Background: Testicular cancers occur most frequently in young adults. Our institute treats most patients with this condition during their compulsory military service, but there are no published data in Taiwan reporting the symptoms and histology in this group. We investigated whether the clinical presentation of these patients correlated with particular types of cancer. Methods: Forty-seven patients diagnosed with testicular cancer between 1996 and 2005 were included. Systemic review of the clinical features, demographic data, and diagnoses was performed, and correlations between symptoms and histology were evaluated using the chi-square test. Results: Age at diagnosis was 31±13.3 years (mean±SD; median 28 years). Only 61.7% of the patients presented with the classic painless enlarged testicle. In 25.6% of patients, scrotal pain with or without enlarged testicles was the first presenting symptom, while 12.8% of patients presented without obvious scrotal symptoms, indicating the need for thorough examination of all patients. The risk of incorrect first diagnosis was 14.9%, which was reduced to 6.4% by preoperative sonography. Embryonal carcinomas were associated with pain at presentation (p = 0.001), while seminomas (p = 0.09) and mixed germ cell tumors (p = 0.75) were not. The overall incidence of each histological type was similar to that of the general population. Conclusion: Although the incidence of testicular cancers is low in young adults, a large percentage had pain as the presenting symptom. While embryonal carcinoma may have an increased likelihood of pain on presentation, symptoms did not predict the final diagnosis. A combination of careful history taking, thorough physical examinations, and scrotal sonography will help to minimize the risk of misdiagnosis.