One of the most common causes of acute scrotal pain is either testicular torsion or epididymitis. Students often mix them up in MCQs—but clinically, they are very different. Here is the simplest and most exam-friendly comparison.
Key clinical differences (Pain, Age, Onset)
The first and most reliable clue is history. Pain onset: Testicular torsion causes sudden, severe pain, usually awakening the patient or starting abruptly.Epididymitis typically causes gradual, progressive pain developing over hours to days.
Age group: Torsion is most common in adolescents and young teens, while epididymitis is more frequent in sexually active adults.
Physical signs (Prehn sign, Cremasteric reflex)
Prehn sign: Lifting the scrotum may relieve pain in epididymitis (Prehn’s sign positive) but not in torsion (Prehn’s sign negative).
Cremasteric reflex: The cremasteric reflex is absent in torsion and usually present in epididymitis. Both conditions can cause swelling and erythema, so use these specific signs for differentiation.
Investigation: ultrasound and lab tests
Doppler ultrasound is the investigation of choice: reduced or absent blood flow to the testis suggests torsion; increased blood flow (hyperemia) points to epididymitis.
Urinalysis and urine culture support epididymitis, and STI testing should be considered in sexually active patients.
Management and time sensitivity
Testicular torsion = surgical emergency. Immediate detorsion ideally within 6 hours gives the best chance to salvage testicular function. If torsion is strongly suspected, urgent urology referral and surgical exploration are required. Epididymitis is treated medically with antibiotics, analgesia, scrotal support and rest.
High-yield summary table
| Feature | Torsion | Epididymitis |
|---|---|---|
| Pain onset | Sudden | Gradual |
| Age | Teens | Adults (sexually active) |
| Prehn sign | Negative | Positive |
| Cremasteric reflex | Absent | Present |
| Doppler US | ↓ or absent flow | ↑ flow |
| Treatment | Urgent surgery | Antibiotics |
Exam strategy: how to answer MCQs quickly
Treat “sudden severe pain” + “absent cremasteric reflex” as torsion unless the stem clearly points to infection. If the question mentions gradual onset, fever, urinary symptoms, or positive Prehn sign, lean towards epididymitis.
Why students confuse these two
Both cause scrotal pain, swelling and erythema. However, focused history and specific physical signs (onset, Prehn sign, cremasteric reflex) make differentiation straightforward.
Tags:
testicular torsion symptoms, epididymitis vs torsion difference, acute scrotal pain, prehn sign mnemonic, FMGE high yield notes, NEET PG urology questions, emergency scrotum diagnosis, torsion treatment India
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