted saddle compresses the area between the scrotum and anus. This can cause ache, tingling, numbness, or discomfort that may be felt in the testicle or groin.
• Nerve irritation: Prolonged pressure or vibration can irritate the pudendal nerve. Nerve injury can occur with bicycling through direct trauma, stretch, or reduced blood flow. Imaging Anatomy Text and Atlas, Vol. 3, p. 1905.
• Pelvic-floor tension: Cycling posture and repetitive effort may tighten pelvic-floor muscles. These muscles can refer pain into the testicle, groin, perineum, penis, or lower abdomen.
• Pressure on a pre-existing issue: If you have epididymal tenderness, varicocele, an inguinal hernia, or chronic pelvic pain, cycling can act as a trigger without being the underlying cause.

What to do now

1. Stop cycling for 1-2 weeks while arranging your medical assessment. Keep a note of whether pain reduces.
2. If you restart, begin with short, easy rides. Stop if pain, numbness, tingling, or groin ache appears.
3. Have the bike professionally fitted if possible:
   • Use a saddle wide enough to support the sitting bones, rather than the perineum.
   • Keep the saddle level or slightly nose-down, not tilted up.
   • Consider a wider, pressure-relief or noseless saddle.
   • Avoid very aggressive forward-leaning riding positions.
   • Stand on the pedals regularly, such as every 10-15 minutes, to unload the perineum.
   • Use padded shorts, but do not rely on padding alone.
4. Avoid long rides, rough terrain, and heavy resistance until symptoms are clarified.