Groin Pain: Insights on Diagnosis and Home Care Tips

Inguinal pain has been preliminarily assessed, and a hernia has been ruled out due to the absence of any protrusion?

Hello, I am a 27-year-old male who has lived in the UK since childhood.
At around 17 years old, I underwent a left orchiectomy due to testicular torsion, and the right testicle was also fixed to prevent future torsion.
I have a long history of depression and am currently taking antidepressants, which I have been on for an extended period with no changes, taking one pill a day, and my condition is stable.

For the past three weeks, I have been experiencing severe pain in the right inguinal region, and I am unable to clearly describe the nature of the pain.
There has been no issue with decreased urine output, and I do not experience discomfort during urination; however, after urination, I feel pain above the scar in the left inguinal region (where the left testicle was removed), and I have also noticed a discharge resembling prostatic fluid from the penis.

I have contacted medical facilities and have been referred to a larger hospital in hopes of receiving treatment multiple times, but I have only received speculative diagnoses without any examinations.
A preliminary visual assessment ruled out the possibility of a hernia.
Initially, I was told it might be a muscle strain and was given anti-inflammatory pain medication, but there was no improvement.
I sought further medical attention, and it was later suggested that it could be epididymitis.
I was prescribed Amoxicillin (500 mg) BID for 5 days, but my condition did not improve.
I raised concerns about the possibility of testicular torsion, but the doctors in the UK dismissed it, stating it was unlikely due to the previous fixation.
I was then prescribed Ciprofloxacin BID for 7 days, and now on the third day of treatment, the pain remains significant, yet the hospital is reluctant to conduct any examinations.

I am also worried that there might be other immune or infection-related issues, so I am seeking help and would be very grateful for any advice.
If you could provide suggestions for home care, that would be even better! Additionally, I would appreciate guidance on how to communicate with the doctors in the UK about what further actions can be taken.

Patrick, 20~29 year old female. Ask Date: 2021/04/11

Dr. Li Xinyi reply Urology

It could also be neuropathic pain, which can be managed with some B vitamins or medications that stabilize nerve function.
There is also the possibility of a difficult-to-diagnose femoral hernia, which may require MRI or CT scans for diagnosis.
Regarding testicular torsion, since you have already undergone fixation surgery, it is unlikely; however, if there are concerns, a Doppler ultrasound can be performed to confirm.
It is also possible that there may be a stone issue, which would require a urinalysis and renal ultrasound.
Diverticulitis or appendicitis should also be considered.
As for the potential chronic prostatitis or epididymitis, it seems that treatment has already been provided, so these may be less likely considerations.

Reply Date: 2021/04/11

More Info

Understanding groin pain, especially in the context of your medical history, is crucial for effective management and treatment. Given your background of testicular torsion and subsequent surgery, as well as your current symptoms, it’s important to approach this situation with a comprehensive understanding of potential causes and appropriate home care strategies.

Potential Causes of Groin Pain
1. Muscle Strain: This is a common cause of groin pain, particularly if you've engaged in physical activities that may have strained the muscles in that area. However, since you mentioned that the pain has persisted despite anti-inflammatory medications, this may not be the sole issue.

2. Epididymitis: This is an inflammation of the epididymis, which can cause pain in the groin and may be associated with discharge. Your treatment with antibiotics suggests that this was considered, but the lack of improvement indicates that it may not be the primary issue.

3. Hernia: While initial examinations ruled out a hernia, it’s worth noting that some hernias can be subtle and may require imaging studies for confirmation.

4. Nerve Entrapment or Neuropathy: Given your history of depression and potential medication side effects, it’s possible that nerve-related issues could be contributing to your pain.

5. Referred Pain: Sometimes, pain in the groin can be referred from other areas, such as the lower back or pelvis. Conditions like herniated discs or pelvic inflammatory disease (in females) can cause similar symptoms.

6. Chronic Pain Syndromes: Given your history of depression, it’s also possible that chronic pain syndromes could be at play, where pain persists despite the absence of a clear physical cause.

Home Care Recommendations
1. Pain Management: Continue taking the prescribed medications as directed. Over-the-counter pain relievers like ibuprofen or acetaminophen can also help manage pain and inflammation.

2. Rest and Activity Modification: Avoid activities that exacerbate the pain. Gentle stretching and strengthening exercises may be beneficial, but these should be approached cautiously and ideally under the guidance of a physical therapist.

3. Heat and Cold Therapy: Applying a cold pack to the affected area can help reduce inflammation, while heat can help relax tight muscles. Alternate between the two based on what feels best for you.

4. Hydration and Nutrition: Ensure you are well-hydrated and maintain a balanced diet to support overall health and recovery.

5. Mental Health Support: Since you have a history of depression, consider discussing your pain with a mental health professional. Pain can often exacerbate feelings of depression, and addressing both can lead to better overall outcomes.

Communicating with Healthcare Providers
When discussing your situation with healthcare providers, consider the following points:
- Be Specific About Symptoms: Clearly describe the nature of your pain (sharp, dull, throbbing), its location, and any associated symptoms (like discharge or changes in urination).

- Request Specific Tests: If you feel that your concerns are not being adequately addressed, you can ask for specific tests such as an ultrasound of the groin area or a referral to a specialist (like a urologist) for further evaluation.

- Express Your Concerns: Let them know about your worries regarding potential infections or immune issues. This can prompt them to consider further investigations.

- Follow-Up: If your symptoms do not improve with the current treatment, insist on a follow-up appointment to reassess your condition and explore other diagnostic options.

Conclusion
Groin pain can be multifactorial, especially in the context of your medical history. While home care strategies can provide some relief, it’s essential to continue advocating for your health with your healthcare providers. If your symptoms persist or worsen, don’t hesitate to seek further evaluation or a second opinion. Your health and well-being are paramount, and you deserve thorough and compassionate care.

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