Scrotal Pain: Causes, Diagnosis, and Treatment Options

Q: Scrotal Pain: Causes, Diagnosis, and Treatment Options

Hello： One can only say to pay attention to life. <br>Currently, it's important not to sit or stand for prolonged periods, wear loose-fitting pants, limit spicy and irritating foods, take medication on schedule, avoid intense exercise, and in my personal opinion, it is still nerv

The inside of the scrotum is very painful?

Hello, doctor.
Before I turned 30, I used to masturbate almost every day.
Recently, I've been experiencing significant pain in my scrotum, and I'm really worried about having a varicocele.
I went to the hospital for an examination, and the doctor said my testicles were slightly inflamed and had some fluid buildup.
They performed an ultrasound and prescribed antibiotics, pain relievers, and stomach medication.
However, the pain became very severe.
About five days later, I went to a nearby hospital for another check-up.
The doctor mentioned that my testicles had mild inflammation and that the fluid buildup had no specific symptoms.
I told her that the area around my scrotum was extremely painful, and she suggested that the hospital's equipment might not be precise enough and referred me to Chang Gung Memorial Hospital.

At Chang Gung, the doctor examined my testicles and said there were no significant abnormalities.
However, I insisted that the area around my scrotum was really painful, sometimes to the point where I couldn't sleep, and I would wake up from the pain.
He told me it was nerve pain and advised me to take hot showers.
The ultrasound showed some dilation of the veins, but I am still in a lot of pain.
If it were a varicocele, these three doctors have examined me, and the ultrasound should be able to determine that, right? They have also palpated the area.
I feel really helpless; I've been in pain for almost a month now.

I would like to ask the doctor what my symptoms could indicate, whether it could affect my fertility, how to relieve the pain, and I am currently taking pain medication and doxycycline.
The doctor at Chang Gung said I could stop taking the medication, but I still asked him to prescribe me a five-day supply because I am in so much pain.
Sometimes, I also experience pain on top of my scrotum.
The doctors I have seen haven't provided much information, and I really don't know what to do anymore.
If I weren't sick, I wouldn't have gone to see a doctor.

A Chao, 30~39 year old female. Ask Date: 2019/04/27

Dr. Du Shixi reply Urology

Hello: One can only say to pay attention to life.
Currently, it's important not to sit or stand for prolonged periods, wear loose-fitting pants, limit spicy and irritating foods, take medication on schedule, avoid intense exercise, and in my personal opinion, it is still nerve pain.
Varicocele typically does not cause significant pain, and resting usually improves the condition.
Wishing you good health.

Reply Date: 2019/04/27

More Info

Scrotal pain can be a distressing symptom, and it’s understandable that you’re feeling anxious about your condition. Given your age and the history of frequent masturbation, it’s important to consider various potential causes for your pain, as well as the appropriate diagnostic and treatment options.

Possible Causes of Scrotal Pain
1. Epididymitis: This is an inflammation of the epididymis, often caused by infections, including sexually transmitted infections. Symptoms typically include pain and swelling in the scrotum, which can sometimes radiate to the lower abdomen.

2. Orchitis: This is inflammation of the testicle, which can occur due to viral or bacterial infections. It may present with swelling, tenderness, and pain in the affected testicle.

3. Hydrocele: This is a fluid-filled sac around a testicle, which can cause swelling and discomfort. While it may not always be painful, it can lead to discomfort in the scrotal area.

4. Varicocele: This condition involves enlarged veins within the scrotum, similar to varicose veins. It can cause a dull ache or discomfort, especially after prolonged standing or physical activity.

5. Nerve Pain: As suggested by the doctor you consulted, nerve pain can occur in the scrotal area, leading to sharp or burning sensations. This can be due to various factors, including previous trauma or irritation.

6. Testicular Torsion: This is a medical emergency where the spermatic cord becomes twisted, cutting off blood supply to the testicle. Symptoms include sudden, severe pain and swelling. While your doctors have ruled this out, it’s important to be aware of its symptoms.

Diagnostic Approach
Given that you have undergone ultrasound examinations and consultations with multiple specialists, it seems that the more serious conditions like testicular torsion and significant infections have been ruled out. However, the persistent nature of your pain suggests that further investigation may be warranted.
1. Repeat Ultrasound: If the pain persists, a repeat ultrasound may be necessary to assess for any changes or to evaluate for conditions like varicocele or hydrocele that may not have been evident previously.

2. MRI or CT Scan: In some cases, advanced imaging may be required to rule out other underlying issues that may not be visible on ultrasound.

3. Urology Consultation: A referral to a urologist, if not already done, can provide specialized insight into your symptoms and may lead to further diagnostic tests or treatments.

Treatment Options
1. Medications: Since you are currently taking antibiotics and pain relievers, it’s important to follow your doctor’s advice regarding their use. If the pain is nerve-related, medications such as gabapentin or pregabalin may be considered.

2. Physical Therapy: Sometimes, pelvic floor physical therapy can help alleviate pain related to nerve irritation or muscle tension in the pelvic region.

3. Heat Therapy: Applying warm compresses to the scrotal area can help relieve discomfort. However, be cautious with temperature to avoid burns.

4. Surgical Options: If a varicocele or hydrocele is confirmed and is causing significant pain or discomfort, surgical intervention may be necessary.

5. Lifestyle Modifications: Reducing activities that exacerbate the pain, such as heavy lifting or prolonged sitting, may help. Additionally, wearing supportive underwear can provide comfort.

Impact on Fertility
While conditions like varicocele can potentially affect fertility, many men with scrotal pain do not experience fertility issues. It’s essential to discuss your concerns with a urologist, who can provide a more tailored assessment based on your specific situation.

Conclusion
It’s clear that you are experiencing significant discomfort, and it’s crucial to continue seeking answers. If your symptoms persist despite treatment, don’t hesitate to advocate for further evaluation. Sometimes, a multidisciplinary approach involving urologists, pain specialists, and physical therapists can yield the best outcomes. Remember, your health and comfort are paramount, and it’s important to find a treatment plan that works for you.

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