by Lisa Pavese, FNP, Tory McJunkin M.D., and Paul Lynch M.D.

Testicular-Pain1Testicular pain, or orchialgia, can be quite an alarming experience for men. There are many different causes, some of which are considered medical emergencies. Some common causes of testicular pain include trauma, infection, and inflammation. Trauma typically causes only temporary pain, but some types of trauma can be quite severe. Testicular torsion is a traumatic condition in which the testicle twists inside of the scrotum, cutting off the blood supply. This is a medical emergency and typically requires surgical intervention. Trauma can also cause testicular rupture, which is an emergency situation as well. Some symptoms of testicular torsion or testicular rupture include sudden, severe testicular pain as well as redness and swelling of the scrotum. If you suspect either one of these conditions, seek medical attention immediately.

A common infection of the testicles is called epididymitis, an infection or inflammation of the epididymis. This condition is frequently caused by sexually transmitted diseases, including chlamydia or gonorrhea. Epididymitis in older men may be related to an enlarged prostate. This condition usually results in a gradual onset of pain, with redness and swelling of the scrotum. Some other symptoms associated with epididymitis include nausea, vomiting, fever, painful urination, and painful intercourse. The usual course of treatment for this condition is antibiotics.

Epididymitis-DiagramOrchitis is an inflammation of the testicle, usually caused by an infectious process. Orchitis may be caused by epididymitis that has gone untreated and can be a very painful condition. Symptoms of orchitis are similar to epididymitis and are typically treated with pain medications, antibiotics, and ice. Occasionally orchitis needs to be surgically drained. Another common type of inflammation in the testicular region is an inguinal hernia. An inguinal hernia occurs when a loop of bowel protrudes into the scrotum through a weakened part of the abdominal musculature and is typically treated by surgical intervention. Symptoms include pain (usually gradual onset) and bulging in the groin and scrotum that is worse with heavy lifting. If the intestine becomes trapped, or strangulated, in the hernia, medical attention should be sought as soon as possible.

Treatment for Testicular Pain

Any acute testicular pain must be properly diagnosed and treated appropriately. When testicular pain has been present for three or more months, it is considered chronic orchialgia. Chronic orchialgia may be treated with medications, acupuncture, biofeedback, physical therapy, pelvic floor muscle relaxation techniques, nerve blocks, and spinal cord stimulation. Common types of medications used to treat pelvic pain include anti-inflammatories (ibuprofen, naproxen), antidepressants (Cymbalta, amitriptyline), neuropathic medications (gabapentin, Lyrica), and occasionally opioids (hydrocodone, oxycodone).

Physical therapy for testicular pain can include pelvic floor muscle training, hot and cold applications, ultrasound therapy, and stretching. Acupuncture may also be helpful and can be administered by a licensed acupuncturist. Biofeedback is a technique in which a person learns to control pain through thoughts. It can be very helpful for treating testicular pain. A licensed therapist can teach biofeedback, relaxation techniques, and guided imagery, all of which are very effective techniques in controlling chronic pain.

Neuropathic testicular pain may respond well to various nerve blocks. Some peripheral nerve blocks include ilioinguinal, iliohypogastric, or genitofemoral nerve blocks. These can be very beneficial in those who suffer from chronic orchialgia. Localized injections can also be performed into the spermatic cord to relieve pain. Lumbar (L1) sympathetic nerve blocks can be helpful in treating testicular pain, as well as some other male pelvic pain conditions. Sacral nerve blocks may also help to decrease pain.

Spinalcord Stimulator Testicular PainFor male pelvic pain that does not respond to more conservative treatment modalities, a spinal cord stimulator (typically with sacral leads) may be beneficial. Spinal cord stimulation (SCS) is often described as a pacemaker for pain and uses groundbreaking technology that works by introducing an electrical current into the epidural space near the source of chronic pain impulses.  Under a local anesthetic and minimal sedation, your doctor will first place the trial SCS leads into the sacral space. The SCS lead is a soft, thin wire with electrical leads on its tip and is placed through a needle in the back into the sacral space.  The trial stimulator is typically worn for five to seven days as the lead is taped to your back and connected to a stimulating device.  If the trial successfully relieves your pain, you can decide to undergo a permanent SCS if desired.

If you suffer from chronic pelvic pain, Arizona Pain Specialists can help. We offer advanced and comprehensive treatment options that encompass all of your pain management needs. Call us today to schedule an appointment!

At Arizona Pain, our goal is to relieve your testicular pain and improve function to increase your quality of life.
Give us a call today at 480-563-6400.

References

  • Bennett, D. (2005). Interventional Approaches to Pain Management. Retrieved on February 17, 2010 from: cme.medscape.com/viewarticle/502018
  • E-medicinehealth (2010). Testicular Pain. Retrieved on February 23, 2010 from www.emedicinehealth.com/testicular_pain
  • McJunkin, T., Wuollet, A., and P. Lynch (2009). Sacral Nerve Stimulation as a Treatment Modality for Intractable Neuropathic Testicular Pain. Pain Physician 209; 12:991-995.
  • National Guideline Clearinghouse (2008). General Treatment of Chronic Pelvic Pain. In: Guidelines on Chronic Pelvic Pain. Retrieved on February 23, 2010 from: www.guideline.gov/summary/summary.aspx