Around 2pm yesterday I noticed some discomfort in my testicles. I walked it off. Things get uncomfortable down there on occasion — that’s just life. I went about my afternoon.

By 3:30 it was more than discomfort. A quick self-check turned up swelling and real tenderness. My working assumption was epididymitis — when I had my vasectomy a decade ago, my urologist flagged it as something to watch for, since vasectomies elevate the risk. So I had a plausible explanation in my back pocket. Not a crisis. Thirty minutes later, though, the pain had jumped to an 8. In ninety minutes it had gone from background noise to my wife Corinne driving me to the ER because I didn’t trust myself behind the wheel.

It wasn’t the pain that concerned me so much as the speed. That trajectory — that rate of escalation — is the thing worth paying attention to. Here’s why.

The first thing they rule out: torsion

Testicular torsion is a surgical emergency. The testicle twists, cutting off its own blood supply. Without surgery within roughly six hours, you lose the testicle. Permanently. Forever. Gone.

Now, I want to be clear: I have a vasectomy, I’m done having kids, and I fully appreciate that a missing testicle would make for an excellent nickname. “One Ball Chris” has a certain ring to it. Very on-brand.

But here’s the thing — testicles aren’t just decorative, and they’re not just for making babies. They produce testosterone. And testosterone, particularly as men age, is not optional equipment. It’s what keeps your muscle mass, your energy, your mood, your libido, your bone density, and your general will to get off the couch all functioning as intended. Lose a testicle and you significantly reduce your testosterone production — and that gap only grows as you age. That complicates things considerably, especially in your 40s and beyond when levels are already trending the wrong direction.

So no. Not interested in the nickname. Went to the ER.

Rapid onset is a classic red flag for torsion. Epididymitis typically builds gradually over hours or days. Pain that escalates fast — the kind that sneaks up on you in under two hours — warrants ruling torsion out. That requires imaging, which means the ER.

If you have sudden testicular pain, go to the ER — not urgent care. Ruling out torsion requires a scrotal ultrasound with Doppler imaging. Most urgent care centers don’t have that capability. If they send you to the ER anyway, you’ve just lost precious time. Go directly.

Yes, the conversation is awkward. Go anyway.

Let me be honest about what the intake conversation actually looks like. Within the first few minutes, a clinician — who you have never met — is asking you: Who do you have sex with? How often? Do you have anal sex? How often do you masturbate? Any discharge? Any rash? Anything new or different you’ve noticed?

It’s a lot. There’s no warm-up, no small talk. You’re sitting in a hospital gown answering questions you’ve never said out loud to a stranger, about topics most men don’t discuss with their closest friends.

Here’s the thing: the clinician doesn’t care. Not in a cold way — in a professional way. They’ve asked these questions a thousand times. The answers are diagnostic information, nothing more. The awkwardness is entirely on your side of the conversation, and it’s over in five minutes.

What isn’t over in five minutes is the fallout from not going. Keep that in mind.

What I actually had: epididymitis

After a urinalysis and a scrotal ultrasound with Doppler imaging — which measures blood flow and definitively rules out torsion — the diagnosis was epididymitis. My vasectomy urologist’s decade-old warning turned out to be worth remembering. The hunch was right; it was the speed of onset that made the ER the right call rather than a wait-and-see.

Boring, manageable, and fixable. Exactly the kind of diagnosis you want.

And here’s the thing about that ultrasound: urgent care couldn’t have done it. Most don’t have the equipment or the trained sonographers on staff. They would have examined me, made an educated guess, and either sent me home or sent me to the ER anyway — having burned an hour in the process. For something where torsion is on the table, that hour matters.

Left untreated, epididymitis can progress to abscess, spread to the testicle itself, become chronic, or in rare cases lead to sepsis. None of those outcomes are acceptable for something a course of antibiotics handles cleanly.

The ultrasound found other things worth knowing

The imaging also turned up several incidental findings — things I had zero awareness of before yesterday, discovered only because I was there in the first place.

The most notable: bilateral hydroceles. That’s a collection of fluid surrounding each testicle, inside the scrotum — on both sides. Small ones, in my case, and almost certainly benign. Many men have them and never know it. They don’t always cause symptoms, they’re not inherently dangerous, and they often require no treatment at all.

So why does it matter? Because hydroceles can sometimes develop as a secondary response to an underlying condition — infection, injury, or in rarer cases, a tumor. The ultrasound ruled out anything concerning driving mine, but that’s exactly the point: you only know that if you get the imaging. Left unexamined, a hydrocele is just a mystery. Examined and baselined, it becomes something a urologist can monitor over time and catch if it ever changes.

The ER doctor recommended urology follow-up to properly document these findings and establish a baseline. Good advice I wouldn’t have received if I’d stayed on the couch Googling myself into a spiral.

Why men don’t go

We’re conditioned to minimize. I did it myself — at 2pm I walked it off, because that’s usually the right call. The key is knowing when it isn’t. A slow build that stays mild? Maybe monitor it. A rapid escalation that has you reconsidering your ability to drive? That’s the ER.

The things that cost men organs, testosterone, and quality of life are overwhelmingly the things we decided weren’t worth a doctor’s time. Testicular torsion is completely reversible with prompt treatment. Testicular cancer has a very high survival rate when caught early. Epididymitis is straightforward to treat. Every one of these outcomes depends on whether you actually go — and whether you go to the right place.

What to watch for

See a doctor same day — ER if needed — for any of the following: sudden or severe testicular pain, swelling or tenderness in the scrotum, a lump or change in size or texture of a testicle, or pain that radiates to the lower abdomen or back.

And do monthly self-exams. Two minutes. That’s it. The earlier you catch something, the better your options.

The bottom line

I’m fine. The vasectomy urologist’s decade-old heads-up proved useful, the diagnosis was epididymitis, antibiotics started, urology follow-up booked. And as a bonus, I now know about two hydroceles I didn’t know I had. Best possible outcome — and it only happened because I paid attention to the trajectory, and Corinne got me there.

The conversation was awkward. Go anyway. Keep both of yours.