Chronic Scrotal/Testicular Pain (Chronic Orchialgia) is it common?
Chronic scrotal or testicular pain, medically termed chronic orchialgia, is a common condition that affects many men. It is characterised by intermittent or constant pain in one or both testicles lasting for at least three months. Chronic orchialgia can significantly impact daily life and physical activity.
Chronic orchialgia is relatively common, although precise prevalence rates are not well-documented. Estimates suggest that up to 5% of men may experience chronic testicular pain at some point in their lives. This condition can affect men of all ages and backgrounds, though it is particularly prevalent in men between the ages of 20 and 50. Chronic orchialgia often remains underreported, as some men may not seek medical attention for their symptoms, contributing to the uncertainty around its exact frequency.
What Causes Chronic Scrotal/Testicular Pain?
Chronic orchialgia can develop for various reasons, including:
- Infection: Bacterial or viral infections can cause inflammation and pain in the testicles.
- Trauma: Injury to the testicles or surrounding areas can lead to chronic pain.
- Inflammation: Conditions such as epididymitis (inflammation of the epididymis) can result in persistent discomfort.
- Surgery: Procedures like vasectomy, hydrocoele, epididymal cyst excision, varicocoele surgery or hernia repair can sometimes cause lingering pain.
- Referred Pain: Pain originating from other areas, such as kidney stones or spinal problems, can be felt in the scrotum.
- Unknown Causes: In many cases, the exact cause of the pain cannot be identified, making treatment challenging.
How is Chronic Scrotal/Testicular Pain Diagnosed?
Diagnosis typically involves a thorough medical history and physical examination. Additional tests may include:
- Ultrasound: To check for abnormalities in the testicles or scrotum.
- Urine and Blood Tests: To identify infections or other medical conditions.
- Physical Examination: To check for lumps, tenderness, or swelling.
- Nerve Block Test: A local anaesthetic may be injected into the spermatic cord to determine if pain relief is achieved, indicating a nerve-related cause.
What are the Treatment Options for Chronic Orchialgia?
Conservative Treatments
Before considering surgical options, conservative measures are often recommended for at least three months:
- Rest: Reducing physical activity to avoid aggravating the pain.
- Heat Therapy: Applying heat to the affected area can help relieve pain.
- Tight-Fitting Underwear: Provides support and reduces discomfort.
- Quercetin: a natural flavonoid found in many fruits and vegetables, has shown promise in alleviating chronic orchialgia. It possesses anti-inflammatory and antioxidant properties, which can help reduce inflammation and oxidative stress in the testicular region. Some studies suggest that quercetin supplements may help alleviate chronic testicular pain, mainly when inflammation contributes. However, more research is needed to fully understand its effectiveness and optimal dosage for treating chronic orchialgia.
- Oral Anti-Inflammatory Medications: Over-the-counter medications like ibuprofen can help manage pain and inflammation.
Physical Therapy
If the pain is due to muscle spasms in the pelvic floor, pelvic floor physical therapy may be beneficial. This involves exercises and techniques to relax and strengthen the pelvic muscles.
Nerve Block Injection
If conservative treatments are ineffective, a nerve block injection may be considered. The procedure works by injecting an anaesthetic and steroid into the spermatic cord. There is no incision, just an injection through the skin. The simple procedure is performed in the outpatient clinic, with no need for hospitalisation or general anaesthesia. Though there is no pain involved, some men may feel a slight pinch at the injection site.
I had the nerve injection block but the testicle pain has come back what can i do?
If the nerve block injection provides relief, but pain returns or persists, a surgical option called Microsurgical Cord Denervation: An outpatient surgery where the spermatic cord is exposed and using an operating microscope, the blood and lymphatic supply to the testicle is carefully preserved, while the remaining structures, which contain the nerves that are transmitting the pain, are transected. For appropriately selected patients, this procedure has a high success rate however one needs to be aware that pain may persist.
What are frequently asked questions about testicular pain?
Can Chronic Orchialgia Go Away on Its Own?
In some cases, the pain may resolve without specific treatment, especially if it is related to an underlying condition that can be managed. However, persistent pain often requires medical intervention.
Are There Any Lifestyle Changes That Can Help?
Maintaining good overall health, avoiding activities exacerbating the pain, and following a healthy diet can help manage symptoms. Stress reduction techniques and proper physical support can also be beneficial.
Is Microsurgical Cord Denervation Safe?
Yes, microsurgical cord denervation is considered a safe procedure with a high success rate. It is important to discuss potential risks and benefits with a urologist.
When Should I See a Doctor?
If you experience persistent scrotal or testicular pain that lasts more than a few weeks, it is important to see a healthcare professional for an evaluation and appropriate management.
Reflection by a consultant urologist
Chronic scrotal or testicular pain can significantly affect a man's quality of life. Understanding the potential causes and available treatments is crucial for effective management. If you are experiencing persistent pain, consult with a healthcare professional to explore your options and find relief. To understand the patient is key.
