With the rise in dismounted complex battle injuries from explosive devices during combat operations in Iraq and Afghanistan and polytrauma involvement of the lower extremities, perineum, pelvis, and lower abdomen, greater attention has turned to the management of soft tissue injury to the external genitalia and urethra. Testicular injuries are easily missed due to small scrotal entry wounds in some cases and require a high index of suspicion when evaluating patients with significant blast injuries. If you are suspicious of penetrating trauma or believe it may be possible, a low threshold should be employed to explore the scrotum bilaterally. This holds true for blast injuries, as overpressure can cause testicular rupture in patients with no overt injury; a low threshold should be employed in these patients. (See Figure 8).