Cannot say in your particular case, and the location of the pain is paramount. Localized surface pain is just from superficial rubbing irritation and usually has signs of a brush burn (redness) associated with it. A problem with the sacs that fill with blood on the sides of the penis (corpus cavernosa) would be localized, and on the sides. Can be a sign the area has had a mild/major rupture. I have no idea what twisted means, but it would be in the area of the corpus. A small hole in the covering of the corpus with a small herniation out of it would give this. Generally surgery is the recommendation these days; 20 yrs ago just rest and healing were the recommendation. But neither recommendation takes into account the variation in this disorder. Generally, the ruptures are BIG, Painful, and prevent erection. Surgery is pretty obviously a good idea in this context, but might not apply to everyone. Moving inward, There can be irritation of the urethra or deformity of the urethra. Often urination is a trigger of problems in this context. Can be associated with an STD (which causes inflammation, scarring, and deformity of the urethra). Can be in the testes. It would be obvious where the source is (testicular pain). Can be in the lining of the abdomen, or with a hernia in the inguinal region. These symptoms can give widespread pain and not be correctly localized by the patient and easily found by the doctor.