Chronic Testicular Pain

What is chronic testicular pain?

Chronic testicular pain, or orchialgia, is a condition that can significantly impact a man’s quality of life, affecting daily activities, sleep, and even mental health. While occasional testicular discomfort is common, persistent pain lasting three months or longer (chronic orchialgia) requires medical evaluation.

At Tower Urology, we thoroughly investigate, diagnose, and treat the underlying causes of testicular pain, developing personalized treatment plans. Whether the pain originates from nerve entrapment, infection, trauma, or prior surgery, our expertise in microsurgical and non-surgical approaches and commitment to individualized care allow us to provide practical, long-term relief.

What causes chronic testicular pain?

The etiology, or cause, of chronic testicular pain is complex and can vary from person to person. Pain may originate from the testicle itself, structures within the scrotum, such as the epididymis or vas deferens, or the surrounding nerves and muscles of the pelvic floor. Some of the most common causes include:

• Infection or inflammation: Conditions such as epididymitis, orchitis, or prostatitis — all terms for inflammation of various scrotal structures — can cause persistent pain.
• Prior surgery or trauma: Men who have undergone a vasectomy, hernia repair, or testicular surgery may develop nerve irritation or scar tissue formation that contributes to persistent discomfort. Injury or trauma can result in testicular torsion (when the spermatic cord twists, cutting off the blood supply to the testicle). It may also result in persistent scrotal pain after the injury has resolved.
• Varicoceles and hydroceles: Abnormalities such as enlarged veins in the scrotum (varicoceles) or fluid accumulation around the testicle (hydroceles) can cause aching, particularly after prolonged standing or physical activity.
• Nerve entrapment: The ilioinguinal nerve, which runs near the pubic bone, can become compressed due to surgery, trauma, or inflammation, leading to testicular pain that radiates to the groin or thigh.
• Idiopathic testicular pain. Sometimes, no clear cause is found, making treating it more challenging.
• Testicular Torsion: Testicular torsion is a medical emergency that happens when a testicle twists around the spermatic cord, the structure that supplies it with blood, cutting off the blood flow to the testicle

How is chronic testicular pain diagnosed?

At Tower Urology, we use a multistep diagnostic approach. First, a detailed medical history and physical exam can provide crucial insights into possible sources of discomfort. A scrotal ultrasound helps evaluate the structures inside the scrotum and can identify swelling or inflammation. Meanwhile, urinalysis and laboratory tests are used to check for infection.

In cases where nerve involvement is suspected, diagnostic nerve blocks with local anesthetic can confirm the role of nerves in pain symptoms.

What are the treatment options for chronic testicular pain?

Sometimes, testicular pain caused by a minor injury or infection may resolve on its own over time. However, chronic pain lasting more than three months typically requires treatment to prevent further discomfort or complications.

Non-surgical treatments

For many patients, non-surgical therapies provide significant pain relief. Over-the-counter NSAIDs, antibiotics, or prescription medications such as anticonvulsants like gabapentin or certain antidepressants can help manage pain associated with nerve abnormalities, infection, or inflammation.

Pelvic floor physical therapy often benefits men with pain related to muscle tension or nerve dysfunction. For those with persistent symptoms, nerve blocks near the spermatic cord or ilioinguinal nerve can provide temporary or lasting relief.

Microsurgical and advanced procedures

If pain does not improve with conservative treatments, it may be necessary to consider one of the surgical procedures available:

• Microsurgical denervation of the spermatic cord. This advanced outpatient procedure targets and removes pain-transmitting nerves in the spermatic cord, offering long-term relief for many patients.
• Varicocele repair. Microsurgical varicocele removal improves blood flow and can alleviate the aching associated with varicoceles.
• Hydrocele or cyst removal. If a hydrocele or cyst is the source of discomfort, surgical removal may be recommended.
• Vasectomy reversal. In some cases, post-vasectomy pain syndrome may be relieved through vasectomy reversal, restoring natural sperm flow and reducing inflammation.
• Orchiectomy. An orchiectomy, or removal of one or both of the testicles, is an option reserved as a last resort when other conservative and surgical interventions have failed.

What should I expect during recovery from chronic testicular pain?

Most procedures, including microdenervation of the spermatic cord and varicocele repair, are performed as outpatient procedures under local anesthesia, allowing patients to go home the same day. Typically, minimal downtime is required; full recovery only takes one to two weeks, depending on the procedure.

Symptom improvement may be gradual for non-surgical approaches, requiring ongoing management with medications, nerve blocks, or physical therapy. Our team at Tower Urology provides long-term follow-up care to ensure patients achieve optimal results and improved quality of life.

When should I see a urologist for testicular pain?

Seek immediate attention from one of our urologists if you experience:

• Sudden, severe testicular pain
• Pain in the genital area accompanied by swelling, redness, or warmth
• Any change in testicular size or shape, or a new lump
• Pain that radiates to the groin or lower abdomen
• Pain that persists beyond one hour after trauma or injury

Have questions about chronic testicular pain? Talk to Tower Urology

Tower Urology’s board-certified urological team, with specialists trained in all aspects of men’s health, has been a leader in this field for over two decades.

With access to state-of-the-art scrotal ultrasound technology and diagnostic nerve block techniques at Tower Urology, we ensure an accurate diagnosis of the cause of chronic testicular pain before recommending treatment.

Our team specializes in treating nerve entrapment, idiopathic pain, and post-surgical complications that many general providers may not be equipped to manage. Whether through physical therapy, medications, or surgical interventions, our goal is to provide long-lasting relief from pain and discomfort while preserving testicular function and quality of life.

Another advantage of Tower Urology lies in our unwavering commitment to providing world-class urologic care through advanced technology, personalized treatment plans, and a patient-centered approach. With a reputation for excellence and innovation, we deliver superior outcomes that distinguish us as leaders in urologic health.

We invite you to experience the personalized care and expertise of Tower Urology.

Tower Urology is a proud affiliate of Cedars-Sinai Medical Center, ranked #1 in California and #2 nationwide by U.S. News & World Report. This partnership reflects our dedication to delivering the highest standard of urologic care alongside the best urologists in Los Angeles. Our years of experience and access to Cedars-Sinai’s world-class facilities ensure that our exceptional and innovative urological care positions Tower Urology as a leader in Southern California.

Tower Urology is conveniently located for patients throughout Southern California and the Los Angeles area, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, and Downtown Los Angeles.

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Sources

Chronic Testicular Pain and Orchalgia
https://pubmed.ncbi.nlm.nih.gov/29494088/

Testicle ischemia resulting from an inguinal hernia
http://www.ncbi.nlm.nih.gov/pubmed/20832968

Pain in the scrotum
http://www.ncbi.nlm.nih.gov/pubmed/3971083

Canadian Urological Association best practice report on chronic scrotal pain
https://pmc.ncbi.nlm.nih.gov/articles/PMC5994986