Severe Scrotal Pain: Symptoms and Seeking Solutions

Severe pain in the scrotum?

Hello, doctor.
I would like to ask you about the severe pain I am experiencing on both sides of my scrotum.
Sometimes, there is also pain above the scrotum.
After seeing a doctor, he examined my testicles and said there were no significant abnormalities and no signs of testicular inflammation.
I have visited three clinics; the first two (Taoyuan Hospital and St.
Paul’s Hospital) noted some mild inflammation and fluid accumulation.
Later, I was referred to Chang Gung Hospital, where the doctor performed an ultrasound and found no signs of inflammation.
The nerve pain lasted for 3 to 5 days, and there was slight venous dilation.
However, the pain is unbearable, and it has been ongoing for almost three weeks.
Could you help me determine what symptoms I am experiencing? If it is indeed a varicocele, the doctor should have informed me after the ultrasound.
The pain has persisted for almost three weeks, and I have had sexual intercourse three times during this period, but I have not engaged in any for the past week due to the pain.
I am really worried about the possibility of infertility and its impact on my reproductive health.

Niming, 20~29 year old female. Ask Date: 2019/04/27

Dr. Fu Shizhang reply Urology

Based on the symptom description, it could be a varicocele.
If this is the case, it may indeed affect sexual function.
Online consultations cannot replace an in-person examination and physical assessment by a physician.
It is still recommended to seek medical attention at a healthcare facility if there is a medical condition.

Reply Date: 2019/04/27

More Info

Severe scrotal pain can be a distressing condition, and it’s understandable that you are seeking clarity and relief after experiencing this discomfort for nearly three weeks. Based on your description, it seems you have already consulted multiple healthcare providers and undergone various diagnostic tests, including ultrasounds, which did not reveal any significant abnormalities such as inflammation or testicular torsion.

Understanding Scrotal Pain
Scrotal pain can arise from various causes, and it’s essential to consider both urological and non-urological factors. Common causes of scrotal pain include:
1. Epididymitis: Inflammation of the epididymis, often due to infection, can cause significant pain. However, you mentioned that your doctors did not find signs of inflammation.

2. Testicular Torsion: This is a surgical emergency where the spermatic cord becomes twisted, cutting off blood supply to the testicle. It typically presents with sudden, severe pain and requires immediate intervention.

3. Varicocele: This condition involves the enlargement of veins within the scrotum, similar to varicose veins. It can cause a dull ache or heaviness in the scrotum, and while it may not always be painful, it can lead to discomfort, especially after prolonged standing or physical activity.

4. Hernia: An inguinal hernia can cause pain in the scrotal area, especially if there is a protrusion of tissue into the scrotum.

5. Nerve Pain: Conditions such as neuropathy or referred pain from other areas (like the lower back) can manifest as scrotal pain.

6. Trauma or Overuse: Physical activity or trauma to the groin area can lead to pain that may persist for some time.

Diagnostic Considerations
Since your ultrasounds did not indicate significant issues, it may be worthwhile to consider the following:
- Further Imaging: If varicocele is suspected, a Doppler ultrasound can assess blood flow and confirm the diagnosis.

- Nerve Conduction Studies: If nerve pain is suspected, these tests can help identify any underlying nerve issues.

- Referral to a Specialist: If you haven’t already, consider seeing a urologist who specializes in chronic pain or a pain management specialist.

Management Strategies
1. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help alleviate discomfort. If the pain is severe, your doctor may prescribe stronger medications.

2. Supportive Care: Wearing supportive underwear can help reduce discomfort. Cold compresses may also provide temporary relief.

3. Physical Therapy: If nerve pain or muscular issues are suspected, physical therapy may help alleviate symptoms through targeted exercises and stretches.

4. Surgical Options: If a varicocele is confirmed and is causing significant pain or fertility issues, surgical intervention may be considered.

5. Monitoring: Since you have experienced this pain for a few weeks, it’s crucial to keep your healthcare provider updated on any changes in symptoms, including the severity and nature of the pain.

Concerns About Fertility
You expressed concern about potential impacts on fertility. While conditions like varicocele can affect sperm quality, many men with varicoceles can still father children. If fertility is a significant concern, a semen analysis can provide insights into sperm health, and further discussions with a fertility specialist may be warranted.

Conclusion
In summary, while your symptoms are concerning, the absence of acute findings on ultrasound is reassuring. However, persistent pain warrants further investigation and management. Continue to communicate openly with your healthcare providers about your symptoms, and don’t hesitate to seek a second opinion if you feel your concerns are not being adequately addressed. Your comfort and health are paramount, and there are various avenues to explore for relief and resolution of your symptoms.

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