Right Groin, Testicular, and Lower Back Pain: A Urology Perspective

Right groin, testicle, and right flank pain?

Hello doctor, I recently experienced pain and discomfort in my right testicle, accompanied by soreness in my right flank.
I visited a urologist, initially suspecting it might be due to a varicocele.
However, after an ultrasound of the scrotum, the doctor assessed that the degree of varicocele in the right testicle is very mild and does not believe it is the cause of my symptoms.
Additionally, I had a urinalysis and a kidney ultrasound, both of which returned normal results.
I also had a semen analysis, which showed a sperm count of 186×10^6/ml and motility of 73%, both of which the doctor considered normal (I have a severe varicocele on the left side, but my discomfort has been on the right side recently).
Therefore, the doctor diagnosed me with right epididymitis and prescribed antibiotics, which I have been taking for a week.
However, I am confused about whether epididymitis causes the testicle to swell, as my testicle shows no signs of redness or swelling.
Recently, over the past couple of days, the pain in my right groin, right flank, and right testicle has resumed.
Is it possible that the epididymitis has not resolved? If it were prostatitis, would the urinalysis and semen analysis indicate that? I am quite troubled and a bit worried about whether I need to undergo further examinations.
Thank you, doctor!

Cheng, 30~39 year old female. Ask Date: 2017/07/11

Dr. Du Shixi reply Urology

A physician must not administer treatment, prescribe medication, or provide a diagnosis without a personal examination.
Hello: Epididymitis can lead to swelling of the testicles, but this is not always the case.
Prostatitis is difficult to diagnose; urinalysis may be one method, but it may not always yield results.
Therefore, a comprehensive assessment is necessary.
Wishing you good health.

Reply Date: 2017/07/11

More Info

Understanding right groin, testicular, and lower back pain from a urology perspective involves a comprehensive evaluation of various potential causes and symptoms. Based on your description, it seems you have already undergone several diagnostic tests, including ultrasound examinations and urinalysis, which have returned normal results. The fact that your doctor suspects epididymitis (inflammation of the epididymis) and has prescribed antibiotics indicates that they are considering an infectious cause for your symptoms.

Epididymitis can indeed cause pain in the testicle and groin area, and while it often presents with swelling and tenderness of the affected testicle, it is not always the case that swelling is prominent. In some instances, the inflammation may be mild enough that the testicle does not visibly swell, but the pain can still be significant. The absence of redness or swelling does not rule out epididymitis, especially if the pain persists.
The pain you are experiencing in the right groin, lower back, and testicle could be related to the ongoing inflammation. It is not uncommon for symptoms to take time to resolve fully, even with appropriate antibiotic treatment. If you have been on antibiotics for a week and are still experiencing significant discomfort, it may be worthwhile to follow up with your urologist. They may consider additional imaging studies or a repeat examination to assess the situation further.

Regarding your concern about prostatitis (inflammation of the prostate), it is important to note that urinalysis and semen analysis can provide some insights, but they may not definitively diagnose prostatitis. Prostatitis can sometimes present with urinary symptoms, pelvic pain, and discomfort in the lower back or groin. If your symptoms suggest prostatitis, your doctor might recommend further tests, such as a prostate-specific antigen (PSA) test or a digital rectal examination (DRE), to evaluate the prostate's condition.

In summary, while your current treatment for suspected epididymitis is appropriate, ongoing pain warrants further evaluation. It is essential to communicate your symptoms clearly to your healthcare provider, as they may need to adjust your treatment plan or conduct additional tests to ensure that any underlying issues are addressed.
In the meantime, consider the following general recommendations to help manage your symptoms:
1. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help alleviate discomfort. Always consult your doctor before starting any new medication.

2. Rest: Avoid activities that may exacerbate your pain, such as heavy lifting or prolonged standing.

3. Supportive Underwear: Wearing supportive underwear can help reduce discomfort in the testicular area.

4. Hydration: Staying well-hydrated can help maintain urinary tract health.

5. Follow-Up: Keep a close eye on your symptoms and follow up with your urologist if your pain persists or worsens.

It is crucial to remain proactive about your health and seek further evaluation if your symptoms do not improve. Your well-being is paramount, and addressing these concerns with your healthcare provider is the best course of action.

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