OBJECTIVE To analyze the possible association between orchidalgia and testicular microlithiasis and to determine if this condition has a negative effect on fertility. METHODS Two male patients with similar findings of microlithiasis on the testicular ultrasound were studied. One patient had a history of thalassemia and the other patient had intermittent episodes of testicular torsion. A histological study was performed in both patients. RESULTS The testicular pain remitted spontaneously in the first case and after orchidopexy in the other patient. Biopsy disclosed a diminished spermatogenesis and no anomaly, respectively. CONCLUSIONS Our findings and the reports published in the literature indicate that testicular microlithiasis cannot be considered to be an etiological factor in orchidalgia or infertility.