[1][2] Causes range from non-serious muscular skeletal problems to emergency conditions such as Fournier gangrene and testicular torsion.

[3] It occurs in 15-19% of men post vasectomy, due to infections such as epididymitis, prostatitis, and orchitis, as well as varicocele, hydrocele, spermatocele, polyarteritis nodosa, testicular torsion, previous surgery and trauma.

[citation needed] The differential diagnosis of testicular pain is broad and involves conditions from benign to life-threatening.

[7] Another version of this condition is a chronic illness called intermittent testicular 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.

[7] This condition usually presents with gradual onset of varying degrees of pain, and the scrotum may be red, warm and swollen.

[7] Fournier's gangrene (an aggressive and rapidly spreading infection of the perineum) usually presents with fever and intense pain.

These include inguinal hernias, injury, hydroceles, degenerative disease of lumbar spine,[10] disc herniations,[11] and varicoceles among others.

Pyuria and bacteriuria (white blood cells and bacteria in the urine) in patients with acute scrotum suggests an infectious cause such as epididymitis or orchitis and specific testing for gonorrhea and chlamydia should be done.