The testis is a highly complex organ, sensitive to minor injury, with the potential for severe pain and discomfort. Testicular pathology ranges the full gamut from benign to life threatening. Treatment for some disease processes are time sensitive, so it is important to be able to rapidly identify the potentially serious issues and appropriately manage them. The diagnostic approach involves a careful history, a thorough physical exam, and the use of noninvasive x-ray studies and laboratory tests. An intra-operative image of an ischemic testicle that suffered torsion is shown.