Chronic scrotal or testicular pain – medically termed chronic orchialgia – is a common condition that affects the male population and is characterized by intermittent or constant unilateral or bilateral testicular pain. Occurring for at least 3 months, that has a significant negative impact on daily living and physical activity.
Initially, the pain may develop on its own or following infection, trauma, inflammation or surgery (vasectomy, hernia repair). Pain can also be experienced in the scrotum even though the actual source of pain is coming from somewhere else. Causes can include a kidney stone or a spinal problem that traps or inflames the nerves. In most cases though, the pain is not attributable to a specifically identified cause, which makes treatment challenging.
Treatment Options
Any testicular cause should be diagnosed and treated (eg. infection, hydrocele). Pain due to spasm of the muscles of the pelvic floor can be treated with pelvic floor physical therapy. Otherwise, conservative measures are best to try for at least 3 months. These can include rest, heat, tight-fitting underwear and oral anti-inflammatory medications (eg ibuprofen). If pain persists, an important diagnostic test to see whether a Urologist can help is to inject a local anaesthetic into the spermatic cord (the structure carrying the vas, nerves, blood vessels and lymphatics to the testicle).
If a cord block relieves the pain, then the most appropriate treatment option is microsurgical cord denervation. In this outpatient (i.e. no overnight stay is required) surgery, the cord is exposed and using an operating microscope and meticulous microsurgical technique, the blood and lymphatic supply of the testicle are preserved and the remaining structures (which contain the nerves) are transected. For properly selected patients, the success rate for this treatment option is extremely high and over 90% of patients enjoy long-term pain relief.
