Chronic testicular pain

Chronic testicular pain is long-term pain of the testes.[2][3] It is considered chronic if it has persisted for more than 3 months.[1] Chronic testicular pain may be caused by injury, infection, surgery, cancer or testicular torsion and is a possible complication after vasectomy.[2] IgG4-related disease is a more recently identified cause of chronic orchialgia.[4]

Chronic testicular pain
Other namesChronic orchialgia
1 - 6: Epididymis 7: Vas deferens
Differential diagnosisVaricocele, spermatocele, Henoch–Schönlein purpura, post-vasectomy pain syndrome, chronic pelvic pain syndrome[1]

One author describes the syndromes of chronic testicular pain thus:

"The complaint is of a squeezing deep ache in the testis like the day after you got kicked there, often bilateral or alternating from one side to the other, intermittent, and, most commonly, associated with lower back pain. Sometimes it feels like the testicle is pinched in the crotch of the underwear but trouser readjustment does not help. There may also be pain in the inguinal area but no nausea or other symptoms. Back pain may be concurrent or absent and some patients have a long history of low back pain. Onset of pain is commonly related to activity that would stress the low back such as lifting heavy objects. Other stresses that might cause low back pain are imaginative coital positions, jogging, sitting hunched over a computer, long car driving, or other such positions of unsupported seating posture that flattens the normal lumbar lordosis curve."[5]: p.237 

Diagnosis

Testing for gonorrhea and chlamydia should be routinely performed.[2]

Differential diagnosis

Treatment

Treatment is often with NSAIDs and antibiotics however, this is not always effective.[2]

References
  1. Leslie, Stephen (2 May 2019). "Chronic Testicular Pain and Orchalgia". Chronic Testicular Pain (Orchialgia). StatPearls. PMID 29494088.
  2. Wampler SM, Llanes M (September 2010). "Common scrotal and testicular problems". Prim. Care. 37 (3): 613–26, x. doi:10.1016/j.pop.2010.04.009. PMID 20705202.
  3. Masarani M, Cox R (2003). "The aetiology, pathophysiology and management of chronic orchialgia". BJU International. 91 (5): 435–437. doi:10.1046/j.1464-410x.2003.04094.x. PMID 12603394. S2CID 45339688.
  4. Bobby B Najari; Brian D Robinson; Stephen A Paget; Darius A Paduch (October 2014). "Clinical, radiographic, and pathologic description of IgG4-related perivasal fibrosis: a previously undescribed etiology of chronic orchialgia". Urology. 84 (4): 748–750. doi:10.1016/j.urology.2014.06.035. PMID 25260440.
  5. Granitisioti, P. (2008). "Scrotal pain conditions". In Baranowski, Andrew Paul; Abrams, Paul; Fall, Magnus (eds.). Urogenital pain in clinical practice. New York: Informa Healthcare USA. ISBN 978-0849399329.


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