Arteriovenous malformations (AVMs) of the scrotum are uncommon lesions, usually picked up incidentally during the evaluation of scrotal masses or infertility. They have also been reported to present with acute bleeding. We present a case who presented with acute pain following an abandoned surgical attempt at excision, elsewhere. Diagnosis was confirmed by duplex ultrasound and magnetic resonance imaging. Angioembolization was deferred quoting concerns with radiation exposure. The patient underwent a near total excision of the scrotal mass. This is the first reported case, in the English literature, of a surgical resection of a scrotal AVM without a preceding angioembolization. Patients should be counselled about radiation exposure risks before angioembolization, and allowed to make an informed decision.