Chronic Testicular Pain
Overview
Chronic testicular pain (CTP) is a poorly understood but common condition that can be a terribly frustrating for both clinician and patient. Formal terms for CTP include chronic epididymitis (pain in the epididymitis), chronic orchitis (pain in the testicle), and chronic scrotalgia (scrotal pain), terms that denote the location of pain (see below).
Patients with CTP present in many different ways. For example, some have pain when the testicle is touched; others have no pain when the testicle is examined. Some patients have pain increased with various activities; others do not. Some patients have swelling in the area of pain, while others have a normal exam. Pain is often described as burning, gnawing, throbbing, twisting, dragging, pulling, etc. CTP may also be part of the chronic prostatitis/chronic pelvic pain syndrome.
The cause of CTP may be readily obvious, but in many instances no apparent cause can be found. CTP may occur due to:
- Infection
- Certain medications
- Blockage of the vas deferens (the tube that carries sperm out of the testicle) from infection, trauma, or previous surgery
- Nerve entrapment within scar after surgery or trauma
- Varicocoele (these are varicose veins of the pampiniform plexus - see above diagram)
- Hydrocoele/spermatocoele. These are discrete fluid collections around the testicle and epididymis which may be associated with discomfort
- Intermittent twisting (torsion) of the spermatic cord (see above diagram)
- "Referred" pain from the abdomen or pelvis
- Muscle spasm of the spermatic cord
- Neurological conditions
- Malignant or benign lesions of the testicle, epididymis, and/or spermatic cord
