What is the most common cause of acute scrotal pain in adults?

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Acute scrotal pain in adults is most commonly due to epididymitis, an inflammatory infection of the epididymis. This usually arises from an ascending urinary or sexually transmitted infection, so in sexually active younger men it’s often caused by pathogens like Chlamydia or gonorrhea, while in older men urinary tract organisms are more common. The typical picture is gradual onset of pain and swelling localized to the epididymis, sometimes with fever or dysuria. On examination, the epididymis is tender and swollen and the cremasteric reflex is usually preserved. Doppler ultrasound helps distinguish it from torsion: epididymitis tends to show increased or preserved blood flow due to inflammation, whereas torsion shows reduced or absent flow. Torsion presents with sudden, severe pain and is a surgical emergency, hydrocele is usually a painless swelling, and orchitis can occur but epididymitis remains the more common cause of acute pain in adults.