Chronic scrotal content pain involves a discomfort localized to the scrotal area that may affect one or both sides.
The discomfort may be intermittent though has persisted for at least 3 months and interferes with daily activities.
Causes and Risk Factors
Many events can trigger scrotal content pain. Over time, the nerves may change and continue to result in pain despite resolution of the underlying cause. Scrotal content pain may be caused by underlying abnormalities like varicoceles, hernias or excessive pelvic muscle tension. It may follow surgeries involving the groin or scrotum result from inflammation or infections or be referred from elsewhere in the body.
When to Speak with a Urologist about Chronic Scrotal Pain
You should speak to a Urologist about chronic scrotal pain if you have persistent discomfort in your scrotal area that is interfering with your daily activities or bothering you.
What to Expect when Seeking Treatment
In addition to a history and physical examination, initial assessment includes testing to rule out infections and scrotal ultrasound to rule out anatomic abnormalities. Further testing may be necessary to look for other sources of referred pain. For example, imaging of the back may reveal spine changes sending pain signals to the scrotum.
Multiple conservative approaches can be useful to help reduce your chronic scrotal content pain. Stress reduction is important as many pain syndromes are related to and made worse by psychological distress. Wearing an athletic supporter for scrotal support can also be helpful. Pelvic floor physical therapy for biofeedback and pelvic floor muscle relaxation training can reduce referred pain from tense pelvic floor muscles. A prolonged course of anti-inflammatory pain medications, such as ibuprofen, may reduce pain by limiting inflammation.
Various medications can be used to treat nerve pain, such as Gabapentin or Amitriptyline at bedtime, which have been shown to reduce pain by at least 50% in around two-thirds of patients with chronic scrotal content pain. Side effects of these medications can include sleepiness and mental fogginess. Formal evaluation by pain medicine specialists may also be able to provide further insight.
In patients with persistent pain despite conservative measures or with clear anatomic abnormalities, surgery may be an option to attempt to alleviate the pain. It is important to recognize though that it is possible the pain may persist or even worsen following surgery. Furthermore, a possible complication of these surgeries is permanent damage or loss of the testicle.
Microsurgical varicocelectomy may be used in the setting of clinical varicocele with chronic pain. Microscopic cord denervation to divide the nerves to the testicle can be considered. Before recommending this, your Urologist will perform a spermatic cord nerve block to determine if the procedure might be successful (indicated by > 50% pain reduction for at least several hours with cord block). If the cord block works for you, success rates with surgery range from 70 – 97%. If the pain localizes to the epididymis alone, surgical removal of the epididymis may improve pain with success rates ranging from 11 – 59 %. In the setting of chronic pain for at least 6 months following vasectomy, vasectomy reversal has been shown to improve pain in 75 – 100% of patients with 50 – 69% of patients being pain free.