Hernia: The most common cause of scrotal pain that worsens with coughing is a hernia, particularly an inguinal hernia. Coughing increases intra-abdominal pressure, which can exacerbate hernia symptoms, including pain and discomfort in the scrotal area.

Epididymitis: Inflammation of the epididymis, often due to infection, can cause scrotal pain that may worsen with physical activities like coughing.
Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections, can lead to scrotal pain that may be exacerbated by coughing.
Varicocele: Enlargement of the veins within the scrotum can cause aching pain, which might worsen with increased abdominal pressure from coughing.

Testicular Torsion: Although less common, testicular torsion is a medical emergency that can cause severe scrotal pain. It might not be directly related to coughing but is crucial to rule out due to its urgency and potential for testicular loss.
Appendicitis (with a retrocecal appendix): In rare cases, an inflamed appendix located behind the cecum can cause referred pain to the scrotum, especially if the appendix is in close proximity to the testicular vessels.

Spermatocele: A cystic structure filled with sperm that arises from the head of the epididymis can cause scrotal pain, though it's less likely to be directly exacerbated by coughing.
Scrotal Masses (e.g., hydrocele, sperm granuloma): Various scrotal masses can cause discomfort or pain, which might be noticed or worsened during activities that increase abdominal pressure, like coughing.