Ache in the left testicle and lower back

The side of the pain does not identify its cause. A clinician may need to examine the abdomen, groin, scrotum, back, and nerves, and may use urine testing or imaging according to the symptoms and findings.

Scrotal causes include inflammation around a testicle and problems with local blood flow. A groin hernia can cause discomfort that extends into the scrotum, especially with lifting or coughing. A urinary stone or infection may produce pain from the flank or back toward the groin, sometimes with nausea, fever, burning urination, urgency, or blood in the urine.

Irritation of nerves in the lower spine, pelvis, or groin can also refer discomfort toward the testicle. Lumbar wear-related changes can present with back pain and nerve symptoms, but a spinal explanation should not be assumed until urgent scrotal, urinary, and abdominal causes have been considered.

Arrange a medical assessment, particularly if the ache is new, persistent, recurrent, or unexplained. Record when it began, whether onset was sudden or gradual, and whether movement, coughing, urination, bowel movements, or touching the area changes it. Note any swelling, lump, skin colour change, fever, nausea, urinary symptoms, leg symptoms, or recent injury.

Until assessed, avoid heavy lifting if it aggravates the pain and use supportive underwear if that feels more comfortable. Do not press repeatedly on a painful or swollen testicle, and do not let temporary improvement postpone evaluation when a warning sign has occurred.

Go to emergency care for sudden or severe testicular pain, a high-riding or unusually positioned testicle, rapid swelling, marked tenderness, or pain with nausea or vomiting. These features can occur when blood flow to a testicle is threatened, and assessment should not wait.

Urgent assessment is also needed for fever with scrotal or flank pain, inability to pass urine, visible blood in urine with severe pain, a painful groin bulge that will not settle, new leg weakness, numbness around the genitals or buttocks, or loss of bladder or bowel control.

Ask whether the examination points to a scrotal, urinary, hernia-related, abdominal, or nerve source; whether urine tests or ultrasound are appropriate; and what changes should prompt emergency reassessment. If back-related referral is suspected, ask which neurological findings support it and whether physiotherapy or spinal imaging would alter management.