Chronic Testicular Pain
A large number of men have testicular pain at some point in their lives. Sometimes this pain is mild and goes away on its own, but other times, the pain is persistent and severe. There are a number of causes of testicular pain, all of which are treatable.
Testicular Pain Causes
Some of the causes of testicular pain include:
- Testicular torsion, or twisting – this is an emergency!
- Trauma
- Infection
- Post-vasectomy pain
- Pelvic floor dysfunction
- Neurologic disease
- A history of prior testicular surgery
Diagnosis Of Testicular Pain
When evaluating your testicular pain, your doctor will take a complete history regarding your pain and will do an examination of your testicles. Depending on what your doctor thinks the cause of your testicular pain is, he or she may recommend urine and / or blood testing, and a scrotal ultrasound.
Testicular pain can result from old trauma, infection, or neurologic problems, such as diabetic neuropathy. Sometimes, as in the case of an infection, even if the infection is completely gone, the pain may persist. Similarly, even if the painful part is removed, the pain may persist.
In order to determine if your testicular pain is localized within the testicle or affected by your brain and nervous system, your doctor will inject a local anesthetic into the area of the blood and nerve supply to the testis (spermatic cord). If this temporarily relieves the pain, it strongly suggests that the origin of the pain is in the testicle rather than the brain.
Treatment Of Testicular Pain
A patient with testicular torsion usually needs emergent surgery, as a prolonged delay could cause death of the testicle.
Other causes of testicular pain would be treated in the following manner:
- Infection – treating the infection with antibiotics and possibly anti-inflammatory medications
- Trauma – depending on the severity, either allowing it to heal or operating to fix a ruptured testicle
- Post-vasectomy pain – trying to treat the pain with medications or operating to denervate the spermatic cord or reverse the vasectomy
- Pelvic floor dysfunction – stress reduction and pelvic floor physical therapy
- Neurologic disease – treatment of the neurologic condition
In some patients, medications or other interventions do not work. In those patients, a spermatic cord block is typically done, and in patients in whom the testicular pain is temporarily alleviated, a microscopic denervation of the cord is often recommended.
Microsurgical Denervation of the Spermatic Cord
Microscopic denervation of the spermatic cord is an outpatient surgical procedure done through a small incision in the groin. The spermatic cord contains the arteries, veins, nerves, vas deferens and lymphatic vessels that go to the testicle. During surgery, we identify all of these parts and cut all except the testicular arteries, lymphatics, and vas deferens under an operating microscope. If a man no longer wants children, a vasectomy can be performed at the time of cord denervation. The procedure typically takes one to two hours, and the patient goes home the same day.
Results
In properly selected patients, we have had excellent results, with over 90 percent of patients achieving between 70–100 percent resolution of their pain.
Cost
Most insurance plans cover this procedure, but patients should check with their individual insurers before scheduling surgery to make sure that they are covered. If insurance does not cover the procedure, we have competitive pricing.
There is no reason to suffer with chronic pain. Let our fellowship-trained physicians at Utah Men’s Health help you find a solution. Make an appointment today!
