Condition: Chronic Testicular Pain
Brief Overview: Chronic testicular pain is intermittent or constant scrotal/testicular pain lasting ≥3 months that disrupts activities or quality of life. Causes include post-infectious inflammation, neuropathic pain, pelvic floor dysfunction, varicocele, hernia, and postsurgical syndromes; in many cases no single cause is found.
Etiology: According to Virginia Urology, “In some cases, the root cause may be coming from the epididymis, which surround the testicles. Other causes can result from trauma, orchitis, which is infection of the testicles or surrounding epididymis, post-surgical pain, testicular torsion, varicoceles, kidney stones, hernia, spermatoceles, blockages, hydroceles, benign cysts, and in severe cases, tumors.”
Risk Factors:
- Prior STIs/UTIs, epididymitis, prostatitis
- Vasectomy or hernia repair; other inguinal/scrotal procedures
- Trauma, heavy lifting, cycling, prolonged sitting
- Varicocele, hydrocele, spermatocele
Commonly Associated Conditions:
- CPPS/chronic prostatitis
- Anxiety, sleep disturbance, sexual dysfunction
Common Medications:
- Medication for any underlying etiology
- Antibiotics if infectious
- NSAIDs
- Neuropathic pain agents – i.e. amitriptyline, gabapentin
Common Labs, Imaging, and Tests:
- Urine testing
- Blood tests
- Ultrasound
Common Symptoms:
- Persistent testicular pain, can be intermittent
- Swelling, redness
Common Treatments:
- Procedures, surgery may be indicated in some cases
- Ice/heat therapy
- Stop any activities that worsen pain
- Avoid heavy lifting
- Pelvic floor physical therapy
- Scrotal support
Physical Findings:
- Localized epididymal or cord tenderness/induration; possible varicocele (“bag of worms”) or hydrocele
Potential Complications and Contraindications:
- Chronic pain affecting activity, work, relationships
- Sexual dysfunction; anxiety/depression
- Procedure-related risks (hematoma, numbness, recurrence)
- Missed serious pathology if evaluation incomplete (e.g., tumor)
- Adverse effects from unnecessary antibiotics or long-term analgesics
General Health and Lifestyle Guidance:
- Supportive underwear; limit prolonged sitting/cycling
- Ice/heat as preferred; ask your healthcare provider if you should avoid heavy straining/constipation
- Maintain adequate hydration; reduce bladder irritants if LUTS present
- Safe sexual practices; encourage partners to get tested/treatment when STI suspected
- Pelvic floor relaxation, stress reduction, sleep hygiene
- Set expectations: improvement is often gradual with a multimodal plan; escalate if red flags appear (sudden severe pain → ED for possible torsion).
Suggested Questions to Ask Patients:
- How long has the pain been present? Is the pain constant or intermittent? Triggers (activity, ejaculation, sitting)?
- Prior STIs/UTIs, epididymitis, prostatitis? New partners?
- History of vasectomy, hernia repair, scrotal/inguinal surgery, or trauma?
- Any swelling, lumps, systemic symptoms (fever, weight loss, night sweats)?
- Urinary or perineal symptoms (CPPS overlap)? Bowel issues or back/hip pain?
- What treatments have you tried (antibiotics, NSAIDs, PT) and results?
- How is pain affecting work, activity, sexual function, mood?
Suggested Talking Points:
- Your healthcare provider will typically start by ruling out serious causes and then use a multimodal plan: support/ice/NSAIDs, pelvic floor PT, and targeted meds.
- Antibiotics help when tests point to infection; otherwise, your healthcare provider will likely focus on other treatment modalities.
- If pain is localized and persistent, nerve blocks or microsurgical denervation may be indicated after evaluation.
- Please seek urgent care for sudden severe testicular pain (possible torsion).
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Sources:
- https://uro.com/conditions/chronic-testicular-pain/
- https://healthcare.utah.edu/mens-health/conditions/chronic-testicular-pain
- https://my.clevelandclinic.org/health/symptoms/16292-testicular-pain