Testicular pain, while alarming to a patient, is rarely a sign of a significant medical problem. Any man with ongoing testicular pain should seek appropriate medical evaluation in order to exclude a significant medical problem.
Patients frequently present with pain that is annoying and more chronic in nature. Symptoms may occur directly within the testicle or surrounding structures such as the epididymis and frequently radiate to the groin. In most patients, the intensity of the pain waxes and wanes over time. It is uncommon for the pain to be significant enough to limit any physical activity.
Causes of testicular pain may represent significant medical problems such as testicular cancer or testicular torsion. In rare cases, a varicocele may contribute to testicular pain but this is more frequently described as a dull ache or discomfort. Other causes of testicular pain may include orchitis (inflammation or infection of the testicle) or epididymitis (inflammation or infection of the epididymis).
In many cases, patient’s experience pain in the testicle or scrotum without a defined cause. In many of these cases the pain may be referred – i.e. the nerve that provides the testicle with pain sensation may be irritated elsewhere in the body such as by a herniated disc or spinal stenosis.
Most treatments for testicular pain are non-surgical. It is rare that the patient would require surgery for treatment of testicular pain. The initial approach will be very conservative. If infectious epididymitis is suspected, then antibiotics may be prescribed. Frequently, NSAID’s (nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen, or other similar medications) will be used as first line therapy. Other medications for treatment of nerve related pain such as gabapentin or pregabalin may be used. Tricyclic antidepressants such as amitriptyline and nortriptyline have also been used to treat chronic pain syndromes.
Treatment of testicular pain rarely requires surgery. Surgery is most beneficial when an underlying cause is identified and surgery will correct it. For example, patients with large varicoceles may experience improvement of testicular pain after undergoing surgical correction of a varicocele.
In patients with chronic testicular pain and no defined cause, spermatic cord denervation (cutting the nerves to the testicle) may be beneficial. This intervention would be recommended in only a very small subset of patients.
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