The differential diagnosis of<unk>  is broad and involves conditions from benign to life-threatening. The most common causes of pain in children presenting to the emergency room are<unk>  torsion (16%), torsion of a<unk>  appendage (46%), and epididymitis (35%). In adults, the most common cause is epididymitis.<unk>  torsion<unk>  torsion usually presents with an acute onset of diffuse<unk>  and tenderness of less than 6 hrs of duration. There is often an absent or decreased cremasteric reflex, the testicle is elevated, and often is horizontal. It occurs annually in about 1 in 4,000 males before 25 years of age, is most frequent among adolescents (65% of cases presenting between 12 – 18 years of age), and is rare after 35 years of age. Because it can lead to necrosis within a few hours, it is considered a surgical emergency. Another version of this condition is a chronic illness called intermittent<unk>  torsion (ITT) which is characterized by recurrent rapid acute onset of pain in one testis which will temporarily assume a horizontal or elevated position in the scrotum similar to that of a full torsion followed by eventual spontaneous detortion and rapid solution of pain. Nausea or vomiting may also occur. Epididymitis and orchitis Epididymitis occurs when there is inflammation of the epididymis (a curved structure at the back of the testicle). This condition usually presents with gradual onset of varying degrees of pain, and the scrotum may be red, warm and swollen. It is often accompanied by symptoms of a urinary tract infection, fever, and in over half of cases it presents in combination with orchitis. In those between the ages of 14 to 35 it is usually caused by either gonorrhea or chlamydia. In people either older or younger E. coli is the most common bacterial infection. Treatment involves the use of antibiotics. Fournier's gangrene Fournier's gangrene (an aggressive and rapidly spreading infection of the perineum) usually presents with fever and intense pain. It is a rare condition but fatal if not identified and aggressively treated with a combination of surgical debridement and broad spectrum antibiotics. Others Segmental testis infarction in a patient presenting with right testis pain. Many other less common conditions can lead to<unk> . These include inguinal hernias, injury, hydroceles, degenerative disease of lumbar spine, disc herniations, and varicoceles among others.<unk>  cancer is usually painless. Another potential cause is epididymal hypertension (also known as "blue balls").
Testicular pain
Pelvic pain
Penile pain
Penile discharge
Hematospermia
Penis enlargement
Hypospermia
Pelvic girdle pain